Course Roster Form PDF Details

The Course Roster form plays a pivotal role in documenting the nuanced details of American Heart Association Emergency Cardiovascular Care Program courses, specifically within the Heartsaver First Aid CPR AED segment. It meticulously records various facets of the course, including but not limited to the lead instructor's details, whether they hold a status of BLS (Basic Life Support) Instructor, HS (Heartsaver) Instructor, or BLS TCF/RF, and the crucial renewal dates. This form also catalogs the specific components of the Heartsaver core that were covered, such as first aid, adult CPR AED, and optionally, child and infant CPR AED, along with any written exams. Further details encompass the course location, schedules, duration, the student to manikin ratio, number of cards issued, and information on assisting instructors or specialty faculty. The roster ensures that each course is aligned with AHA guidelines through a verification process signed off by the lead instructor, underscoring the commitment to accuracy and adherence to standards. By capturing such comprehensive data, this form not only facilitates administrative oversight and quality control but also supports the certification process for participants, thereby playing a crucial role in the broader mission of promoting lifesaving skills.

QuestionAnswer
Form NameCourse Roster Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesheartsaver first aid roster, how to cpr roster form, heartsaver course roster, aha heartsaver roster 2020

Form Preview Example

American Heart Association Emergency Cardiovascular Care Program

Heartsaver First Aid CPR AED

Course Roster Form

Course Information

Lead Instructor___________________________________________

 

Status: BLS Instr. HS Instr.

BLS TCF/RF

Heartsaver First Aid CPR AED Provider Course:

Status Renewal Date: _______________________________________

This course included the following Heartsaver Core components:

 

 

First Aid

Training Center____________________________________________

Adult CPR AED

 

 

Child CPR AED (optional)

 

 

Infant CPR (optional)

Course Location____________________________________________

Written Exam (optional)

 

 

Course Start Date/Time_______________

Course End Date/Time_________________

Total hours of Instruction __________

# of Cards Issued_________

Student/Manikin Ratio__________

Issue Date of cards________________

Assisting Instructors / Specialty Faculty (Attach copy of instructor card for instructors aligned with other than primary TC)

Name

Instr. card Exp. Date

Name

Instr. card Exp. Date

1.

 

5.

 

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I verify that this information is accurate and truthful, and that it may be confirmed. This course was taught in accordance with AHA guidelines.

____________________________________________

_______________________________________________

Signature of Lead Instructor

Date

Heartsaver First Aid 2010, page 1

DATE_________________ COURSE

Heartsaver First Aid CPR AED

INSTRUCTOR ________________________________

 

FULL NAME

 

 

 

1st Aid

Adult

Child

Infant

Written

Card

Job Title

Department

VUNet ID

Skills

CPR AED

CPR AED

CPR

Exam

Issued

 

PLEASE PRINT

 

 

 

 

 

 

 

 

 

 

 

(optional)

Y orN

 

 

 

 

 

 

 

 

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Heartsaver First Aid 2010, page 2