Course Roster Form – Fill Out and Use This PDF

Course Roster Form PDF Details

The Course Roster form is a required document for AHA Emergency Cardiovascular Care Program courses. It provides a full record of the Heartsaver First Aid CPR AED session, including instructor credentials, course content delivered, and all student documentation.

The form records the head instructor's name, status (BLS Instructor, Heartsaver Instructor, or BLS TCF/RF), and certification renewal date. Course content fields show which Heartsaver core components were covered: first aid, adult CPR AED, and optional child and infant CPR AED modules, along with any written exams administered.

Key Features and Fields

• Instructor details: Name, credential status, and renewal date
• Course content: Which modules were covered and whether exams were given
• Students: Total students enrolled, manikin ratio, and cards issued
• Course location: Training center name and ID, course date, and total instruction hours
• Verification: Head instructor signature confirming alignment with AHA standards

Assisting instructors and specialty faculty are also listed on the course roster. The verification section, signed by the head instructor, confirms the course meets AHA program standards. By capturing these details, the document supports administrative oversight, quality control, and the certification process for all participants.

How to Complete the Course Roster Form

1. Enter instructor information: Record the head instructor name, credential status, and renewal date.
2. Record course components: Mark each module covered, including first aid, adult CPR AED, and any child or infant CPR AED content.
3. Document student data: Enter total students, student-to-manikin ratio, and cards issued.
4. Add course location details: Document the training center name, ID, course date, start and end times, and total instruction hours.
5. Sign to verify: The instructor signs and dates the course roster to confirm all information meets AHA guidelines.

What Are the Submission Standards?

Course rosters are required for all AHA-authorized training centers. Keep copies in your training records and submit to your training center coordinator per AHA program guidelines. Explore related digital tools on FormsPal: the AHA Fillable Roster Form, the AHA BLS Roster 2016, and the AHA Instructor Monitor Form.

About the Course Roster Digital Document

This digital course roster document is a standardized template for recording AHA training data. Training centers use it to maintain accurate records across multiple class sessions. The course roster form template covers all key data fields and can be shared with program coordinators.

Use the PDF tool on this page to view and download the course roster. Review all fields before printing or saving the document to your records. For AHA-authorized training centers, this digital document helps maintain accurate audit records and supports ongoing program compliance across sessions.

Recordkeeping and Submission

Completed course rosters document instructor qualifications and student participation for each AHA session. Organized records support certification tracking and renewal scheduling. Instructors managing multiple course types may also use the Certification of Completion for Basic Training for individual participant records. The DHSR HCPR Form covers CPR program reporting at the state level.

The head instructor completes all fields and signs the form after each session. The completed roster goes to the training center coordinator. Coordinators retain it per AHA recordkeeping requirements.