Form 6418R04 PDF Details

When it comes to ensuring the quality and consistency of educational courses, especially those with critical life-saving skills at their heart, the documentation and certification process is key. This is where the 6418R04 form comes into play, a crucial piece of the administrative puzzle for courses endorsed or offered by the American Red Cross. This detailed form serves several vital functions, from recording the specifics of the course such as the name, code, total hours, and the instructor and co-instructor's details, to capturing the essence of the training audience including demographics and the occupational context of the participants. Furthermore, the form lays out a structured method for noting the start and end dates of the course, enrollment numbers, and outcomes in terms of participants passed or in need of further auditing. It even accommodates details pertaining to the issuing of certificates, a fundamental aspect of course completion, allowing options for distribution mode while requiring the instructor's certification that the training was conducted as per American Red Cross standards. Beyond its functional role, the form embodies the essence of organized and responsible record-keeping, ensuring that the training delivered holds up to scrutiny and maintains the integrity the Red Cross is known for worldwide.

QuestionAnswer
Form NameForm 6418R04
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other names6418R04, E-MAIL, course record addendum form 6418ardendum, CHERS

Form Preview Example

Course Record

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Page

      of

     

 

INSTRUCTOR

 

     

 

 

 

 

 

 

SPONSORING RED CROSS UNIT

     

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(last name, first name, middle initial)

 

 

 

 

 

 

 

 

 

 

 

 

ADDRESS

 

     

 

 

 

 

 

 

DATE COURSE STARTED

 

     

 

 

DATE COURSE ENDED

     

 

 

 

 

 

 

 

 

 

(street)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

     

 

 

 

 

 

 

COURSE NAME

     

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(city, state, zip code)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PHONE

 

     

 

E-MAIL

 

     

 

 

 

 

 

COURSE CODE

     

 

 

 

 

 

 

 

 

UNIT OF

 

 

 

     

 

 

 

 

 

 

TOTAL ENROLLED IN COURSE

     

 

 

 

 

 

 

AUTHORIZATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ADDRESS

 

     

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

COMPONENT INFORMATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CO-INSTRUCTOR

 

     

 

 

 

 

 

 

COMPONENT NAME

CODE

HOURS

NUMBER

NUMBER

NUMBER

 

 

 

 

 

 

 

 

ENROLLED

PASSED

AUDIT/INC

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(last name, first name, middle initial)

 

     

     

     

 

     

     

     

 

ADDRESS

 

     

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(street)

 

 

 

 

 

     

     

     

 

     

     

     

 

 

 

 

 

 

     

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(city, state, zip code)

 

 

 

 

     

     

     

 

     

     

     

 

PHONE

 

     

 

E-MAIL

 

     

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

UNIT OF

 

 

 

     

 

 

 

 

 

 

     

     

     

 

     

     

     

 

AUTHORIZATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ADDRESS

 

     

 

 

 

 

 

 

     

     

     

 

     

     

     

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TOTAL HOURS

     

 

     

     

     

 

Check here if address for either instructor or co-instructor is new.

 

 

 

 

 

 

COMMENTS      

 

 

 

 

 

 

 

 

 

 

TRAINING SITE INFORMATION (name of authorized provider, school, workplace, community

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

organization or American Red Cross unit)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NAME

     

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Authorized Provider ID

     

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

STREET

     

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CITY, STATE, ZIP

     

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

HOW COURSE WAS DELIVERED Full-service contract

 

Community

Authorized Provider

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TRAINING AUDIENCE: Check the box that best describes the training audience:

 

 

 

 

ETHNIC ORIGIN INFORMATION

 

 

 

 

SEX

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OCCUPATIONAL/WORKPLACE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

WHITE

 

  

 

 

BLACK OR AFRICAN AMERICAN

  

MALE

  

(Manufacturing, Administrative/Offices, Retail Stores/Malls, Transportation Centers)

 

 

 

 

MEDICAL/RESCUE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

HISPANIC OR LATINO

  

 

 

AMERICAN INDIAN/ALASKAN NATIVE

  

FEMALE

  

(Hospitals, EMS/Fire, Police)

 

 

 

 

 

 

 

 

 

 

 

 

ACADEMIC

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NATIVE HAWAIIAN OR PACIFIC

 

 

 

 

 

(K–12, Colleges/Universities)

 

 

 

 

 

 

 

 

 

 

ASIAN

 

  

 

 

  

DID NOT REPORT

  

CONSUMER

 

 

 

 

 

 

 

 

 

 

 

 

 

ISLANDER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Youth Groups, Military, Organizations, Religious Group, Park & Recreation/Government)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CERTIFICATES (Check one): Instructor will pick up certificates Send certificates to instructor Send certificates to authorized provider Certificates issued on site Not applicable Other

I certify this training session has been conducted in accordance with the requirements and procedures of the American Red Cross. Note: All co-instructors named above must sign or include ID numbers.

INSTRUCTOR SIGNATURE or ID NUMBER

     

 

CO-INSTRUCTOR SIGNATURE or ID NUMBER

 

     

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OFFICE USE ONLY

 

 

DATE RECEIVED

 

DATE CERTIFICATES ISSUED

DATE RECORDED

 

INITIALS OF PERSON

LMS OR CHERS CLASS

 

 

 

 

 

 

 

ENTERING DATA

ID NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

 

TOTAL FEES

     

 

REDCROSS BRANCH

 

     

     

 

     

     

     

     

 

COLLECTED

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Form 6418R04 (Revised October 2004)

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