Forms
These forms may be downloaded and copied
for use by instructors.
AHA Course Roster Effective July 1, 2006:
Page 1 (Note: You must always turn in Page 1 & Page 2
Page 2 regardless of how many participants you have.)
***Your rosters will be returned if you do not turn in Page 2 with signature***
Important Information for Our Instructors
It is imperative that all participants in a class receive a card upon successful completion (except for CPR-Family & Friends where no cards are issued). Only then should their names appear on a roster. If a participant needs only to refresh his skills for his employer/agency, and will not receive a card, do not add his/her name to the roster. Instructors will receive credit for the class taught and the number of participants who are issued cards.
Page 1 Supplement - List of extra instructors (May be used in conjunction with Page 1, but not on its own) Strongly recommended for ACLS & PALS Courses
Page 2 Supplement - List of additional students (May be used in conjunction with Page 2, but not on it’s own.)
Instructor Monitoring Form – Must be completed by TC Faculty or TC Coordinator
TC Affiliation Application
Healthcare Provider Skills Checklist
Heartsaver Skills Checklist
BLS Course Evaluation Form
BLS Course Evaluation Form (First Aid Specific)
***INSTRUCTORS MUST HAVE EACH STUDENT TO COMPLETE A COURSE EVALUATION IN EVERY CLASS. A SUMMARY OF THE EVALUATIONS, ON ONE PAGE, MUST BE INCLUDED WITH EACH ROSTER.*********
ACLS, PALS & Instructor Course Requirements
You must submit a Course Approval Form no later than 30 days prior to an ACLS, PALS or Instructor course.
Course Approval Form – Please note tabs at bottom of screen. Fill out appropriate form for ACLS, PALS or BLS Instructor Courses
Once you have received approval for your course you must turn in the following or your rosters will be returned:
• AHA Rosters Pages 1 & 2
• Complete list of instructors and topics taught (we
strongly recommend you use the Page 1 Supplement
for this)
• Summarized Course Evaluation - please do not send us
individual evaluations from your students (See sample
evaluations below)
• Course agenda if different from agenda turned in with
original Course Approval Form
********CALL TRAINING CENTER FOR SAMPLES**************