RESA VII Community Training Center (CPR Roster)
WVPST Martinsburg Training Center CPR Course Roster Must be typed when submitted to WVPST
|MAIL CARDS TO: | |Cards Mailed: | |WVPST Class Number | |
| | | | |
|PRIMARY INSTRUCTOR’S NAME |Instructor ID # |PRIMARY TRAINING CENTER AFFILIATION |RANK |
| | | | |
|ASSISTING INSTRUCTOR(S). Attach copy of AHA instructor card for instructors aligned with|Instructor ID # |PRIMARY TRAINING CENTER AFFILIATION |RANK |
|other than EPIC Training Center. | | | |
| | | | |
| | | | |
| | | | |
|Course Location |Date(s) Conducted |Total Hours |Type of Course |Initial |Renewal |
|Student /Manikin Ratio |I verify that the manikins used in this course were cleaned in accordance with AHA standards. | |
| | | |
| | |Primary Instructor’s Signature |
|Return this roster, along with any answer sheets, evaluation forms, and practical skills sheets to the WVPST Martinsburg Office. |
|No. |Student Name |STUDENT Birth Date MM/DD/YYYY |Student email address |Score |Remed√ |
| |First Last | | | | |
|2 | | | | | |
|3 | | | | | |
|4 | | | | | |
|5 | | | | | |
|6 | | | | | |
|7 | | | | | |
|8 | | | | | |
|9 | | | | | |
|10 | | | | | |
|11 | | | | | |
|12 | | | | | |
|13 | | | | | |
|14 | | | | | |
|15 | | | | | |
|16 | | | | | |
|17 | | | | | |
|18 | | | | | |
|19 | | | | | |
|20 | | | | | |
The American Heart Association strongly promotes knowledge and proficiency in BLS, ACLS, and PALS and has developed instructional materials for this course. Use of these materials in an educational course does not represent course sponsorship by the American heart Association, and fees charged for such a course do not represent income to the association.
Form Revised 9-12-2019
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