2004 HS CPR and HCP Course Roster
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American Heart Association Emergency Cardiovascular Care Programs
Heartsaver® eLearning
Skills Session Roster
|Course Information | |
Heartsaver First Aid CPR AED Online Part 1 Instructor
Heartsaver First Aid Online Part 1 Status: Heartsaver Instructor BLS Instructor
Heartsaver CPR AED Online Part 1 Status Renewal Date
Heartsaver Pediatric First Aid CPR AED Online Part 1 Training Center
Training Center ID#
Training Site Name (if applicable)
Course Location
Address
City, State ZIP
|Assisting Instructors (Attach copy of instructor card for instructors aligned with a TC other than the primary TC) |
|Name and Instructor ID# Card Exp. Date |Name and Instructor ID# Card Exp. Date |
|1. |5. |
|2. |6. |
|3. |7. |
|4. |8. |
I verify that this information is accurate and truthful and that it may be confirmed. This session was conducted in accordance with AHA guidelines.
____________________________________________ _______________________________________________
Signature of Instructor Date
Session Roster for ____________________________________ Instructor________________________________________________
Course Participants (Note: If you are performing multiple skills practice and testing sessions over multiple days, you may use one roster.)
|Name and Email |Address |Telephone |Session Date |Session Start |Session End |Successfully |Remediation Date |
|Please PRINT as you wish your name to appear on your| | | |Time |Time |Completed |(if applicable) |
|card. Please print email address legibly. | | | | | |Y or N | |
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