Edcor ACLS PALS Roster
Course Director:Name:Phone:Email:Training Location:Training Site:Address:Type of Program:Program Date(s): ACLS PALSProvider (2 day)Update (Renewal) (1 day)InstructorCourse DirectorHeart Code CheckoffProvider (2 day)Update (Renewal) (1 day)InstructorCourse DirectorHeart Code CheckoffNameTitleAddressEmailWritten Exam ScoreBLS Check off completedBLS on-line Cert. in fileStatus1 CompletedCompleted after remediationNot yet completed2 CompletedCompleted after remediationNot yet completed3CompletedCompleted after remediationNot yet completed4CompletedCompleted after remediationNot yet completed5CompletedCompleted after remediationNot yet completed6CompletedCompleted after remediationNot yet completed7CompletedCompleted after remediationNot yet completed8CompletedCompleted after remediationNot yet completed9CompletedCompleted after remediationNot yet completed10CompletedCompleted after remediationNot yet completed11CompletedCompleted after remediationNot yet completed12CompletedCompleted after remediationNot yet completed13CompletedCompleted after remediationNot yet completed14CompletedCompleted after remediationNot yet completed15CompletedCompleted after remediationNot yet completed16CompletedCompleted after remediationNot yet completedThe American Heart Association strongly promotes knowledge and proficiency in BLS, ACLS, PEARS, and PALS and has developed instructional materials for this purpose. Use of these materials in an educational course does not represent course sponsorship by the American Heart Association Any fees charged for such a course, except for a portion of fees needed for AHA course material, do not represent income to the pleted Course Roster must be submitted to EdCor within 14 days of the class. For Students who have not yet met course completion requirements, a copy of their written examination answer sheet and skills performance sheet is attached to the roster. A copy of the on-line certificate CPR Critical Skills Testing Check List for BLS Provider must be available by the Training Site or Instructor upon request at any time or sent to EdCor within 30 days of the course. I, ______________________________________ (Course Director Signature) verify that I have followed the AHA requirements in presentation and testing for this class and have used the AHA course materials. I have included the roster, evaluations or summary of evaluations, and required written test answer sheet and skills performance sheet for any student that has not yet met AHA completion requirements for the Training Site and Training Center files.Date:___________________(Valid Signature is accepted when full name is typed in above)Additional Instructors for this course:NameTitleAddressEmailWritten Exam ScoreBLS Check off completedBLS on-line Cert. in fileStatus17 CompletedCompleted after remediationNot yet completed18 CompletedCompleted after remediationNot yet completed19CompletedCompleted after remediationNot yet completed20CompletedCompleted after remediationNot yet completed21CompletedCompleted after remediationNot yet completed22CompletedCompleted after remediationNot yet completed23CompletedCompleted after remediationNot yet completed24CompletedCompleted after remediationNot yet completed ................
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