Delaware County, Pennsylvania



EMS Instructor Checklist

Name______________________ Date____________

PA DOH Certification level & Number _________________

Initial

o Completed EMS Provider Certification Application

o Government issued photo ID for proof of age

o Successful completion of one of the following:

• EMS Instructor course approved by the Department OR; Bachelor’s degree in education OR; Teacher’s certification in education OR; A Master’s degree OR; Doctorate

o Possess current certification as an EMT or higher

o Possess at least 1 year experience in providing EMS at an EMT or higher EMS provider level

o Proof of current CPR certification as defined by the current EMS Information Bulletin

o Has twenty (20) hours of instructional time monitored by an PA DOH EMS Instructor designated by an EMS Educational Institute’s Administrative Director

NOTE: An EMS Educational Institute must submit a letter on letterhead indicating that the candidate has completed twenty (20) hours of monitored EMS instructional time and provide a favorable recommendation. The EMS Instructor should utilize the approved DOH monitoring forms (Appendix ) to provide feedback to the EMS Instructor Candidate.

Re-Registration:

• Candidate shall register 30 days prior to expiration of current registration

o Provide documentation through the EMS Educational Institute or Continuing Education Sponsor of sixty hours of EMS provider, continuing education or rescue courses. Documentation should include course number, date(s) taught, hours for each date, and topic. A completed course roster is acceptable documentation.

• NOTE: EMS provider, continuing education, and rescue courses are considered to be any registered class.

o Be a current EMS provider at or above the EMT level

o Proof of current CPR certification as defined by the current EMS Information Bulletin

o Provide any other instructor requirements (e.g. Module I, II, III, IV)

Re-entry:

• Completed EMS Provider Certification Application

o Candidate shall:

• Provide documentation through the EMS Educational Institute or Continuing Education Sponsor of completed instructional hours of lapsed registration periods missed. Documentation should include course number, date(s) taught, hours for each date, and topic. A completed course roster is acceptable documentation.

• Be a current EMS provider at or above the EMT level

• Provide proof of current CPR certification as defined by the current EMS Information Bulletin

Date Reviewed: Approved? Yes No

Approved By: ____________________ 5/5/2014DK

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