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AHA Basic Life Support Course Roster

The document is a roster for a Basic Life Support (BLS) course, detailing course information, instructor details, and participant information. It includes sections for course dates, instructor signatures, and participant names along with their contact details. The document ensures compliance with American Heart Association guidelines.

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macleggett
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286 views2 pages

AHA Basic Life Support Course Roster

The document is a roster for a Basic Life Support (BLS) course, detailing course information, instructor details, and participant information. It includes sections for course dates, instructor signatures, and participant names along with their contact details. The document ensures compliance with American Heart Association guidelines.

Uploaded by

macleggett
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

Basic Life Support Course Roster

Emergency Cardiovascular Care Programs

Course Information
Lead Instructor __________________________________________
BLS Course (instructor-led)
Lead Instructor ID#
BLS Renewal Course (instructor-led) Card Expiration Date
HeartCode® BLS Training Center
Training Center ID#
BLS Instructor Training Site Name (if applicable)
Address
City, State ZIP
Course Location

Course Start Date/Time Course End Date/Time Total Hours of Instruction

No. of Cards Issued Student-Manikin Ratio Issue Date of Cards

Assisting Instructor (Attach copy of instructor 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 course was taught in accordance with AHA guidelines.

Signature of Lead Instructor Date

KJ1216 BLS R1/18 © 2018 American Heart Association


Course Participants

Date Course Lead Instructor Lead Instr. ID#

Name and Email Remediation/Date


Complete/
Please PRINT as you wish your name to appear on your card. Please print Mailing Address/Telephone Completed
Incomplete
email address legibly. (if applicable)

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

KJ1216 BLS R1/18 © 2018 American Heart Association

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