ERTSS
American Heart Association Training Center
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Complete the form below to submit your course roster information.
Instructor Name:
*
Instructor Email:
*
Course Name (select from drop down menu):
*
BCLS for Healthcare providers
Heartsaver CPR
Heartsaver AED
Heartsaver Adult First Aid
Heartsaver Pediatric First Aid
CPR in the Schools
CPR Family & Friends
BloodBorne Pathogens
ACLS Provider
ACLS - EP
PALS Provider
PEARS
Heartsaver Instructor
BCLS Instructor
ACLS Instructor
PALS Instructor
Type Course (select from drop down menu):
*
Initial
Recertification
Online Skills Check-Off
Remediation Completion ( Use if remediation is completed on seperate day from course )
Course Location:
*
Course Date:
*
Total Hours of Instruction:
*
Student to Manikin Ratio (select from drop down menu):
*
1-1
2-1
3-1
4-1
Assisting Instructors:
Student Names ( include exam scores for BCLS, ACLS or PALS ):
*
Course Notes ( include Remediation or any students who did not complete course ):
Card Delivery Method:
*
Mail Cards To:
Pick Up at ERTSS
Cards Issued Onsite
Mail To Address if Selected Above ( include "attention to" name ):
I verify that this course was taught following the current AHA standards and that current AHA training materials were used:
Yes
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