Instructor Monitoring Form

Instructor / Candidate Information:
Name of Instructor / Candidate:*
Training Site Affiliation*

Enter Training Site candidate is affiliated with or has approval for affiliation. If affiliating as a new training site put NEW prior to the training site name. If transferring to another Training Center, put TRANSFER OUT.
Instructor / Candidate Address:*
Street Address Address Line 2 City State ZIP Code
Instructor / Candidate Email:*

A copy of the completed monitor form will be emailed to the Instructor / Candidate.
Instructor / Candidate AHA ID:*
Obtain from the American Heart Association Instructor Network at https://ahainstructornetwork.americanheart.org
Reviewer / Training Center Faculty Information:
Name of Reviewer / Training Center Faculty:*
Reviewer Status:*
- AHA Instructor / Course Coordinator
- Training Center Faculty
- Training Center Coordinator
Reviewer / Training Center Faculty Email:*

A copy of the completed monitor form will be emailed to the Reviewer / Training Center Faculty.
Monitoring Session Information:
Monitoring Date*
MM slash DD slash YYYY
Type of Course Monitored:*
Disciplines Renewed
- BLS
- ACLS
- PALS
Instructor Course Discipline:*
Course Location:*
Monitoring Type:*
Certification Expiration Date:*
MM slash DD slash YYYY
Reviewer / Training Center Faculty (TCF) will use this form to assess the competencies of instructor candidates and renewing instructors. For each competency, there are several indicators or behaviors that the instructor may exhibit to demonstrate competency.
Remote Monitoring
Remote Monitoring Checklist
- Professional environment
- Instructor professional appearance
- Adequate manikins
- Use of current DVD
- Students have workbooks
Link to Video:
1. ECC/AHA Cognitive and Psychomotor Skills
Definition (Goal): Maintains proficiency in provider-level cognitive and psychomotor skills; fulfills requirements for initial or renewal instructor certification
a. Demonstrates proficiency in provider-level skills:*
Conduct a provider skills test for the Instructor / Candidate utilizing the skills checklist for the course being monitored.
- Successful
- Needs Remediation
Provider Written Exam Score:

b. Teaches at least the minimum number of classes per cycle*

The AHA requires instructors teach at least four (4) courses per two (2) year certification period. List the date, course type (HS, BLS, ACLS, PALS), and location of four courses instructor in the past two years.

Date	Course	Location

c. Is aligned on the Instructor Network*
- Successful
- Needs Remediation
If Instructor / Candidate has an instructor number, then they are aligned on the AHA Instructor Network.
d. Completes the required provider and instructor updates.*
- Successful
- Needs Remediation
If Instructor / Candidate has an instructor number, then they have completed their instructor updates.
e. Achieves satisfactory rating during instructor monitoring*
- Successful
- Needs Remediation
2. Course Delivery
Definition (Goal): Presents AHA course content as intended by using AHA course curricula and materials
a. Delivers content that is consistent with Lesson Maps and agenda*
- Successful
- Needs Remediation
b. Uses videos, checklists, equipment, and other tools as directed in the Instructor Manual*
- Successful
- Needs Remediation
c. Allows adequate time for content delivery, skills practice, and debriefing*
- Successful
- Needs Remediation
d. Promotes retention by reinforcing key points*
- Successful
- Needs Remediation
e. Delivers course in a safe and nonthreatening manner*
- Successful
- Needs Remediation
f. Uses student and faculty feedback to improve teaching performance*
- Successful
- Needs Remediation
- Not Observed
g. Provides precourse instructions and resources to students before the course*
- Successful
- Needs Remediation
- Not Observed
h. Ensures equipment is in working order and available in sufficient quantity as recommended*
- Successful
- Needs Remediation
- Not Observed
i. Relates course material to practical events*
- Successful
- Needs Remediation
- Not Observed
j. Effectively operates technology used in the course*
- Successful
- Needs Remediation
- Not Observed
k. Adapts terminology appropriate to location, audience, and culture*
- Successful
- Needs Remediation
- Not Observed
l. Accommodates students who have disabilities and other special needs*
- Successful
- Needs Remediation
- Not Observed
m. Provides timely and appropriate feedback to students*
- Successful
- Needs Remediation
- Not Observed
n. Uses principles of effective team dynamics during small group activities*
- Successful
- Needs Remediation
- Not Observed
o. Secures and protects testing materials*
- Successful
- Needs Remediation
- Not Observed
p. Decontaminates/cleans equipment according to manufacturer's instructions*
- Successful
- Needs Remediation
- Not Observed
Testing and Remediation
Definition (Goal): Measures students’ skills and knowledge against performance guidelines and provides remediation when needed to consolidate learning
a. Tests students by using AHA course materials according to instructions in the Instructor Manual*
- Successful
- Needs Remediation
b. Provides feedback to students in a private and confidential manner (observation and review of students’ course evaluation forms)*
- Successful
- Needs Remediation
c. Remediates by directing students to reference material and by providing additional practice opportunities*
- Successful
- Needs Remediation
d. Retests students when indicated*
- Successful
- Needs Remediation
- Not Observed
e. Facilitates debriefings after scenarios to improve individual and team performance*
- Successful
- Needs Remediation
- Not Observed
Professionalism
Definition (Goal): Maintains a high standard of ethics and professionalism when representing the AHA
a. Endorses the ECC Leadership Code Of Conduct*
All persons in AHA ECC leadership and Instructor roles are expected to conduct themselves with honesty, integrity, and a commitment to the goals of the AHA and the ECC program. This code is intended to provide standards of professional conduct. The scope of the standards implied in this code includes activities directly related to the discharge of ECC leadership functions, such as committee activities and assignments, as well as actions performed with other AHA programs or activities, such as ECC classes and activities related to AHA affiliate programs. Furthermore, AHA Instructors and faculty have a special responsibility to maintain neutrality while serving in leadership and educational roles.
- Successful
- Needs Remediation
b. Acknowledges the AHA Statement of Conflict of Interest*
The American Heart Association has established a Conflict of Interest policy that applies to all ECC leaders. Throughout the course of performing duties associated with the ECC leadership role, all ECC leaders must comply with these policies.
- Successful
- Needs Remediation
c. Demonstrates professional behavior in physical presentation and teaching, including enthusiasm, honesty, integrity, commitment, compassion, and respect*
- Successful
- Needs Remediation
d. Follows HIPAA, FERPA, and/or local guidelines maintaining confidentiality*
- Successful
- Needs Remediation
e. Recognizes and appropriately responds to ethical issues encountered in training*
- Successful
- Needs Remediation
- Not Observed
f. Appropriately manages conflicts of interest*
- Successful
- Needs Remediation
- Not Observed
g. Maintains student confidentiality when appropriate (observation and review of students’ course evaluation forms)*
- Successful
- Needs Remediation
- Not Observed
Program Administration
Definition (Goal): Successfully manages available resources, including time, materials, space, and budget, to deliver high quality training in accordance with AHA guidelines
a. Completes postcourse records, including an accurate roster, grade report, and summary evaluation*
- Successful
- Needs Remediation
b. Complies with the current, appropriate version of the Program Administration Manual (PAM)*
- Successful
- Needs Remediation
- Not Observed
c. Ensures that AHA course completion cards are issued in a timely manner*
- Successful
- Needs Remediation
- Not Observed
Notes / Recommendations:
Notes
Recommend Instructor Status:*
Based upon your observations from this monitoring session only, do you recommend that the Instructor / Candidate be issued an American Heart Association Instructor certification card?
- Yes – Issue Instructor Certification Immediately
- Yes – Issue Instructor Certification Upon Expiration
- Yes – Instructor is Utilizing Code One as Secondary TC; Primary TC will Issue Instructor Card
- No – Needs Remediation, Further Monitoring
Remediation Plan:
Untitled

Instructor Monitoring Form

Instructor / Candidate Information:

Reviewer / Training Center Faculty Information:

Monitoring Session Information:

Remote Monitoring

1. ECC/AHA Cognitive and Psychomotor Skills

2. Course Delivery

Testing and Remediation

Professionalism

Program Administration

Notes / Recommendations:

BEACON by Code One

EMS Programs

Instructor-Led Training

AHA Instructor Training

About Code One

Let’s Talk