Course Completion Worksheet | Code One Training Solutions, LLC

Course Information

Lead Instructor:*

Additional Instructors:

Course Date*

Start Time*

: HH

MM

End Time*

: HH

MM

Course:*

Location:*

Off Site Location:*

Did any participants add on BLS Skills Testing?*

Yes
No

Did any participants add on First Aid Skills Testing?*

Yes
No

Complete Participants - ACLS:*

Complete Participants - ACLS Update:*

Complete Participants - BLS Provider:*

Complete Participants - Heartsaver First Aid CPR AED:*

Complete Participants - Heartsaver First Aid ONLY:*

Complete Participants - Heartsaver CPR AED ONLY:*

Complete Participants - Heartsaver Pediatric First Aid CPR AED:*

Complete Participants - Heartsaver Online:*

Complete Participants - Heartcode BLS:*

Complete Participants - Heartcode ACLS:*

Complete Participants - Heartcode PALS:*

Complete Participants - BLS Instructor:*

Complete Participants - Heartsaver Instructor:*

Complete Participants - PALS:*

Complete Participants - Med Admin:*

Complete Participants - Epi Refresher:*

Complete Participants - BLS Add On:*

Incomplete Participants*

No Show Participants*

Quality Assurance

Paperwork completed, uploaded to Enrollware, and roster finalized?*

Yes
No

Reason for incomplete paperwork:*

Were all participants issued books?*

Yes
No

Reason for no books:*

Were all participants issued an eCard or certificate?*

Yes
No

Reason for no eCards or certificates:*

Were all participants issued a CT Supplemental Materials certificate?*

Yes
No

CT OEC requires the Supplemental Certificate in addition to eCards for licensed childcare providers. Certificates are located on Enrollware. Click on the class, then "Certificates" then "Pediatric Supplemental Certificate" and it will download a batch for the class.

Reason for no supplemental certificates:*

Is this a United Way course?*

Yes
No

Was there an Instructor Candidate Skills Verification as part of this class?*

Yes
No

Instructor Candidate Skills Verification*

Instructor candidate will need to complete provider exam, instructor exam, and skills test. Allow only one attempt at each during this session. Please upload skills sheet and exams to their class on enrollware.

Candidate Name	Provider Score	Instructor Score	Skills Pass/Fail

Send roster to United Way.*

Please send the roster to United Way. Finalize the course in Enrollware. Click "View Roster" then "Email Roster" and send to: "[email protected],[email protected],[email protected]"

Roster sent
Roster NOT sent

Are any participants CCMC employees?*

Yes
No

Send eCards to CCMC:*

Please have participants claim and print their eCards. Scan the eCards and save to Enrollware and email the eCard file to: "[email protected]"

eCards Sent to CCMC
eCards NOT Sent to CCMC

Evaluations

Excellent Marks for Question 3a:

Good Marks for Question 3a:

Fair Marks for Question 3a:

Poor Marks for Question 3a:

List any comments participants wrote on their evaluations:

Opportunities

List any trends or opportunities identified in this class:

Examples: Margaret wants to purchase an AED for her office. Daniel wants to take ACLS. There were 5 participants from Memorial Hospital because they no longer offer BLS for employees.

Facilities, Equipment, Inventory:

Office was clean and professional upon arrival:*

Yes
No

What was wrong?*

Please take a photo and send to [email protected] (northeast) or [email protected] (southeast).

Office was left clean and professional upon departure:*

Yes
No

Push in chairs, put away equipment, vacuum, empty trash if more than half full.

One full and sealed box of pocket masks is in stock:*

Yes
No

One full and sealed box of first aid kits is in stock:*

Yes
No

Count remaining BLS Provider books:*

A sealed box contains 30 books.

Count remaining ACLS Provider books:*

Count remaining Heartsaver First Aid CPR AED books:*

Count remaining Heartsaver Pediatric books:*

Most offices don't have these, mark as 0 if none.

Count remaining PALS Provider books:*

All equipment is clean and in good working order:*

Yes
No

What equipment needs attention?

Any equipment that is unsafe must be taken out of service and tagged "Out of Service." Please report any equipment that requires repair as well.

Is there anything we can do to make Code One better?*

Yes
No

How can we improve?

Notes:

Thermostat*

Thermostat set to 55 degrees (winter), 80 degrees (summer)