Course Completion Worksheet Course InformationLead Instructor:* Additional Instructors: Course Date* MM slash DD slash YYYY Start Time* : Hours Minutes AM PM AM/PM End Time* : Hours Minutes AM PM AM/PM Course:*Select CourseACLS Provider (Initial/Update)Advanced ECGBLS ProviderHeartsaverHeartsaver PediatricMedication Administration / Epi RefresherPALSLocation:*Select LocationOff SiteAllentownBlue BellBoston / WoburnCharlestonEast HartfordNew Haven / WoodbridgePhiladelphiaPortlandSavannahStamfordWillimanticWorcesterOff Site Location:* Hours Worked (for Off Site Differential Calculation):* Off Site Differential will start 10/1/2019.Did any participants add on Coast Guard credential?*If YES, student must complete the written Heartsaver First Aid CPR AED exam. Upload it to the class paperwork on enrollware. Brian will send them the additional certificate they'll need for their Coast Guard licensing. Yes No Complete Participants - ACLS:*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 - PALS:*Complete Participants - Med Admin:*Complete Participants - Epi Refresher:*Complete Participants - BLS Add On:*Incomplete Participants*No Show Participants*Quality AssuranceEnrollware roster scores added and finalized.* Yes No No paperwork/scanning is necessary.Reason for incomplete roster:*Were all participants issued books?* Yes No Reason for no books:*Were manikins and equipment decontaminated and cleaned?* Yes No Were all participants issued an eCard or certificate?* Yes No Reason for no eCards or certificates:*As of Nov 5, 2019 we are using AHA Direct Connect to issue eCards. To use this method, you must add the AHA eCard Key to your Enrollware account. For assistance, please email rich@code1web.com 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 NameProvider ScoreInstructor ScoreSkills 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: "Amanda.McCaffrey@ctunitedway.org,Valerie.grant@ctunitedway.org,amanda@code1web.com" 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: "cpr@connecticutchildrens.org,licandcerts@connecticutchildrens.org" eCards Sent to CCMC eCards NOT Sent to CCMC OpportunitiesList 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 amanda@code1web.com (northeast) or brian@code1web.com (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 Adequate PPE and Cleaning Supplies:* Yes No Add Inventory Received a new shipment of books / masks / first aid kits. Inventory AddedItems added to inventory: Please include name of item, quantity, and last 4 digits of tracking number if it was shipped. Items added to inventory should be included in the overall item count below.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 PALS Provider books:*All equipment is clean and in good working order:* Yes No Virtual skills station is clean, organized, stocked, and logged into the skills meeting::* 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 62 degrees (winter), 80 degrees (summer)
