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The AHA BLS Roster form serves as an essential document for recording important details related to Basic Life Support courses. It captures information that ensures compliance with the American Heart Association guidelines while providing a clear overview of course logistics. Within its structure, the form includes spaces for the lead instructor's details, their credentials, and card expiration dates. Training centers and site names, along with the course's start and end dates, are also documented to maintain an organized training record. The roster reflects crucial metrics such as the total hours of instruction, the number of cards issued, and the student-manikin ratio, ensuring the training is effective and meets the required standards. Additionally, an area is designated for the names and details of assisting instructors, reinforcing the collaboration that enhances the learning experience. Through the signature of the lead instructor, the accuracy of the information provided is confirmed, holding all parties accountable. This form not only tracks participant details like names, email, and addresses but also points out those who may need remediation or additional assistance. Ensuring every aspect is completed correctly supports the integrity of the training process and ultimately contributes to better preparedness in emergency situations.

Aha Bls Roster Example

Basic Life Support Course Roster

Emergency Cardiovascular Care Programs

  Course Information

……BLS Course (instructor-led)

……HeartCode® BLS

……BLS Instructor

Lead Instructor __________________________________________

Lead Instructor ID#

Card Expiration Date

Training Center

Training Center ID#

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

 

 

 

 

 

 

 

 

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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  4/16  © 2016 American Heart Association

Course Participants

Date

 

Course

 

Lead Instructor

 

Lead Instr. ID#

 

 

 

 

 

 

 

 

 

 

 

 

Name and Email

 

 

 

 

Complete/

Remediation/Date

 

 

Mailing Address/Telephone

 

Completed

Please PRINT as you wish your name to appear on your card. Please print

 

 

Incomplete

 

email address legibly.

 

 

 

 

(if applicable)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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KJ1216  BLS  4/16  © 2016 American Heart Association

Form Characteristics

Fact Name Details
Course Types The AHA BLS Roster form is applicable for both instructor-led BLS courses and the HeartCode® BLS courses.
Lead Instructor Requirements The form requires the name and ID number of the lead instructor overseeing the course.
Card Expiration Instructors must provide the expiration date of their certification cards as a part of the documentation.
Training Center Information A designated training center name along with its ID number needs to be listed on the form.
Student-Manikin Ratio The form includes a section to show the student-to-manikins ratio, ensuring proper hands-on practice during the course.
Issue Date of Cards The form collects the date on which the course completion cards were issued, which is crucial for record-keeping.
Participant Details Space is provided on the form for listing up to ten course participants, along with their mailing addresses and email information.
Compliance Verification Before submission, the lead instructor must verify that all information is accurate and complies with AHA guidelines.

Guidelines on Utilizing Aha Bls Roster

Filling out the Aha BLS Roster form requires careful attention to detail. This form collects essential information about a Basic Life Support course and the participants involved. Make sure to have all necessary information ready before you start. Follow the steps below to complete the form accurately.

  1. Begin with the Course Information section. Indicate the type of BLS course you conducted, either instructor-led or HeartCode BLS.
  2. Fill in the Lead Instructor information. Provide the instructor's name and ID number, and the expiration date of their certification.
  3. In the Training Center section, provide the name and ID number of the training center where the course took place.
  4. If applicable, fill in the Training Site Name along with the full address, including city, state, and ZIP code.
  5. Enter the Course Location and the Course Start Date/Time and Course End Date/Time.
  6. Compute the Total Hours of Instruction and list the No. of Cards Issued.
  7. Provide the Student-Manikin Ratio and the Issue Date of Cards.
  8. If an Assisting Instructor was present, complete their information. Attach a copy of their instructor credential if they were aligned with a training center other than the primary one.
  9. Proceed to the verification section. The lead instructor must sign and date the form to confirm that all information is accurate.
  10. In the Course Participants section, list the names and email addresses of each participant. Make sure to print their names as they want them to appear on their cards. Indicate whether they completed the course or require remediation.

After completing the form, review all entries for accuracy and completeness. Ensure all signatures are in place before submitting the document.

What You Should Know About This Form

What is the AHA BLS Roster form used for?

The AHA BLS Roster form is utilized for documenting the completion of Basic Life Support (BLS) courses. It captures essential information about the course, the instructors, and the participants who successfully complete their training. This form ensures that all records are maintained in compliance with American Heart Association guidelines.

Who needs to fill out the AHA BLS Roster form?

The Lead Instructor is responsible for filling out the roster form. This includes details about the course, the instructors involved, and the participants. An Assisting Instructor may also be required to provide information if they are affiliated with a different training center.

What information is required on the roster form?

Key details include the Lead Instructor’s name and ID number, course information (start and end dates, total hours of instruction), the training center’s name and ID, and the addresses. You’ll also need to list participants’ names, contact info, and completion statuses. Additionally, each instructor involved must provide their ID and card expiration dates.

How should participant names be listed on the roster?

Participants' names should be printed clearly and legibly as they wish them to appear on their BLS certification cards. This ensures that the cards issued are accurate and can be easily recognized when verified.

What happens if an instructor is affiliated with a different training center?

If an Assisting Instructor is connected with a different training center, a copy of their information must be attached to the roster form. This ensures accurate documentation and compliance with AHA standards.

Is a signature required on the roster form?

Yes, the Lead Instructor must sign the roster form. This signature confirms that all information provided is accurate and truthful. It also affirms that the course was conducted following AHA guidelines.

When should the AHA BLS Roster form be submitted?

The roster form should be submitted promptly after the completion of the BLS course. Ensuring timely submission helps to maintain updated records with the relevant training center and the American Heart Association.

What should I do if I made a mistake on the roster form?

If an error is noticed, it’s important to correct it immediately. Clearly mark out the mistake, write the correct information beside it, and initial the correction if necessary. Keeping records accurate is crucial for compliance and verification purposes.

Common mistakes

Filling out the AHA BLS Roster form can seem straightforward, but many people encounter several common pitfalls. One of the major mistakes is filling in the Instructor ID# incorrectly. This number is crucial for tracking and verifying credentials. A minor typographical error may lead to delays in processing or confusion regarding certification.

Another frequent error involves the Course Location. Participants often overlook this section, leaving it blank or providing an incomplete address. Without accurate location details, the records may lack context, which can complicate any future inquiries or confirmations regarding the course.

Many individuals make the mistake of not verifying the Expiration Dates of their cards. If instructors list outdated information, it could cause complications later when students attempt to use their certifications. Always double-check that these dates are current to avoid any issues down the line.

Recording participants’ names is equally critical, yet mistakes are common here as well. Failing to print names legibly can lead to errors on the official certifications. If a name is unclear, the card may be issued incorrectly, creating additional hassle for both instructors and students.

Finally, people often neglect to include proper contact information for course participants. Missing or incomplete phone numbers and email addresses can create challenges when the course organization tries to reach out to students for follow-ups or notifications. Always ensure that this information is complete and accurate to facilitate future communication.

Documents used along the form

The AHA BLS Roster form is an essential document for those involved in Basic Life Support training. However, there are additional forms and documents that are frequently used in conjunction with this roster to ensure comprehensive record-keeping and compliance with training standards. Below are some key documents that often accompany the BLS Roster form.

  • AHA BLS Certification Cards: These cards are issued to participants upon successful completion of the BLS course. They serve as proof of certification and include details such as the individual's name, certification number, and expiration date.
  • Course Evaluation Form: Participants complete this form to provide feedback on the course's content, the instructor's effectiveness, and overall experience. This feedback is valuable for improving future training sessions and ensuring a high standard of quality.
  • Instructor Agreement Form: This document outlines the responsibilities and expectations for instructors leading BLS courses. It helps ensure that instructors are aware of their roles in providing training that meets AHA guidelines.
  • Training Center Affiliation Agreement: This agreement establishes the relationship between instructors and the training center. It clarifies expectations regarding the delivery of BLS courses and the adherence to certification protocols.
  • Student Evaluation Form: Instructors use this form to assess the skills and knowledge of each participant. It provides a structured way to evaluate performance and can highlight areas where further training may be required.

These documents work together to support the smooth operation of BLS courses and ensure that all participants are adequately trained and certified. Having them on hand promotes accountability and helps maintain the high standards set by the American Heart Association.

Similar forms

The Aha Bls Roster form serves an important purpose in documenting the completion of Basic Life Support courses. Several other documents share similar functions and structures in educational and certification settings. Understanding these documents can be helpful for trainers and organizations involved in emergency training. Below is a list of six documents that are similar to the Aha Bls Roster form, along with an explanation of how they are alike.

  • Training Completion Certificate: This document certifies that an individual has successfully completed a specific training program, similar to how the Aha Bls Roster confirms participants' completion of a BLS course. Both forms contain information about the course, including dates, instructor details, and participant names.
  • Course Attendance Sheet: This sheet tracks attendees of a specific course. It generally includes the names and signatures of participants, similar to the Aha Bls Roster where each participant's name is recorded alongside important course details.
  • Participant Feedback Form: While the focus is on gathering feedback, this form often requires participants to provide their names and related data about a course. Like the Aha Bls Roster, it supports quality assurance for training programs by assessing participant experiences.
  • Certification Renewal Application: This application is completed by individuals seeking to renew their certifications, requiring proof of prior training and course completion, much like the Aha Bls Roster, which verifies participation in BLS courses.
  • Instructor Evaluation Form: This form evaluates the performance of the instructor based on participant feedback. It includes course details similar to those found in the Aha Bls Roster, which also records instructor information for course accountability.
  • Training Program Overview: This document outlines the curriculum and objectives of a training program. It often lists instructors and course details, akin to the comprehensive nature of the Aha Bls Roster, which encapsulates essential information about the BLS course.

In summary, each of these documents serves to track and verify the progress and completion of training programs, reinforcing the commitment to maintaining high standards in life-saving education.

Dos and Don'ts

When filling out the AHA BLS Roster form, attention to detail is crucial. Here are key practices to follow and avoid:

  • Do print all information clearly to ensure legibility.
  • Do verify the accuracy of the Lead Instructor's ID number and card expiration date.
  • Do include the correct Training Center name and ID number.
  • Do list all course participants in the designated area.
  • Don't use abbreviations or shorthand when completing the form.
  • Don't omit the date of the course as it is required.
  • Don't forget to sign the form as the Lead Instructor to confirm accuracy.
  • Don't leave any fields blank unless specifically noted as optional.

Adhering to these guidelines ensures compliance with AHA standards and enhances the processing of the course roster.

Misconceptions

Here are six misconceptions about the AHA BLS Roster form, along with explanations to clarify each one.

  1. The form is only for instructors.

    This form is not limited to instructors alone. While it is used by instructors to document course details, it also includes important information for course participants. Each participant's information must be accurately recorded to ensure proper certification.

  2. All fields on the form are optional.

    Many fields on the AHA BLS Roster form are mandatory. Completing required fields ensures the integrity of the data and confirms that the course meets AHA standards. Missing information may lead to complications in issuing certification cards.

  3. The form does not need to be filled out completely.

    Completing the form entirely is crucial. Incomplete forms can result in delays in processing certifications or even significant issues in record-keeping. Every section serves a purpose and must be filled out accurately.

  4. Only the lead instructor is responsible for the form.

    While the lead instructor signs the form, all instructors involved in the course share responsibility for the accuracy of the information. The data regarding participants and course details reflect the collective work of the instructional team.

  5. Participants do not need to sign the form.

    Participants are typically required to print their names as they wish them to appear on their certification cards. This ensures clarity and helps avoid any discrepancies when cards are issued. Participants play an active role in validating their information.

  6. The form can be submitted at any time.

    There are deadlines associated with the submission of the AHA BLS Roster form. It is essential to submit the form within the designated timeframe to ensure timely receipt of certification cards and to comply with AHA requirements.

Key takeaways

Here are key takeaways for filling out and using the AHA BLS Roster form:

  • Ensure all fields are filled out correctly. Double-check the Lead Instructor's name, ID number, expiration date of their card, and training center details.
  • Verify participant information. Each participant's name, email, and mailing address must be legible. This information will appear on their certification cards.
  • Maintain accurate records of course details, such as start and end times, total hours of instruction, and the number of cards issued.
  • Incorporate the signatures. The Lead Instructor's signature is vital for confirming the information's accuracy and adherence to AHA guidelines.