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The AHA BLS Roster form plays a crucial role in documenting participation in Basic Life Support (BLS) courses, which are vital for equipping individuals with the skills necessary to respond to cardiac emergencies. The form captures essential details about each course, including the type of training—whether instructor-led BLS or HeartCode® BLS—as well as the identity and credentials of the lead instructor and any assisting instructors. Key date and location information is meticulously recorded, ensuring that the course’s start and end times, training center details, and associated addresses are clearly outlined. Additionally, it reflects the total instructional hours and the number of certification cards issued, which is vital for tracking the impact of these training efforts on community preparedness. To verify the accuracy of information, instructors must sign the form, affirming that the course adhered to the standards set forth by the American Heart Association. Furthermore, a section for participant details allows for individual tracking of course attendance and completion status. The AHA BLS Roster form serves not only as an official record but also as an important tool for ensuring that life-saving skills are adequately disseminated and recognized within the community.

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

 

 

 

 

 

 

 

 

1.

 

 

5.

 

 

 

 

 

 

 

 

 

 

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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

File Breakdown

Fact Name Description
Course Types The AHA BLS Roster form is used for two main course types: instructor-led BLS courses and HeartCode® BLS courses.
Lead Instructor Requirement Each course must have a designated lead instructor, who needs to provide their instructor ID number and card expiration date.
Verification Statement The lead instructor verifies that the provided information is accurate and complies with AHA guidelines by signing the form.
Assisting Instructor If there’s an assisting instructor from a different training center, their details must be attached and included on the form.
Course Duration The form requires the course start and end dates, along with total hours of instruction to ensure proper documentation.
Student-Manikin Ratio Accurate reporting of the student-manikin ratio is mandatory for compliance with training requirements.
Card Issuance The form includes space for the number of cards issued and the issue date, which is critical for tracking certification.
Contact Information Each course participant must provide their name, email address, and mailing address to facilitate communication.
State-Specific Compliance Each state may have additional requirements or specific laws governing the use of the BLS Roster form, such as record-keeping regulations.
AHA Copyright The form contains a copyright notice, indicating that it is a protected document under the rights of the American Heart Association.

Guide to Using Aha Bls Roster

Filling out the AHA BLS Roster form is an important part of documenting the details of a Basic Life Support course. The information collected will help ensure that all participants receive proper certification and that the course meets the required standards.

  1. Begin by entering the Course Information at the top of the form. Choose whether it is a BLS Course (instructor-led) or HeartCode® BLS.
  2. Fill in the details of the Lead Instructor. Write the instructor’s name and their ID number. Include the Card Expiration Date.
  3. Enter the Training Center name and ID number. If applicable, include the Training Site Name and its address, city, state, and ZIP code.
  4. Complete the Course Location and provide the Course Start Date/Time and Course End Date/Time.
  5. Indicate the Total Hours of Instruction and the No. of Cards Issued.
  6. Provide the Student-Manikin Ratio and Issue Date of Cards.
  7. If applicable, list the Assisting Instructor alongside their ID number and expiration date of their card. Attach a copy of the instructor's credentials if they are affiliated with a different training center.
  8. Affirm that the information is accurate by signing and dating the form as the Lead Instructor.
  9. Proceed to fill in the participant section at the bottom. List each course participant's name and email address. Indicate whether they completed the course or require remediation, along with their mailing address and telephone number.
  10. Print each participant's name clearly as it should appear on their card. Ensure that the email addresses are legible.

Get Answers on Aha Bls Roster

What is the AHA BLS Roster form?

The AHA BLS Roster form is a document used to record important information about individuals who have completed a Basic Life Support (BLS) course. This form includes details such as the course instructors, student details, training center information, and the specifics of the course that was taught. It serves as a comprehensive record that can be used by the American Heart Association (AHA) and training centers to verify course completion and maintain accurate training statistics.

Who needs to fill out the AHA BLS Roster form?

The lead instructor of the BLS course is responsible for filling out the AHA BLS Roster form. They need to provide accurate details regarding instructors and participants. Assisting instructors may also contribute information if they are linked to a training center other than the main one. This ensures complete documentation of all involved in the training process.

What information is required on the AHA BLS Roster form?

The form requests various pieces of information, including but not limited to:

  • Course details (type, start and end times, total hours)
  • Lead instructor's name and ID number
  • Training center and site information
  • Student details including names, emails, and mailing addresses
  • Card expiration dates for instructors and issued cards
  • Verification of course adherence to AHA guidelines

This thorough collection of data helps ensure a streamlined verification process and provides necessary documentation for all participants involved.

What happens if incorrect information is submitted on the form?

If incorrect information is found on the AHA BLS Roster form, it may lead to delays in issuing BLS cards to participants or could potentially affect the recognition of training completion. It is vital to verify all the details before submitting the form. If errors are discovered after submission, the lead instructor should contact the training center to determine the best course of action for correction.

How is the information on the form used?

The information collected through the AHA BLS Roster form is primarily used for certification purposes. It allows the AHA to track course completion for participants. Additionally, it provides a record for quality assurance and compliance with training standards. This data may also be used for reporting and research purposes within emergency cardiovascular care programs.

Is the personal information on the form protected?

Yes, personal information on the AHA BLS Roster form is generally treated with confidentiality. The AHA and training centers are obligated to follow privacy regulations that govern the handling of personal data. This ensures that students' names, contact details, and other sensitive information are kept secure and used solely for the intended purposes related to course completion and certification.

What should I do if I did not receive my BLS card after completion of the course?

If you have completed your BLS course but have not received your card, reach out to the lead instructor of your course or the training center directly. They can verify your attendance and the submission of the roster form. If everything checks out, they can help facilitate the issuance of your BLS card.

When should the AHA BLS Roster form be submitted?

The AHA BLS Roster form should be submitted as soon as possible after the course is completed. Prompt submission helps ensure that students receive their certification cards in a timely manner. The lead instructor or training center should maintain a timeline for submission, ideally within a few days to settle records efficiently.

Common mistakes

Filling out the AHA BLS Roster form can be a straightforward process, but several common mistakes can lead to complications. Avoiding these pitfalls will ensure that the form is processed correctly and efficiently.

One of the most prevalent errors is providing incomplete or illegible information. Participants must ensure that their names are printed clearly, as this is how their official certification will appear. If a name is misspelled, it may lead to complications down the line when certifications are issued.

Another mistake involves incorrect email addresses. To receive important notifications or confirmation, it's imperative to double-check that email addresses are accurate and complete. A simple typo can result in the lack of communication or important updates being missed.

People also often overlook the necessity of including all relevant information about the instructor. This includes both the lead instructor and any assisting instructors. Not providing the instructor's ID or card expiration date can delay the processing of the roster, as the AHA needs this information for verification.

Failing to verify the accuracy of course dates and times can also create confusion. Participants must ensure that the course start and end dates/times are entered correctly. If these details are wrong, it may affect the validity of the participants' certifications.

Another frequent error is neglecting the student-manikin ratio, which is a critical component of the BLS training. If this ratio is not properly documented, it can lead to questions about the quality and compliance of the instruction provided.

Lastly, some individuals fail to sign and date the form, indicating their confirmation of the information provided. This signature is essential as it confirms that the information submitted is truthful and can be verified. Without it, the form may be deemed incomplete or void.

By being mindful of these common mistakes, individuals can improve the accuracy of their submissions, ensuring a smoother certification process and avoiding any potential delays in receiving cards or further communication.

Documents used along the form

The AHA BLS Roster form is a key document used in registering participants for Basic Life Support courses. Several other forms and documents complement this roster, ensuring proper documentation, record-keeping, and compliance. Below is a list of these vital documents.

  • Course Completion Certificates - These certificates serve as proof that participants have successfully completed the BLS course. They typically include the participant's name, the course date, and the lead instructor's information.
  • Instructor Credentials Verification Form - This form verifies the qualifications of the instructors leading the BLS course. It ensures that they meet the necessary requirements set forth by the American Heart Association.
  • Student Evaluation Form - Participants fill out this form to provide feedback on the course. Their evaluations help improve future training sessions and assess instructors’ performance.
  • Training Center Accreditation Document - This document confirms that the training center offering the BLS course is accredited by the American Heart Association. It outlines compliance with specific guidelines and standards.
  • Course Syllabus - This syllabus outlines the topics covered in the BLS course and the learning objectives. Participants can use it as a reference before and after the training.
  • Attendance Record - This document lists all participants who attended the course, including their contact details. It is crucial for maintaining an accurate roster and for issuing completion cards.

Using these documents alongside the AHA BLS Roster form ensures comprehensive record-keeping and adherence to the standards of the American Heart Association. This combination enhances the integrity of the training process and the recognition of accomplishments by participants.

Similar forms

  • Awareness Training Roster: This document records participants' information in an awareness training program. It includes details such as names, dates, and instructor information, similar to the AHA BLS Roster form.
  • CPR Certification Roster: This roster is used to track individuals who have completed CPR training. Like the BLS Roster, it captures course dates, instructor details, and the number of certifications issued.
  • First Aid Course Roster: This document lists participants who completed First Aid training, including course duration and instructor details. It serves a purpose similar to the BLS Roster by organizing participant information systematically.
  • Instructor Evaluation Form: This form captures feedback on the performance of the instructor, noting participant observations and course outcomes. Much like the BLS Roster, it helps ensure quality compliance in training programs.
  • Emergency Response Training Register: This register details participants in emergency response training. It includes the same type of tracking for course completion and instructor accountability found in the BLS Roster.
  • Training Attendance Sheet: An attendance sheet keeps track of who attended a training event. It shares similarities with the BLS Roster as it documents names, dates, and any relevant course information.
  • Certification Issuance Log: This log records the issuance of various training certifications, similar to the BLS Roster. It ensures transparent tracking of who received their certification cards and when.

Dos and Don'ts

Filling out the AHA BLS Roster form accurately is crucial. This helps ensure that your students receive their cards without delay. Here’s a list of what to do and what to avoid:

  • DO verify all personal and course-related information before submission.
  • DO write clearly and legibly to avoid any confusion.
  • DO ensure all instructors’ details are filled in, including their IDs and card expiration dates.
  • DO check that the course start and end times are accurate.
  • DON'T leave any spaces blank that should be filled in, as this can cause processing delays.
  • DON'T forget to include your signature and the date at the end of the form.
  • DON'T use abbreviations or shorthand when listing names or addresses.
  • DON'T ignore the importance of the student-manikin ratio, as it must meet specific standards.

Following these guidelines will help ensure your roster is complete and compliant with AHA standards.

Misconceptions

When it comes to the AHA BLS Roster form, many people hold misconceptions that can lead to confusion or even mistakes in the completion process. Here are six common misunderstandings:

  • One size fits all: Some believe that there is a single roster form that applies to all courses, but this is not true. Different courses, such as instructor-led versus HeartCode® BLS, have distinct requirements on the roster.
  • Instructors can sign off on any course: It's often assumed that any instructor can validate a course, but only the designated lead instructor can sign the roster for that specific course, as per AHA guidelines.
  • The roster is optional: Many people think that submitting the roster is a choice, but submitting accurate rosters is crucial for maintaining training records and issuing certification cards.
  • All participants must pass the course: A common myth is that everyone listed on the roster has successfully completed the course. In fact, the roster also includes spaces for students who may need remediation or have incomplete assessments.
  • Rosters should be submitted immediately: There's a misconception that rosters need to be submitted right after the course ends. However, as long as the cards are issued following AHA protocols, submission can take place after all necessary verifications are complete.
  • Addresses on the form are insignificant: Some individuals might overlook the importance of providing accurate mailing addresses. In reality, correct information is essential for delivering certification cards to participants.

Understanding these misconceptions not only helps in accurately filling out the AHA BLS Roster form but also ensures that participants receive their certifications and that instructors maintain compliance with AHA standards.

Key takeaways

Filling out and using the AHA BLS Roster form can seem daunting, but the following key takeaways can help guide the process.

  • Accurate Information: Ensure that all details regarding the course, instructors, and participants are filled in correctly. Accurate information is essential for certification and future verification.
  • Signatures Required: The lead instructor must sign the form to verify its accuracy. This signature confirms adherence to AHA guidelines.
  • Complete Student Details: List each participant's name and preferred email carefully. This information will appear on their certification cards, so clarity is crucial.
  • Issue Dates: Clearly record the issue date of each participant’s card. This date serves as an important reference for their certification status.
  • Instructor Details: Include any assisting instructors along with their corresponding details. Attach copies of their instructor credentials if aligned with a different training center.