B BLS COURSE REPORT
For Use By Authorized Cascade Training Sites Only
Date of Transmittal: ____________________________________
Training Site Name: ____________________________________
Sender Name: _________________________________________
Contact Phone: ________________________________________
Contact Email: _________________________________________
Current AHA Skills Check Forms are accessible via the CD-ROM located in
your BLS and/or Heartsaver® Instructor Manual(s). All other documents
are available on the Training Site website.
Training Sites must keep a copy of all completed roster reports and
supplementary documentation for a minimum of three years.
Submission Checklist:
ATTENTION: For each course taught, the Course Director must
complete all sections of this Course Report and the Course
Roster. All
additional required documents (based on checklist above) must then be
combined with the Course Report and Course Roster and submitted as
one .PDF file. Do not submit multiple files for one course, and do not
submit multiple courses within one file.
All courses must be reported within seven (7) days of completion by
uploading all paperwork to the Training Site website:
info.cascadetraining.com/training-sites
BLS Course Report and BLS Course Roster (1 per course)
Copy of current AHA Instructor card(s) for additional
instructors not aligned with Cascade Training Center (Course
Director MUST be aligned with Cascade)
OnlineAHA.org Course Completion Certificate (1/Student; skills
evaluations only)
Skills Check Forms (1 per remediated or failed student)
Written Exam Answer Sheets (1 per remediated or failed student)
Remediated or failed student:
BLS COURSE
ROSTER
USE FOR CPR & FIRST AID COURSES
COURSE TYPE
I
NFORMATION
Course Type:
Check one ONLY. This is the card type that must be issued.
BLS Provider HS First
A
id,
CPR & AED
HS CPR &
AED only
HS First Aid
only
HS Pediatric
First Aid,
CPR & AED
HS
Bloodborne
Patho
g
ens
F&F CPR
& AED
F&F First Aid
BLS = Basic Life Support HS = Heartsaver® F&F = Family & Friends
Course Modules:
Applies to Heartsaver
®
courses only.
Adult CPR
& AED
Child CPR
& AED
Infant CP
R
Written
Exam
Asthma
Care Video
Course Format:
Classroom Course Skills Evaluation fo
r
Online AHA Course
COURSE DETAILS
Location: ________________________________ Date: ______________ Start Time: ____________ End Time: ____________
# of Adult Manikins: __________ # of Child Manikins: _________ # of Infant Manikins: __________ # of AED Trainers: _________
Course Director: ______________________________________ Training Center: Cascade Training Center
Additional Instructor: ___________________________________ Training Center: ___________________________________
Additional Instructor: ___________________________________ Training Center: ___________________________________
Additional Instructor: ___________________________________ Training Center: ___________________________________
COURSE DIRECTOR: Upload all required paperwork via the
Training Site website: info.cascadetraining.com/training-sites
BLS COURSE
ROSTER
USE FOR CPR & FIRST AID COURSES
STUDENT INFORMATION
Student Name Phone Emai
l
Test Score
(if applicable)
eCard Code
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
Course Director certifies:
 All required official American Heart Association training products were utilized as required by the Program Administration Manual and course specific Instructor Manual(s) in this course.
 All instructors involved with the training are current BLS or Heartsaver
®
Instructors credentialed by the American Heart Association.
Course Direct
or Name Printed Course Director Signature Date
COURSE DIRECTOR: Upload all required paperwork via the
Training Site website: info.cascadetraining.com/training-sites
click to sign
signature
click to edit
BLS COURSE
ROSTER
USE FOR CPR & FIRST AID COURSES
STUDENT INFORMATION (CONTINUED)
Student Name Phone Emai
l
Test Score
(if applicable)
eCard Code
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
Course Director certifies:
 All required official American Heart Association training products were utilized as required by the Program Administration Manual and course specific Instructor Manual(s) in this course.
 All instructors involved with the training are current BLS or Heartsaver
®
Instructors credentialed by the American Heart Association.
Cours
e Director Name Printed Course Director Signature Date
COURSE DIRECTOR: Upload all required paperwork via the
Training Site website: info.cascadetraining.com/training-sites
click to sign
signature
click to edit
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome