ECT Information Form

1
ECT Course Selection* This field is required.
HLTAID009 - Provide Cardiopulmonary resuscitation
HLTAID009 - Provide Cardiopulmonary resuscitation + HLTAID011 - Provide First Aid
HLTAID009 - Provide Cardiopulmonary resuscitation + HLTAID015 - Provide advanced resuscitation and oxygen therapy
HLTAID009 - Provide Cardiopulmonary resuscitation + HLTAID011 - Provide First Aid + HLTAID015 - Provide advanced resuscitation and oxygen therapy
2
Branch* This field is required.
Sunshine Coast
North Queensland
North Barrier
Wide Bay Capricorn
Sunshine Coast
South Coast
Point Danger
State
3
Wide Bay Cap Club Name* This field is required.Select your club
Branch
Moore Park
Bundaberg
Elliott Heads
Hervey Bay
Yeppoon
Emu Park
Tannum
Agnes Water
4
Sunshine Coast Club Name* This field is required.Select your club
Branch
Brisbane Life Saving
Noosa Heads
Rainbow Beach
Sunshine Beach
Coolum Beach
Marcoola
Mudjimba
Maroochydore
Alexandra Headland
Mooloolaba
Kawana Waters
Dicky Beach
Metropolitan Caloundra
Bribie Island
Redcliffe Peninsula
Peregian
5
South Coast Club Name* This field is required.Select your club
Branch
Brisbane Life Saving
Northcliffe
Broadbeach
Kurrawa
Mermaid Beach A.E.M.E
Nobbys Beach
Miami Beach
North Burleigh
Burleigh Heads Mowbray Park
Point Lookout
Coochiemudlo Island
Southport
Surfers Paradise
6
Point Danger Club Name* This field is required.Please Select your Club
Branch
Brisbane Life Saving
Tugun
Bilinga
North Kirra
Kirra
Coolangatta
Tweed Heads and Coolangatta
Rainbow Bay
Tallebudgera
Pacific Surf
Palm Beach
Currumbin
7
North Queensland Club Name* This field is required.Please Select your Club
Branch
Mission Beach
Port Douglas
Ellis Beach
Cairns
Etty Bay
8
North Barrier Club Name* This field is required.Please Select your Club
Branch
Eimeo
Mackay
Sarina
Forrest Beach
Arcadian
Townsville Picnic Bay
Ayr
9
ECT Trainer details * This field is required.
Please Select
Please Select
No
Yes
Do you require SLSQ to find you an ECT Trainer?
First, Last Name
Please enter your phone
Please enter your email
10
Direct Supervisor or ECT Trainer with TAE Cert IV* This field is required.At least one ECT Trainer needs to hold a Cert IV or a Direct Supervisor must be allocated.
First/ Last name
Phone number
Email
11
Are you the CTO* This field is required.
YESNO
12
CTO Details* This field is required.
First , Last name
Email
13
List any Probationary Trainers/AssessorsPlease type the probationary name and indicate if they are a Trainer (T), or Assessor (A)
First , Last name (A) / (T)
First , Last name (A) / (T)
First , Last name (A) / (T)
First , Last name (A) / (T)
14
Course Date* This field is required.Minimum 14 Days from submission date If your course is not submitted within 14 days of the start date you will be required to provide sufficient reasoning
Date
Day
Month
Year
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
Hour
00
15
30
45
Minutes
15
Personal Details* This field is required.
First Name
Last Name
16
Approximate Number of Participants* This field is required.First Aid 16 max. participants, ART 16 max. participants Participant enrolments close 3 day prior to first session date
17
Training Details* This field is required.
18
Training Details* This field is required.
19
Additional commentsIf your course is submitted within 14 days of the start date please provide sufficient reasoning below
Should be Empty: