EMS Course Roster (fillable

Virginia Office of EMS Division of Educational Development 1041 Technology Park Drive Glen Allen, VA 23059
Course/Topic Name
MM/ DD / YYYY
Denst plate on rester vetil after the class
Course Number
Topic Number
Course Type
Initial Program:CE Program:Auxiliary Program:
Number of CE Hours Taught
YesNo
01 02 03 04 05 06 07 08 09 10 11 12 13

Ihereby certify that this course and topic was taught to the above students and that the number of continuing education (CE) hours is accurate and a truthful accounting of the hours per the guidelines for this course.
Instructor, Printed Name
Signature

Clear
Date

MonthDayYear
Date
Virginia Office of Emergency Medical Services Page 1 www.vdh.virginia.gov/oems
Virginia
Virginia Office of EMS Division of Educational Development 1041 Technology Park Drive Glen Allen, VA 23059
Course Number
Topic Number
Course Type
14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29

Thereby certify that this course and topic was taught to the above students and that the number of continuing education (CE) hours is accurate and a truthful accounting of the hours per the guidelines for this course.
Instructor, Printed Name
Signature

Clear
Date

MonthDayYear
Date
Virginia Office of Emergency Medical Services www.vdh.virginia.gov/oems
Virginia
Virginia Office of EMS Division of Educational Development 1041 Technology Park Drive Glen Allen, VA 23059
Course Number
Topic Number
(Didactic or SkII)
Donot place ca resiter untiliafter the class.

30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45

Ihereby certify that this course and topic was taught to the above students and that the number of continuing education (CE) hours is accurate and a truthful accounting of the hours per the guidelines for this course.
Instructor, Printed Name
Signature

Clear
Date

MonthDayYear
Date
Virginia Office of Emergency Medical Services www.vdh.virginia.gov/oems
Virginia
Virginia Office of EMS Division of Educational Development 1041 Technology Park Drive Glen Allen, VA 23059
Course Number
Topic Number
(Oidactic or skill)
De not plate on alter the class.

46 47 48 49 50 51 52 53 54 55 56 57 58 59 60

Ihereby certify that this course and topic was taught to the above students and that the number of continuing education (CE) hours is accurate and a truthful accounting of the hours per the guidelines for this course.
Instructor, Printed Name
Signature

Clear
Date

MonthDayYear
Date
Virginia Office of Emergency Medical Services www.vdh.virginia.gov/oems
Virginia
Type a question
Should be Empty:

Virginia

Virginia

Virginia

Virginia