ALS Continuing Education Logbook and Evaluation

ALS CME Logbook and Evaluation

Please complete this survey for your ALS CME experience and attest to your hours.
Select Your Name - This List Reflects the ALS Service Roster as of 4-19-2023. *
Date You Took The Class*

MonthDayYear
Date
Enter Email Address*
example@example.com
Lead Instructor's Name*
Class Title*
Class Location*
If "Other Location" Please List

Please Provide Candid Feedback - Your Perspective Influences Future Content*

	Very Good	Good	Fair	Poor
Overall quality of course was:
The course content was:
The instructor's competence and effectiveness in teaching the subject matter was:
Course content and logistical organization was:
Rate how well the course environment promoted student engagement and expanded my EMS outlook:
Lead and Adjunct Instructor enthusiasm was:
Answers to student questions were:
Availability of extra help when needed was:
Use of class time was:
Amount you learned was:
Relevance of course content was:
Content matched reality of Field EMS:
Content matches directions currently provided by EMHIS:
I would recommend this course to a friend:
Intellectual challenge was:
This course will enhance my ability to provide sound patient care:

Student Participation
The amount of effort you put into this course was:

1

2

3

4

5

6

1 is Very Poor, 6 is Excellent
Is there any other feedback you'd like to give on this class? Are there any specific topics you would like to have for future CME? If you rated any of the above categories as "poor", please elaborate why.
Student Logbook
Sign IN Time*

Hour Minutes

AM/PM Option
Sign OUT Time*

Hour Minutes

AM/PM Option
Pay Status*
I attest that I attended this ALS CME Class during the times I indicated in the above fields:*

Clear
Should be Empty:

ALS CME Logbook and Evaluation