BreatheSafe HB- Training Record
Who is completing this form?
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Fire Company
EMS Staff
Marine Safety
Jr. Guards
Medical Personnel
CERT
Other
Which Fire Company?
Please Select
HE41
HE42
HE43
HE44
HE45
HE46
HE47
HE48
HT42
HT45
Name of primary CPR Instructor
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First Name
Last Name
Description or name of location or event
*
Date of Instruction
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Month
-
Day
Year
Date
Topics Covered- check all that apply
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Hands Only CPR
AED
Stop the Bleed
Narcan Administration
Epinephrine Auto-Injector Awareness
Number of People Trained
*
Number of Narcan Kits distributed
*
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