HEARTSafe HB- Training Record

HEARTSafe HB- Training Record
Who is completing this form?*

Fire CompanyEMS StaffMarine SafetyJr. GuardsHEARTSafe AmbassadorSchool TeacherMedical PersonnelCERTOther
Which Fire Company?
Name of primary CPR Instructor*

First NameLast Name
Date of Instruction

MonthDayYear
Date
Topics Covered- check all that apply*

Hands Only CPRAEDStop the BleedNarcan AdministrationEpinephrine Auto-Injector Awareness
Number of People Trained*
What kind of device are you completing this form on?

iOSAndroidComputer
Please enter address of training location

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Description or name of location or event*
Detected Location: Touch or slightly move position of Red Marker, in order for location to register.
Should be Empty: