External AHA Wrap Up

External AHA Wrap Up

Please complete this at the conclusion of your course.
Instructors who are being compensated by APHE--please use the INTERNAL WRAP UP
Access Code
Course Number*
Course Date*

MonthDayYear
Lead Instructor*
Please select name from list that populates.
Lead Instructor Email*
example@example.com
Additional Instructors?*
Select the Number of Additional Instructors (Not Including Lead Instructor)
Additional Instructor 1*
Please From the List. If Additional Instructor Not Listed, Choose "Unlisted"
Additional Instructor 2*
Please From the List. If Additional Instructor Not Listed, Choose "Unlisted"
Additional Instructor 3*
Please From the List. If Additional Instructor Not Listed, Choose "Unlisted"
Additional Instructor 4*
Please From the List. If Additional Instructor Not Listed, Choose "Unlisted"
Additional Instructor 5*
Please From the List. If Additional Instructor Not Listed, Choose "Unlisted"
Unlisted Additional Instructor(s)*
Enter the Name(s) of the Unlisted Instructor(s)
Unlisted Additional Instructor(s)*
Enter the Email(s) of the Unlisted Instructor(s)
Type of Course*
AHA Course*
Please carefully select your class. eCard billing for external classes is based on your selection (not your Set Up).
ARC Course*
CBRF Course*
NAEMT & EMS Course*
ARC First Aid and/or CPR/AED Classes*
ARC Specialty Class*
ARC Aquatics, Lifeguarding & Water Safety Classes*
ARC Format*
CPR Modules Being Taught*

Adult, Child & Infant (a)Adult (b)Child & Infant (c) (always $21 HS/eCard)Adult & Child
ARC Add-Ons (Check ALL that apply)*

NoneFirst AidBBP - Bloodborne PathogensAEO - Administering Emergency OxygenAE - Anaphylaxis & Epi Auto-Injector AdminAI - Asthma & Quick-Relief Med Admin (Inhaler)OO - Opioid Overdose & Naloxone AdministrationHead, Neck, Muscle, Bone & Joint Injuries & SplintingLife Threatening Bleeding & Tourniquet Application
ARC Lifeguard Add-Ons (Check ALL that apply)*

NoneWaterfrontWaterparkBundle 1Bundle 2Bundle 3Bundle 4
First Aid Course Taught (AHA)*

Basic (Does NOT Meet OSHA Requirements)Total (Meets OSHA Requirements) (always $21/eCard)
Heartsaver eCard*

K12 eCard: Class taught to students or staff of a 4K, Elementary, Middle or High School. ($6/eCard)Pediatric eCard: Class taught to staff of a Daycare. eCard states "Pediatric." ($21/eCard)Heartsaver eCard: Class taught outside of a Daycare or K-12 School. ($21/eCard)
eCards for Child & Infant only classes (without Adult CPR) are always standard Pediatric eCards ($21/eCard).
eCards for TOTAL First Aid CPR AED classes are always standard eCards ($21/eCard).
eCards for Heartsaver First Aid Classes & Skills Sessions are always standard eCards ($21/eCard).
eCards for Heartsaver Pediatric First Aid Classes & Skills Sessions are always standard Pediatric eCards ($21/eCard).
K-12 or Heartsaver Class
Please carefully select your choice. eCard billing for external classes is based on your selection (not your Set Up).
# of Students Start*
# of Students Complete*
Name(s) of Student(s) who Left or Did Not Pass*
If "Number of Students Start" and "Number of Students Complete" are the same number, enter "0 "
Any Students under age 18?*

YesNo
Ensure that the parents of students who are not yet 18 years of age have been sent and completed the APHE Youth Participant Agreement & Permission Form. AHA eCards will not be issued to students until this has been received by APHE.

Organization to Bill*
This is the company or entity name that will appear on the invoice.
Billing Contact Person*
Billing Email Address*
example@example.com
Additional Notes*
Feedback, Information, Billing Comments
Email Skills Session certificates or other paperwork to entry@aphed.com.
APHE TC Equipment Disinfection Verification

All equipment and surfaces will be cleaned and disinfected with a commercial germ-killing disinfectant after each course by the following process:
1. Put on new, clean disposable gloves.
2. As needed, clean any soiled surfaces with a wet paper towel; then, dispose of the paper towl.
3. Apply disinfectant to all surfaces. The surfaces should remain wet for at least six (6) minutes.
4. Wipe any surfaces with clean cloth until dry.
5. Pack up equipment & other supplies.
I complied with the above APHE TC and the AHA or ARC and/or manikin manufacturer guidelines for cleaning and disinfecting the classroom and equipment.*

I agree
Students did not practice “mouth-to-mouth” in this course.*

I agree
Each student had his or her own pocket mask and single-use, disposable mouthpieces.*

I agree
I told students to watch for the email within the next five (5) business days to claim the eCard and complete the survey (certification classes only).*

I agree
By signing here, I agree that:
- This course was taught in accordance with the appropriate AHA or ARC Guidelines and APHE TC Policies;
- The course equipment was thoroughly and completely disinfected following the above APHE TC Equipment Disinfection Verification.
Signature*

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