Direct Service Providers Annual Training Approval List
DSP Name
Calendar Year
To be completed by the contracting Direct Service Provider:
Signature of person completing the form:
Title:
Date of Completion
Please indicate the employees who will receive the training listed below:
Homemakers
Personal Care Workers
Companion Workers
Adult Day Health Workers
Unskilled Respite Workers
RN
LPN
Please indicate which Waiver employees will receive the training listed below:
Elderly and Disabled Waiver (E&D)
Alabama Community Transitions Waiver (ACT)
Please fill out the following:
Rows
Topic
Name/Title of Trainer
Objectives
Outline of Contents
Length
1
2
3
4
5
6
7
8
To be completed by the contracting Area Agency:
The training, as listed, is approved for calendar year
Date:
Signature:
Title:
cc: QA Auditor, ADSS
MW-25B 9/2017R
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