Direct Service Providers Orientation 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
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
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
Continue
Continue
Should be Empty: