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ALS1/ILS Results Submission
Please complete all and upload your results sheet
Course Centre
*
Course Director (Name)
*
First
Last
Course Director Contact Email
*
Date Course Completed
*
DD
/
MM
/
YYYY
(Final Day if modular)
Method of Course Delivery
*
Please select
Standard one day
Remote 1/2 day and Face-to-face 1/2 day
Modular - 2x half day
Half day Remote/Half face-to-face
Recertification Course 1/2 day
Number of Candidates
*
including pass/not passed/did not attend
State/Territory of Course Venue
*
Please select
ACT
NSW
NT
QLD
SA
TAS
VIC
WA
Upload Results Sheet
*
Spelling on this sheet will be used to generate certification cards.
Please ensure all spelling is correct prior to submission.
Any corrections required once cards printed may incur a fee.
Please retain a copy of the course results.
Defibrillation Skill (mode used on course)
Please select
AED Only
Manual Mode Only
Mixed AED and Manual Mode
Please indicate the mode of the defibrillation skill taught on the course
AED = Automated external Defibrillation Mode only
Airway: Was mouth to mouth ventilation instructed on the course
Yes
No
Airway: Was Pocket Mask ventilation instructed on the course
Yes
No
Airway: Was LMA insertion skill instructed on the course
Yes
No
Topic of targeted Training Session
Total Number of Candidates
Number of Candidates - PASSED/Successful
Number of Candidates - DID NOT ATTEND
Name of person submitting results
*
First
Last
Contact Email
*
The ARC will send the certification cards to the registered Course Centre address
The ARC reserve the right to withhold issuing of certification in the event of any breach of course regulations (including financial commitments)
Date Submitted
*
DD
/
MM
/
YYYY
Unique ID
