EmailMe Form - ALS2 Course Approval/Notification

Course Centres will need to complete a risk assessment for the course facilitation and make a local judgement if it safe to continue.

This assessment and decision to facilitate the course should include Organisational Executive and possibly others - for example Health and Safety, Infection Control and Occupational Safety teams in completing this evaluation.

The risk assessment remains the property of the course centre. It does not require submission with the application. It is advised you retain a copy of this assessment.

Course Centre *

Venue Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Course Date day 1 *

DD / MM / YYYY

Day 1 if modular course

Course Date day 2 *

DD / MM / YYYY

Last if modular course/recertification course

Course Format *

If Remote selected - date of first session of remote learning

DD / MM / YYYY

First/Earliest date remote learning to be available/completed

Course Organiser
Name *

First Last

Contact Phone Number *

Email address *

Confirm Email address

Number of Candidates *

Candidate roles *

Nurse

Doctors/Medical

Paramedic

Other

Name of Organisational Executive / Head of Education supporting this training *

First Last

Email of above *

FACULTY DETAILS

ARC must be advised via email arc@resus.org.au of any amendments to the Faculty details prior to the course.

Please upload word copy of FACULTY APPROVAL FORM *

Must be doc/docx copy

Instructor Candidates and Recertifying Instructors

Must attend full course

Course Director/Medical Lead Details

Please indicate if Course Director is Instructing on the course and included in minimum faculty.

Director and Medical Lead must be present for whole course.

Name - Course Director *

First Last

Email - Course Director *

Course Director Instructing

Instructing - full course

Non- Instructing member

Course Director also Medical Lead

Instructing part course

please state % Instructing

Name - Medical Lead

First Last

Email - Medical Lead

Medical Lead Instructing

Instructing - full course

Non- Instructing member

Course Director also Medical Lead

Instructing part course

please state % Instructing

In submission of this form you confirm that you will follow national/local Health and Safety, Infection Control, (including Occupational Health and Safety) requirements in facilitation of this course. You also agree to conduct the course according to the current regulations.

*

I confirm that a local risk assessment has been completed and it is safe to facilitate this course.

Form Completed by Name *

First Last

Form Completed by - Email *

Unique ID