DCSB Course Roster

This DCSB Course Roster form is for DCSB Instructors to submit their online DCSB Course Roster to Newnan CPR AHA Training Site. It also serves to advise Newnan CPR AHA Training Site when more eCards are needed by DCSB. This form is only used to submit DCSB course roster, and order AHA eCards.

DCSB Roster Instructions

An instructor agreement with the Training Site must be in place to use this roster.
Instructors must retain original course roster (with students\’ name/signature) and other course records (exams, evaluations, skill check forms) for 3 years. Course records are subject to inspection by the Training Site, Training Center, or AHA faculty.
Please verify spelling of student names.

DCSB Roster Information

Course Taught:

DCSB Lead Instructor (Pick List):

Instructor E-mail:

Instructor Phone:

Course Location:

Class Date:

Class Start Time

Class Length (hours):

Student to Manikin Ratio:

Assisting Instructor(s) - if any (use pick list):

Student names. Place comma after each name, and exam scores for BLS.

Are certification cards needed for this class?

No, for this class, e-Cards were issued

Yes, we need cert. e-Cards for this class

Inventory of BLS e-Cards?

Are (inventory) BLS Provider e-Cards needed?

# BLS e-Cards needed?

If yes, how many?

Inventory of 1st Aid e-Cards

Are HS First Aid e-Cards Needed?

# of HS 1st Aid e-Cards needed?

If yes, how many?

Go to bottom and \"Submit\" roster).

By submitting, I verify this course was taught in accordance with AHA guidelines, including using current course video feedback manikins, and other AHA Instructor support material.