EmailMe Form - ALS1 Course Notification/Approval

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 *
DD / MM / YYYY
Day 1 if modular 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
Dr
Paramedic
Medical Student
Dentist
Anaesthetic/Cardiac Technician
Allied Healthcare Professional
Other
Name of Organisational Executive / Head of Education supporting this training *
First Last
Email of above *
FACULTY

ALS1 Instructors/IC's to be listed on attached form.

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 in .doc/.docx format
Course Director Details
Please indicate if Course Director is Instructing on the course and included in minimum faculty.

Only Director needs to be present for whole course and may opt to teach only part of the course.
Name - Course Director *
First Last
Email - Course Director *
Course Director Instructing
Instructing - full course
Non- Instructing member
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

FACULTY

Course Director Details

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.