Checklist for First Responder Instructor Candidates

This checklist should be completed during a District #3 approved First Responder course (1995 curriculum).  The Course Coordinator and the Instructor Candidate will work together during this course to complete this checklist.

1. The Instructor Candidate planned and administered the following lessons using the objectives in the 1995 National Standard First Responder Curriculum:

Date: ________  Topic and lesson number: _______________________________

Date: ________  Topic and lesson number: _______________________________

Date: ________  Topic and lesson number: _______________________________

2. The Instructor Candidate planned and organized the following practical sessions using the objectives in the 1995 National Standard First Responder Curriculum:

Date: ________  Topic and lesson number: _______________________________

Date: ________  Topic and lesson number: _______________________________

Date: ________  Topic and lesson number: _______________________________

3. The Instructor Candidate generated at least one class quiz or exam

Date: ________  Module number: ________

4. ________  The Instructor Candidate has been given a “First Responder Resource Packet” distributed by the District #3 Training Committee
5. ________  The Instructor Candidate assisted during at least 80% of the practical and lecture sessions of a District #3 approved First Responder course (1995 curriculum).

For Instructor Candidate:

By signing below, I am indicating that the information in the above checklist is accurate and complete.  I also acknowledge that completion of this checklist does not guarantee that District #3 will approve courses proposed by me:

Signed: _______________________________  Date: ____________

For Course Coordinator:

By signing below, I am indicating that the abovementioned Instructor Candidate completed this checklist under my supervision.  During the length of this First Responder course, the Instructor Candidate developed proficiency in using and implementing the 1995 National Standard First Responder Curriculum.  I am also indicating that the Instructor Candidate is familiar with the District and State requirements for proposing and coordinating a First Responder course:

Signed: _______________________________  Date: ____________

When completed, please turn this checklist in to the District #3 Training Committee Chair.

Approved by the VTEMSD#3 Training Committee on October 12, 2000