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Euclid Fire Class Attendance (Hypothermia)
EMS Con Ed Attendance (Submission of this form constitutes verification of attendance)
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Class Topic/Name:
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Instructor:
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Instructor Ohio Certification Number
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Instructor EMS Certification Level
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Paramedic
EMT-A
EMT-B
Outside or Web-Based
Instructor Certification Level
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Continuing Education Instructor
Assistant EMS Instructor
EMS Instructor
Other or outside sourced
Class Date:
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Location:
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Total Hours:
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1
Provide a detailed description of the training and describe any equipment, props or presentation materials used for the education. (Please be detailed as this section will be used for the Medical Director's sign-off on the class.)
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Attendee #1:
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Attendee #2:
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Attendee #3:
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Attendee #4:
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Attendee #5:
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Attendee #6:
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Attendee #7:
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Attendee #8:
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Attendee #9:
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Attendee #12:
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Attendee #14:
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Attendee #15:
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Attendee #16:
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Attendee #18:
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Attendee #19:
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Attendee #20:
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