Names: EFR Cert Expiry: CFR Cert no.: Expiry: PHECC Instructor or no.: instructor PIN: EA title: level: First Aid Response (FAR) course: Eligible faculty members are: FAR instructors, EFR Instructors or Educational Award (EA) Holders with valid CFR Community or Advanced instructor certificates. Names: Instructor or Cert Expiry: CFR Cert no.: Expiry: PHECC EA title: no.: instructor PIN: level: Emergency First Response (EFR) course: Tick as relevant to application Add on module for EFR-Medicinal Gas 50% Nitrous Tick as relevant to application oxide and 50% oxygen Eligible faculty members are: EFR or EFR-BTEC Instructors or Educational Award (EA) Holders with valid CFR Advanced instructor certificates. Names: Instructor or Cert Expiry: CFR instructor Expiry: PHECC EA title: no.: Advanced cert no.: PIN: Emergency First Response-Basic Tactical Emergency Care (EFR-BTEC) course: Eligible faculty members are: EFR-BTEC Instructors or Educational Award (EA) Holders with valid CFR Advanced instructor certificates. Names: Instructor or Cert no.: Expiry: CFR instructor Expiry: PHECC EA title: Advanced cert no.: PIN: EMS Call Taker and EMS Dispatcher course: Medical Advisor Name: Minimum faculty is: 4 Tutors including 1 facilitator and Contact Tel No: 1 Medical Advisor. EMS Call Taker and Dispatcher No. of hours available per week: Instructors can also be listed. Names: Educational Expiry: PHECC CFR instructor title Expiry: award or PIN: and instructor title: cert no.:
Names: EFR Instructor or EA title: Cert no.: Expiry: CFR instructor level: Cert no.: Expiry: PHECC PIN: First Aid Response (FAR) course: Eligible faculty members are: FAR instructors, EFR Instructors or Educational Award (EA) Holders with valid CFR Community or Advanced instructor certificates. Names: Instructor or EA title: Cert no.: Expiry: CFR instructor level: Cert no.: Expiry: PHECC PIN: Emergency First Response (EFR) course: Tick as relevant to application Add on module for EFR-Medicinal Gas 50% Nitrous oxide and 50% oxygen Tick as relevant to application Eligible faculty members are: EFR or EFR-BTEC Instructors or Educational Award (EA) Holders with valid CFR Advanced instructor certificates. Names: Instructor or EA title: Cert no.: Expiry: CFR instructor Advanced cert no.: Expiry: PHECC PIN: Emergency First Response-Basic Tactical Emergency Care (EFR-BTEC) course: Eligible faculty members are: EFR-BTEC Instructors or Educational Award (EA) Holders with valid CFR Advanced instructor certificates. Names: Instructor or EA title: Cert no.: Expiry: CFR instructor Advanced cert no.: Expiry: PHECC PIN: EMS Call Taker and EMS Dispatcher course: Minimum faculty is: 4 Tutors including 1 facilitator and 1 Medical Advisor. EMS Call Taker and Dispatcher Instructors can also be listed. Medical Advisor Name: Contact Tel No: No. of hours available per week: Names: Educational award or instructor title: Expiry: PHECC PIN: CFR instructor title and cert no.: Expiry:
FOR030_Named%20Faculty%20Form%20Responder%20Courses_V2.docx