AMERICAN HEART ASSOCIATION COURSE EVALUATION

HArts CPR

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* 1. Please complete the following:

Date of Course:

What course did you complete?

Length of class:

What book do you have?

Instructor(s):

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* 2. What CPR Components Were Included in Your Class? (Mark all that apply)

	Yes	No
Adult 1 Rescuer (2 rescuer)	Adult 1 Rescuer (2 rescuer) Yes	Adult 1 Rescuer (2 rescuer) No
Child 1 Rescuer (2 rescuer)	Child 1 Rescuer (2 rescuer) Yes	Child 1 Rescuer (2 rescuer) No
Infant 1 Rescuer (2 rescuer)	Infant 1 Rescuer (2 rescuer) Yes	Infant 1 Rescuer (2 rescuer) No
AED (Automated External Defibrillator)	AED (Automated External Defibrillator) Yes	AED (Automated External Defibrillator) No
Pocket Mask	Pocket Mask Yes	Pocket Mask No
Bag Valve Mask (BLS only)	Bag Valve Mask (BLS only) Yes	Bag Valve Mask (BLS only) No
Choking Emergencies	Choking Emergencies Yes	Choking Emergencies No

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* 3. What First Aid Components (if any) Were Included in Your Class?

	Yes	No
General Principles	General Principles Yes	General Principles No
Medical Emergencies	Medical Emergencies Yes	Medical Emergencies No
Injuries	Injuries Yes	Injuries No
Environmental	Environmental Yes	Environmental No

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* 4. Did your class include video mediated instruction?

Yes

No

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* 5. Did your class include a written examination?

Yes

No

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* 6. COURSE EVALUATION (1=Unacceptable, 3=Satisfactory, 5=Excellent

	1	2	3	4	5
Registration	Registration 1	Registration 2	Registration 3	Registration 4	Registration 5
Class Presentation	Class Presentation 1	Class Presentation 2	Class Presentation 3	Class Presentation 4	Class Presentation 5
Instructor	Instructor 1	Instructor 2	Instructor 3	Instructor 4	Instructor 5
Hands-On Skills	Hands-On Skills 1	Hands-On Skills 2	Hands-On Skills 3	Hands-On Skills 4	Hands-On Skills 5
Class Atmosphere	Class Atmosphere 1	Class Atmosphere 2	Class Atmosphere 3	Class Atmosphere 4	Class Atmosphere 5
Class Length	Class Length 1	Class Length 2	Class Length 3	Class Length 4	Class Length 5

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* 7. What was your overall impression of the course?

This form is kept confidential, however, if you have any concerns regarding the way in which this course was conducted,

please do not hesitate to contact us at the number listed below. THANK YOU!

650 Lindsey Rd., Golden, CO 80401
303.918.8077 www.cpr-professionals.com