Paramedical Program Approval Checklist
Name of School/Training Facility:_______________________________
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| Enclosed is documentation and or proof of the following program approval requirements. | Yes | No |
| 1. Properly completed application | | |
| 2. Application and yearly fees | | |
| 3A. Instructors resume | | |
| 3B. Copy of instructors licensure as a health care professional | | |
| 4. School/training facility brochure | | |
| 5. Course breakdown | | |
| 6. Course outline | | |
| 7A. Specific daily lesson plans including content and contact hours per theory session | | |
| 7B. Specific daily lesson plans including content and contact hours per lab session | | |
| 7C. Students provided with opportunity to achieve CPR (certification required) | | |
| 8. Pictures of facility and training area | | |
| 9. List of needed and available training equipment | | |
| 10. Entrance Exam | | |
| 11. Certificate of student malpractice insurance | | |
| 12. Grading, attendance and tardiness form(s) | | |
| 13. Copy of certificate of completion | | |
| 14A. Letter of health care requirements or form | | |
| 14B. HBV Immunization form and participant declination form | | |
| 15A. STUDENT HANDBOOK CONTAINING: | | |
| 15B. Guidelines for program admission | | |
| 15C. Rules on absences and tardiness | | |
| 15D. Dress Code | | |
| 15E. Program Objectives | | |
| 15F. Class overview of class competencies | | |
| 15G. Grading policy and minimum passing requirements | | |
| 15H. Withdrawal and refund policy | | |
| 16. Program is at least 40 hours in length | | |
| 17A. Program provides at least 2 EKG's per student to be performed in class | | |
| 17B. Program provides for 1 additional EKG to be mounted | | |
| 17C. EKG mounting designed to allow for proper labeling | | |
| 17D. EKG mounting designed to allow for instructor signature and dating | | |
| 18. A list of references and textbooks used in course preparation and training | | |
|
| DOCUMENTATION OF NECESSARY COMPETENCIES FOR EKG APPROVAL | | |
| 19. 5 Health histories completed in class training period | | |
| 20. Vital Signs | | |
| 21. Urinalysis | | |
| 22. Venipuncture - proper steps in collection | | |
| 23. Skin Puncture- proper steps in collection | | |
| 24A. Parts of the EKG machine | | |
| 24B. EKG paper calculations | | |
| 24C. Standardization | | |
| 24D. Marking Codes | | |
| 24E. Patient Preparation | | |
| 24F. Patient Dignity | | |
| 24G. Proper Lead Placement | | |
| 24H. Leads | | |
| 24I. EKG waves; relation to heart action | | |
| 24J. Common Artifacts | | |
| 24K. Cardiac Arrhythmias | | |
| 24L. Cardiac Blocks | | |
Comments:
Approved:_________________________Date:_________ | | |