Florida Training Academy
(An American Heart Association Training Site)
103 Century 21 Drive, Suite 102 Jacksonville, Florida 32216
Phone: 904-551-0918 Fax: 904-302-8055
www.FLtraining.com
INSTRUCTOR AGREEMENT FORM
This is an agreement between __________________, designated as a Basic
Life Support (BLS) Instructor and/or Heartsaver Instructor, and Florida
Training Academy, a contracted training site with the American Heart
Association (AHA). This agreement is valid from issue date of the AHA
Instructor card through the renewal date. The Instructor will conduct all BLS
courses to include: Instructor, Healthcare Provider, Heartsaver, Heartsaver
AED, Heartsaver CPR in Schools, Heartsaver First Aid, Heartsaver First with
CPR & AED, Heartsaver Pediatric First Aid, CPR for Family & Friends, and
Family & Friends First Aid for Children, in accordance with standards and
guidelines set forth by the AHA, using the following criteria:
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CRITERIA
Follow ALL of the most current AHA guidelines.
Maintain a copy of all rosters for classes taught for a period of three (3)
years prior to submitting rosters, course monitoring forms, and required
skills testing checklists to Florida Training Academy within 30 days of the
course date.
Conduct the class using the appropriate video/DVD with the practice
while watch (PWW) format.
Provide students access to the appropriate AHA manual before, during,
and after the class.
Issue appropriate documentation of completion/participation to each
student within 30 days of the class date.
Ensure all training will be done in an appropriate facility with all of the
necessary equipment present.
Maintain proper sanitary conditions on all supplies and equipment.
 Formally acknowledge that all fees for BLS training do not represent
revenue to the AHA.
PROBLEM SOLVING
Incomplete paperwork and classes taught improperly may result in the
following:
 Verbal communication to discuss problems.
 Written communication with possible suspension and/or warning of
termination.
 Possible termination of Instructor privileges with Florida Training
Academy.
This agreement is a one-year agreement and will terminate on and no later
than the date noted on this agreement. Florida Training Academy reserves
the right to terminate this agreement at anytime if Training Site policies
and/or AHA standards and guidelines are not met. Once Florida Training
Academy receives your first Course Roster with appropriate paperwork, if
you choose to transfer your records to another authorized AHA Training
Center or Training Site, a $25.00 Transfer of Records Fee will apply.
As an Instructor, I will adhere to the above criteria. I understand and agree
to follow all of the above criteria and non-compliance may result in
termination of this agreement.
______________________________
Instructor signature
Date
______________________________
TS Coordinator signature
Date
INSTRUCTOR INFORMATION
NAME___________________________________
MAILING ADDRESS________________________
_________________________
PHONE #1________________________________
PHONE #2________________________________
E-MAIL___________________________________
ORGANIZATION or BUSINESS YOU TEACH FOR:
________________________________________
YEAR YOU FIRST BECAME AN AHA INSTRUCTOR:
__________