PROCEDURAL GUIDELINES MANUAL
2012
EDUCATOR HANDBOOK
EXTENDLIFE, INC.
AHA REGIONAL TRAINING CENTER
PROCEDURAL GUIDELINES MANUAL
LAST REVISION: OCTOBER 2011
© COPYRIGHT EXTENDLIFE 2012
The contents of this document are an overview of the procedures by which
all instructors affiliated with Extendlife Training Systems (TC) must comply
when coordinating or conducting American Heart Association® courses.
CONTENTS
 Terminology…………………………………………….. 2
 Pre course registration and Documentation……… 3
 Course Rosters………………………………………… 3
 Course Evaluations…………………………………… 5
 Renewal Course Students…………………………… 5
 Course Card Issuance and Processing Fees….…. 5
 Potential Instructor Candidates…………………….. 7
 AHA Instructor Courses……………………………… 8
 Monitoring Process/Initial Certification…………… 8
 Instructor Renewal……………………………………. 9
 ACLS/PALS Provider Course Guidelines………… 10
 ACLS/PALS Course Compliance………………… .. 11
 Equipment Availability………………………………. 12
 ECC Materials…………………………………………. 13
 AHA Resources……………………………………….. 14
 Good Samaritan Act.…………………………….…… 16
 Sample Disclaimer……………………….…………… 17
 Printing MASTERS……………………….…………… 18
 Forms…………………………………………………… 22
© COPYRIGHT EXTENDLIFE 2012
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PLEASE REVIEW THIS MATERIAL AND RETAIN FOR YOUR RECORDS
It is the intent of this document to accurately define the responsibilities of the
instructor/coordinator, ensuring consistency and continuity within the program. NOTE: It
is the responsibility of the instructor to thoroughly review the information and comply
with the Guidelines as outlined.
This document replaces all Procedures and Guidelines issued prior to December 1, 2008.
AHA Mandate:
Smoking is strictly prohibited during all AHA ECC programs.
Acknowledge the AHA compensation disclaimer relative to courses whereby
attendees pay a fee.
I.
Terminology
1. AHA= American Heart Association
2. ACLS = Advanced Cardiac Life Support
3. ARC = American Red Cross
4. BLS = Basic Life Support
5. ECC = Emergency Cardiovascular Care
6. FA = First Aid
7. HCP = Healthcare Provider
8. HS = Heartsaver
9. TC = Training Center
10. TCF = Training Center Faculty
11. TS = Training Site
12. PALS = Pediatric Advanced Life Support
13. RF = Regional Faculty
14. NF = National Faculty
15. REC = Regional Education Center
16. NTA = National Training Authority
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II.
Pre Course Registration and Documentation
A. Basic Life Support (BLS) Courses:
Community or public BLS courses are scheduled exclusively by the TC. Any
offering of BLS courses to the general public must be approved in advance by the
TC. Extendlife receives daily inquiries regarding available courses, so we must be
aware of all such courses. Certifications will not be issued for public classes
conducted without prior approval of the TC
B. Heartsaver (HS) First Aid (FA) Courses:
Community or public HS FA courses are scheduled exclusively by the TC. Any
offering of HS FA courses to the general public must be approved in advance by
the TC. Extendlife receives daily inquiries regarding available courses, so we must
be aware of all such courses. Certifications will not be issued for public classes
conducted without prior approval of the TC
C. Advanced Cardiac Life Support/Pediatric Advanced Life Support (ACLS/PALS)
Courses:
Pre-Course registration documentation is required for these courses. Pre-course
agreements must be on file in accordance with course policies prior to the start of
the course. ONLY Training Center Faculty (TCF) or ACLS/PALS Instructors are
permitted to conduct a class. Assisting instructors are permitted to aid in
conducting the courses strictly as adjunct instructors only. The Course Director
and/or Lead Instructor are responsible for the entire course and must be in
attendance for the entirety of the course. Directors must be AHA ACLS/PALS
Physician Instructors or a TCF/Lead who has direct communications contact with
the Course Medical Director.
A copy of the Course Agenda and the Pre-Course Agreement form must be
forwarded to the TC Office at least five (5) business days prior to the course date.
III.
Course Rosters
Attached is a Master Course Roster which is to be utilized for all disciplines.
Rosters must be complete, accurate, and legible. Use a separate roster for each
class. Be thorough and fill in all blanks. AHA requires accurate and complete
forms. If there is not sufficient room, use a second roster.
Student-to-Instructor ratio is 8:1. More than 8 students require an additional instructor.
The lead instructor is responsible for the accuracy of all roster information,
including student names. If a certification card contains typographical errors due
to inaccurate or illegible entries on the roster or the accompanying list of typed
names, there will be a charge for replacement. If the error is on the part of the TC,
there will be no charge for replacement.
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Rosters MUST accurately contain:
Course Date
Course Discipline
Lead Instructor Signature
Location
Instructor Primary TC
Written Exam Scores
Number of Students Instructor Contact Info
Student ID Number
Incomplete documents, erroneous entries, and omissions will result in the documents
being returned to the Lead Instructor for correction. COURSE COMPLETION CARDS
WILL NOT BE ISSUED UNTIL ALL DOCUMENTATION IS APPROPRIATELY SUBMITTED.
Submit the ORIGINAL roster to the TC office for processing. All required documents are
to be submitted to the TC office within ten (10) business days from the date of the
course. By special arrangement, select TS managers are permitted to waive the ten (10)
day requirement in lieu of a monthly submission. Per the AHA, Instructor credit for
conducting the class will not be granted nor will Course Completion Cards be issued for
late roster submissions. Additionally, Course Evaluations must be submitted for each
class conducted. Where applicable, payment must be submitted with Course Rosters.
MAKE CHECKS PAYABLE TO EXTENDLIFE, INC.
REMINDER: For future reference, maintain copies of all pertinent documentation.
Should a Lead Instructor find the need to submit additional information to a previously
submitted form, this procedure must be followed:
Submit a copy with the addition information included
Submit a written explanation as to the necessity of the modification
EXAMPLE: A student’s name inadvertently was omitted from the original roster, the Lead
Instructor MUST submit:
A copy of the modified Roster indicating the omitted student’s name
A letter verifying student participation and successful Course completion
NOTE: Be prepared to submit all additional required documentation if requested.
AHA Manuals must be made available to ALL students for ALL courses conducted under
AHA Guidelines. AHA Manuals and support materials are available on the EXTENDLIFE
website at www.extendlife.net . Appropriate AHA textbooks for individual use must be
available BEFORE, DURING, and AFTER the intended course. However, an employer or
school may fulfill this requirement by storing the books on-site, as in a “library”, for
access by participants at all times.
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IV.
COURSE EVALUATIONS
Attached is a master Course/Educator Evaluation form. AHA requires ALL courses be
evaluated in writing by the participating student. While ALL students must receive a
form, it is not mandatory they be completed by the student. Lead Instructors should
encourage students to “Rate the Course” for the purpose of Quality Control. It is the
responsibility of the Lead Instructor to submit ALL evaluations with required Course
documentation.
V.
RENEWAL COURSE STUDENTS
Students holding VALID CURRENT BLS/ACLS/PALS provider cards may attend AHA
Renewal Courses in lieu of attending the full Provider Course. The student must provide
proof of current status prior to admission to a Renewal Course. Expired AHA cards
require the student to attend the complete initial Provider Course. There is no longer a
grace period. This policy applies to ALL AHA disciplines.
VI.
CREDENTIAL CARD ISSUANCE and PROCESSING FEES
AHA maintains each student successfully completing an AHA ECC course MUST be
issued the appropriate course completion card bearing the AHA logo. Cards are valid for
two (2) years. A Fee Schedule is attached for all EXTENDLIFE TC materials and services.
Payment for card processing must accompany required course document submission,
unless specific billing arrangements have made in advance. EXTENDLIFE accepts cash,
checks, money orders, and major credit cards. Please DO NOT send cash in the mail.
Lead Instructor will submit one payment (personal or business check) for the total
number of students in attendance with the required Course documents. All AHA Course
cards will be mailed to the Instructor at the address indicated on the Roster within 30
days of the receipt of required Course documents. It is the responsibility of the
designated course instructor to distribute cards to the attendees.
NOTE: Candidates for the AHA Healthcare Provider Course include, but are not limited
to, healthcare professionals, public safety officers, or any professional whose job or
profession requires the level of training within the Healthcare Provider curriculum to
maintain licensure, certification, or to satisfy professional qualification standards.
AHA provides additional courses to serve the needs of the community.
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AHA Course Card Processing Fees
STANDARD
RATE
CARD
GOVERNMENT
RATE
BLS Heartsaver CPR
$ 10.00
$5.00
BLS Heartsaver AED
10.00
5.00
BLS Heartsaver First Aid
10.00
5.00
BLS Healthcare Provider
10.00
5.00
BLS Instructor
25.00*
25.00*
ACLS Provider
12.00
10.00
ACLS-EP Provider
12.00
10.00
ACLS Instructor
12.00
10.00
PALS Provider
12.00
10.00
PALS Instructor
12.00
10.00
PRICES SUBJECT TO CHANGE WITHOUT NOTICE
Course completion cards are the property of the American Heart Association and are
under the control of EXTENDLIFE Training Systems. All cards are processed through the
TC unless other prior arrangements have been made. Instructors are not permitted to
order cards directly from AHA authorized vendors. Emergency replacement cards are
available at a nominal Replacement Fee. Lost, damaged, or otherwise replaceable cards
are re-issued only after proof of original issuance is verified by TC records. Copies of
cards issued by EXTENDLIFE are maintained for a period of three (3) years from the date
of issuance.
* Includes AHA Instructor Roster Tool Kit for the electronic transmission of course
documents.
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VII.
Instructor Candidates
A. Basic Life Support (BLS) Instructor
It is the policy of EXTENDLIFE Training Systems to accept and train “in-house”
candidates only. The TC DOES NOT train instructors for service outside of the
company.
Qualifications for admission to an AHA BLS Instructor Course include, but are not
limited to, the possession of a current valid Healthcare Provider card, the submission
of an Instructor Application, a minimum of 3 years experience as a Healthcare
Professional and/or teaching experience, the successful completion of an oral
interview, and acknowledge receipt of all EXTENDLIFE and AHA Guidelines and
Procedures.
After successful completion of the AHA Core Instructor course, the BLS Instructor
Course, and/or any additional ancillary AHA update training; the candidate must
submit a written recommendation from the Lead Instructor(s) of the aforementioned
courses.
American Red Cross Reciprocity - The AHA recognizes content-equivalent ARC
Provider Courses as prerequisites for AHA Provider renewal courses. ARC
Instructors desiring to become an AHA BLS Instructor must present a valid current
ARC Instructor Card and documentation verifying at least one course conducted as
and ARC Instructor. To receive designation as an AHA BLS Instructor, the ARC
candidate must:
1.
2.
3.
4.
5.
receive acceptance by letter to an AHA TC
successfully complete the AHA Core Instructor Course
acknowledge the TC Guidelines and Procedures
successfully demonstrate skills performance
successfully conduct a “monitored” AHA Provider Course
After full documented compliance with the above steps, at the will of the TC, an AHA BLS
Instructor Credential will be issued.
B.
ACLS and PALS Instructors
Current ACLS and PALS providers must submit a letter of recommendation from
an AHA Training Center Faculty (TCF), Regional Faculty (RF), of National Faculty
(NF) to qualify for an ACLS or PALS Instructor Course.
C.
Training Center Faculty (TCF) BLS/ACLS/PALS
Training Center Faculty (TCF) positions are appointed by the TC Coordinator in
cooperation with Training Site (TS) representatives.
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VIII. AHA Instructor Courses
AHA Instructor courses are for the benefit of the TC. They are conducted exclusively
by Extendlife and are available to TC affiliate sites or candidate staff and faculty
ONLY. There are no exceptions to this corporate policy.
IX.
Monitoring Process/Initial Certification
The AHA Instructor Course procedure requires, for all disciplines, the following:


Successful completion of the Core Instructor Course and the discipline
appropriate Instructor Course
Successful monitoring by appropriate representative of AHA
Should the Instructor candidate not be adequately prepared or fails to demonstrate a
competent performance during the initial monitoring process, the candidate must be
re-monitored prior to receiving full Instructor status.
The monitoring process will be reviewed within the Instructor Course enabling the
candidate to fully understand what is expected during the actual monitored course.
It is the responsibility of the Instructor Candidate to make certain he/she is monitored
by the TC within 90 days of completing course training. TC office staff will assist in
scheduling a class for candidate monitoring. TC office can be reached for this
purpose at 423 698-4900 ext. 1 or info@extendlife.net .
Training Center general information will be provided candidates. EXTENDLIFE is the
Primary TC for the Instructor. Instructors may instruct for other Training Centers, but
for reasons of competition, they must receive approval from EXTENDLIFE before
doing so. Instructors have the right to change Training Centers if they so choose,
however, Training Center Transfer documentation must be processed as prescribed in
the AHA Program Administration Manual.
NOTE: A TC may refuse to accept an Instructor without cause.
After two unsuccessful monitoring opportunities, it is recommended the Instructor
Candidate repeat the Instructor Course and attempt the monitoring at a later date
Areas of focus during the monitor session include:
Delivery of lecture-style information
Management of teaching station
Management of practical evaluation station
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Upon satisfactory performance review of the candidate, the evaluator complete the
Monitor form and review it with the candidate at the conclusion of the class in the
absence of the course attendees. The candidate is then upgraded to INSTRUCTOR.
The instructor should maintain copies of the evaluation and the course roster for their
personal records. The Lead Instructor is required to submit a copy of the evaluation
to the TC office with the Course Roster and required post-course documents.
Upon receipt of ALL required documentation, affiliation forms, and necessary fees,
the Instructor will be issued the appropriate AHA Instructor Card.
Instructor Cards are issued by the TC ONLY. Training Site are not permitted to
process or issue AHA Instructor Credentials.
Approved AHA Monitoring representatives:
Current Training Center Faculty, Regional Faculty, or National Faculty within their
specific discipline. Should the representative not be affiliated with EXTENDLIFE,
they must submit front and back copies of their current discipline specific AHA
Faculty Card with the monitoring form.
X.
Instructor Renewal
Instructor cards (all disciplines) are valid for two (2) years from the date of issue. The
recommended renewal date is indicated on the card. To maintain automatic renewal,
instructors must attend all AHA and TC Instructor Updates, teach a minimum of four
(4) classes per discipline within the two-year term of their Instructor credential, and be
monitored at least once annually. There is NO GRACE PERIOD! Based on a case-bycase basis, Regional Faculty or National Faculty can waive the NO GRACE PERIOD
policy. Should the Instructor desire a Provider Level credential (card) a separate
request must be made and any applicable fees paid. Provider cards will NOT be
automatically renewed or issued.
In the event an Instructor has an outstanding balance with the TC, the processing of
any current or future cards will be suspended pending the instructor’s account being
bought up to date in full.
TC reserves the right to contact other AHA Training Centers regarding individual
instructor’s outstanding balances, complaints, and/or non-compliance issues,
transfers, or other related AHA matters. The TC and the AHA Regional Office have the
right to deny re-certification or to de-certify as deemed appropriate.
TC will maintain current records and regularly communicate with all instructors
regarding AHA programs, course delivery, and instructor status issues. It is the sole
responsibility of the instructor to submit in a timely fashion, all required course
documentation so as to insure proper TC record maintenance. It is strongly
recommended instructors maintain copies of all submitted documentation for their
personal record.
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XI.
ACLS/PALS Provider Course Guidelines
The American Heart Association maintains standards and instructional guidelines for
Advanced Cardiac Life Support (ACLS) and Pediatric Advanced Life Support (PALS)
Courses. A majority of professional associations and governmental agencies accept
these guidelines. It is the goal of the AHA to continue to update the standards
enabling those organizations to integrate those standards within their various
programs.
EXTENDLIFE Training Systems has established the following guidelines for Advance
Life Support Courses:
1.
A course agenda must be submitted or on file thirty (30) days prior to the
course start date.
The Course Medical Director must be a physician ACLS and/or PALS
Instructor or an appointed TCF Director who has direct contact with a
physician instructor at all times during the Course. It is recommended 50%
of the instructional staff be current ACLS and/or PALS Instructors. All
members of the faculty be proficient in their specific skills area and also be
effective educators in the scientific areas of instruction. The Lead
Instructor must be a Training Center Faculty member or Regional Faculty in
the specific discipline and be in attendance for the entire course.
2.
Distribution of equipment, registering of participants, assigning faculty, and
providing access to required manuals and materials is the responsibility of
the TC.
3.
Eligible participants must be emergency, intensive care, and critical care
healthcare providers (physicians, nurses, emergency medical technicians,
paramedics, respiratory therapists, dental surgeons, and other professionals
who made need to respond to a cardiovascular emergency).
4.
Registrants must be proficient in ECG rhythm recognition, pharmacology,
and BLS skills.
5.
It is strongly recommended pre-course materials be made available 30 days,
no less that 15 days, in advance of the course start date.
6.
It is the responsibility of the Course Director to ensure core objectives are
met within the Course and the students are provided with an in-depth review
of ACLS cases 1 – 10. Additionally, appropriate audio visuals will be utilized
in conjunction with scenario based style instruction. Lecturing at a
minimum…hands on at a maximum.
7.
Successful completion is achieved when the student manages the first 10
minutes of a witnessed adult ventricular fibrillation cardiac arrest. The
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Course coordinator will ensure “reasonable remediation” is provided for
those
students experiencing difficulty correctly answering questions or
accurately
completing scenarios. AHA requires all participants successfully
pass the
Automated External Defibrillator (AED) station.
8.
XII.
Any deviation or modification of the aforementioned Advanced Life Support
guidelines must be approved by the TC office and the participating Regional
Faculty representative(s).
ACLS/PALS Provider Course Compliance Process
To ensure AHA approval for ACLS/PALS Courses, the following criteria must be met:
A.
Pre-Course TC Registration - A written course agenda must be submitted or
on file with the TC Office thirty (30) days prior to the course start date. This
document must be signed by the course director, indicating the exact
date(s), location, and contact person for the Course.
B.
Course Documentation – The following documents must be submitted to the
TC Office no later than thirty (30) days following the completion of the
course:
Course Roster
Written Evaluation Scores
Practical Evaluation Forms
Course Summary
C.
Course Director – The Course Director may be a physician (Course Medical
Director) who is a discipline specific instructor or a non-physician who is
recognized by the AHA as an ACLS/PALS Instructor and is an appointed
TCF Director of ACLS/PALS. Should the Course Director be a TC Faculty, a
Course Medical Director must be available by electronic communication
for the entire Course to address any questions, if needed.
It is recommended physician instructors and AHA ACLS/PALS Regional
Faculty be involved in the planning and delivery of ACLS/PALS Courses,
however, is not required.
C.
Lead Instructor – Lead Instructors must be a Training Center Faculty (TCF)
member and are required to be present the duration of the entire Course.
The Lead Instructor is responsible for the integrity of the class and of the
ability of the Assisting Instructors to effectively support the Course. All
questions and concerns are to be addressed to the Lead Instructor.
Questions or concerns beyond the scope of the Lead Instructor’s expertise
will be addressed by the Course Medical Director as soon as is practical.
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D.
Course Completion Cards – Course Completion Cards will be issued and
distributed by the Training Center office. Lead Instructors are required to
complete the post course documentation and submit them within 30 days or
less of the Course completion date. Course Completion Cards will be
processed and returned to the designee as indicated on the Course Roster.
In the case of pre-registered/pre-paid Courses, cards can be processed in
advance and issued immediately by the Lead Instructor upon successful
completion of the Course.
E.
Test Questions – The AHA will be the repository of the written evaluations.
The TC is responsible for the security and integrity of the exams. Individual
Instructors are not permitted to develop and utilize their own written tests.
AHA exams must be collected and accurately accounted for at each test
sight. Instructors are responsible for securing AHA tests to avoid
unauthorized distribution.
XIII. Equipment Availability
EXTENDLIFE Training Systems is required by the AHA to make available the necessary
training equipment for use by TC Instructors. While we warehouse an ample supply of
manikins, AED Trainers, Oxygen systems, ALS equipment, AV Equipment, and AHA
support materials, the very nature of business demands that the majority of that
equipment is committed for classes scheduled or a pending scheduling. Fortunately,
most of our Training Sites maintain their own equipment. By scheduling all classes
through the TC office, the need for equipment is scheduled as the course is booked,
thereby negating the need for “borrowing” equipment. However, should the need arise
training equipment is available for instructor use on an in-house training basis.
It is EXTENDLIFE’S policy to cooperate with other AHA Training Centers in the Region by
“loaning” equipment as needed on an “available only” basis. This is a reciprocal
arrangement whereby Extendlife can “borrow” equipment from the various Centers in the
Region.
EXTENDLIFE pride’s itself on the condition and sanitation of our equipment. When using
TC equipment, instructors are personally responsible for the care, maintenance, and
sanitation of all equipment. Immediately report any equipment damage, malfunction, or
loss to the TC office.
For further inquiries regarding the use of TC training equipment, contact the TC Office.
TC equipment is maintained and housed at the Chattanooga Regional Education Center.
Textbooks for individual classes must be purchased from the EXTENDLIFE website.
www.extendlife.net select Books & Videos, or from an Authorized AHA vendor. The TC
does not provide books or manuals for classes nor does it maintain a stock of books for
retail sales.
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A.
Manikin Decontamination Policy
All equipment used in the delivery of instruction shall be maintained and
decontaminated in a suitable fashion which is in accordance with the guidelines
set forth by the American Heart Association® and approved by OSHA and the
CDC.
Equipment will be decontaminated before and after class to insure proper
sanitization. If commercially approved solutions are not available, a mixture of one
part chlorine bleach to ten parts water is acceptable. Use caution when allowing
students to make contact with recently cleaned surfaces. Some students may
experience allergic reaction or skin irritation from contact with residual
chemicals.
Any instructor using manikins, barrier devices, AEDs, or other teaching adjuncts,
shall clean all surfaces and internal areas of the equipment with an approved
sanitizing solution. Decontamination of all equipment must be completed at the
conclusion of each course, also, to reduce the risk of cross contamination.
Documentation of TC approved policy for decontamination shall be maintained
by each instructor. Upon signing completed post-course documentation, the Lead
Instructor assumes all liability associated with any further action which could
result from variations of this policy regardless of equipment ownership.
It is strongly recommended manikin practice shields or similar devices be used to
augment sanitation procedures.
TRAINING TIP: Under supervision of the Instructor, students may assist in
sanitizing manikins at the conclusion of manikin practice. This not only saves time
for the instructor; it serves as an excellent public relations tool. The student now
has firsthand knowledge the equipment has been thoroughly sanitized!!
XIV. ECC Materials
The Extendlife website identified above is an excellent source for students and TC
instructors. One of the feature pages – BOOKS and VIDEOS – allows the student to
purchase appropriate AHA textbooks well in advance of scheduled classes, thus
enabling them to preview course subject matter.
An additional source for procuring AHA textbooks and additional AHA materials is by
direct contact with the three (3) authorized AHA vendors. These select companies
provide the highest quality of customer service and support.
Orders cam be made with these vendors through direct phone sales, FAX orders, or web
orders and can be placed at the following locations:
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Channing L. Bete Co. Inc.
One Community Place
South Deerfield, MA 01373
1-800-611-6083
1-800-499-6464 FAX
Laerdal Medical Group
167 Myers Corners Rd
Wappingers Falls, NY 12590
1-888-562-4242
1-800-227-1143 FAX
WorldPoint ECC
1326 S. Wolf RD
Wheeling, IL 60090
1-888-322-8350
1-888-281-2627 FAX
aha.channing-bete.com
laerdal.com
eworldpoint.com
XV. AHA Information Resources
ECC Directors
Southeast Territory Director
Eastern District Director
678 385-2023
518 869-4045
Electronic Resources
The following electronic resources are available to the ECC Training
Network:
Resource
Description
Available to all TS’s and Instructors
Provides up-to-date and reference
Information on ECC programs and
ahainstructornetwrok.org
science
Requires password for access
 Periodically offers surveys and
electronic submission of reports
American Heart Association
Instructor Network (AHA IN)
AHA Learning website:
Provides the ECC online courses
www.onlineeaha.org
AHA website:
americanheart.org
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Provides general information about
AHA program and services
Offers students the ability to search for
ECC courses in a specific or ZIP Code
15
Telecommunications
TCs can contact the AHA ECC Customer Support Center at 888-CPR-LINE in
the United States for all TC-related inquiries. For international calls, phone
214 706-1232.
AHA Phone Numbers
AHA Toll-Free Numbers
800 – AHA – USA1
888 – MY – HEART
888 – 4 – STROKE
877 – AHA – 4CPR
Available Resources
Answers to general inquiries, requests
for educational materials,
Registration for Heart Walks, etc
Information regarding the Women’s
Campaign, i.e., Choose to Move, Take
Wellness to Heart, Walking for
Wellness
Answers to Stroke inquiries and
general educational materials for
stroke survivors and caregivers
Answers to requests for locations of
CPR courses
Print Communications
Currents in Emergency Cardiovascular Care is a quarterly
newsletter published by the Citizen CPR Foundation, Inc and
financially supported by the AHA. Currents provides information on
recent developments in emergency healthcare services. It is
available free on the Internet. The AHA strongly encourages TCs
and Instructors to read Currents to stay updated on useful
information from the National Subcommittees and other ECC
professionals.
To register to receive Currents, visit the AHA Instructor Network to subscribe to the
electronic version. PRINT VERSION NO LONGER AVAILABLE.
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XVI. Good Samaritan Act
Most states have Good Samaritan Statutes for the protection of rescuers; however, the
law varies from state to state. EXTENDLIFE is a multi-regional training center whose
geographic territory encompasses several states. It is therefore strongly recommended
TC instructors refer to the statutes for the particular state(s) in which they will serve and
thus become familiar with the specific law in that jurisdiction. Below is the statute for
the State of Tennessee which is displayed as an example of the law. EXTENDLIFE is a
Tennessee corporation.
Tennessee Good Samaritan Act
63-6-218.
"Good Samaritan Law."
(a) This section shall be known and cited as the "Good Samaritan Law."
(b) Any person, including those licensed to practice medicine and surgery and including any person licensed or
certified to render service ancillary thereto, or any member of a volunteer first aid, rescue or emergency squad
which provides emergency public first aid and rescue services, who in good faith:
(1) Renders emergency care at the scene of an accident, medical emergency and/or disaster, while en route
from such scene to a medical facility and while assisting medical personnel at the receiving medical facility, to
the victim or victims thereof without making any direct charge therefore; or
(2) Participates or assists in rendering emergency care to persons attending or participating in performances,
exhibitions, banquets, sporting events, religious or other gatherings open to the general public, with or without
an admission charge, whether or not such emergency care is made available as a service, planned in advance
by the promoter of the event and/or any other person or association, shall not be liable to such victims or
persons receiving emergency care for any civil damages as a result of any act or omission by such person in
rendering the emergency care, or as a result of any act or failure to act to provide or arrange for further medical
treatment or care for the injured person, except such damages as may result from the gross negligence of the
person rendering such emergency care.
(c) A receiving medical facility shall not be liable for any civil damages as a result of any act or omission on the
part of any member of a volunteer first aid, rescue or emergency squad, which provides emergency public first
aid and rescue services, while such person is assisting medical personnel at the receiving medical facility.
(d) If:
(1) A volunteer fire squad is organized by a private company for the protection of the plant and grounds of such
company;
(2) Such squad is willing to respond and does respond to calls to provide fire protection for residents living within
a six (6) mile radius of the county surrounding such plant; and
(3) The plant is located in a county which does not otherwise provide fire protection to such residents; then the
members of such volunteer fire squad, while providing fire protection within such area outside the plant, shall be
liable to suit under the provisions of the Governmental Tort Liability Act, compiled in title 29, chapter 20, part 2.
[Acts 1963, ch. 46, §§ 1, 2; 1976, ch. 551, § 1; T.C.A., § 63-622; Acts 1985, ch. 338, §§ 1-4; 1994, ch. 556, §
1.]
© COPYRIGHT EXTENDLIFE 2012
17
AHA requires you to include the following disclaimer in any
announcements or advertising related to a class in which the
participants pay a fee.
American Heart Association® Disclaimer
The American Heart Association® promotes knowledge and
proficiency in BLS, ACLS, PALS, and First Aid and has
developed instructional materials for this purpose.
Use of these materials in an educational course does not
represent course sponsorship by the AHA and any fees
charged for such a course does not represent income to the
Association.
© COPYRIGHT EXTENDLIFE 2012
18
Printing
MASTERS
© COPYRIGHT EXTENDLIFE 2012
19
COURSE SUMMARY and VERIFICATION REPORT
Report Date:
Course Date & Time:
Client:
Course Location:
Lead Instructor:
Course Title:
Time In:
Time Out
Total Time
No. Participants:
Additional Instructors (If applicable):
______________________________________________________________________
Comments: ___________________________________________________________
OVERALL ASSESSMENT OF TRAINING SITE
EXCELLENT
SATISFACTORY
UNSATISFACTORY
This document verifies that the entire attached course roster of participants successfully completed the
written and practical evaluations prescribed by the appropriate training agency and is therefore entitled
to receive course completion credentials. Additional support documentation is on file with the lead
instructor and/or ExtendLife Training Systems and will be maintained for a period of no less than three
years from the date of the course and is available for inspection upon request.
I attest the above information is true and correct to the best of my knowledge.
Reviewer _________________
__________________________________
Lead Instructor Signature
Date _____________________
© COPYRIGHT EXTENDLIFE 2012
20
ACLS / PALS
Pre Course Agreement
ACLS Provider Course ____
PALS Provider Course ____
Course Site: _____________________________________________
Address: ________________________________________________
Course Dates: ____________________________________________
Course Times: ____________________________________________
Course Medical Director: ___________________________________
Course Director: __________________________________________
Course Lead Instructor: ____________________________________
Phone: _______________
__________________
Address: ________________________________________________
Email ___________________________________________________
DATE; _____________
____________________________
Signature
© COPYRIGHT EXTENDLIFE 2012
21
ACLS / PALS Course Summary
ACLS Provider Course _____
PALS Provider Course _____
Course Director Data:
Name: ____________________________________________________
Address: _________________________________________________
_________________________________________________
Phone: _________________
___________________
Course Dates: ____________________________________________
Course Site Location: ______________________________________
(Institution Name)
_________________________________________________________
_________________________________________________________
I verify this course was conducted under the standards as set by the
American Heart Association.
Course Director Signature: __________________________________
Enclose this form with all required post course documents and forward to
EXTENDLIFE Corporate Offices within 3 business days of the course conclusion.
Extendlife
209 BROOKWOOD DR
Chattanooga, TN 37411-1804
© COPYRIGHT EXTENDLIFE 2012
22
ACLS Renewal Course
Sample Agenda
Regional Education Center
209 Brookwood Drive
Chattanooga, TN 37411
7:45 am – 8:00 am
Registration
8:00 am – 8:15 am
Welcome - Introductions
8:15 am – 8:45 am
CPR-AED Skills Evaluation
Staff
8:45 am – 9:15 am
Oxygen Therapy Review
Stan Chambers
9:15 am – 9:45 am
Mega Code Review
Mike Nentwig
9:45 am – 10:00 am
BREAK
10:00 am – 10:30 am
10:30 am – 11:15 am
ECG Review
ACLS Core Drug Review
Cutcher/Carter
Joan Cutcher
Wayne Young
11:15 am – 12:15 pm
LUNCH
12:15 pm – 1:15 pm
Mega Code Evaluation
Staff
1:15 pm – 2:15 pm
Written Evaluation
Proctor Staff
2:15 pm – 2:45 pm
Questions & Answers
Staff
2:45 pm – 3:00 pm
Credential Presentation
3:00 pm
DISMISSAL
STAFF
Jim Cutcher BS EMT-P Regional Faculty
Bill Carter Exec. Admn. Regional Faculty
Wayne Young AS EMT-P EMS Instructor
Allen Sherwood, MD
© COPYRIGHT EXTENDLIFE 2012
23
Joan Cutcher BSN ACLS Instructor
Stan Chambers RN ACLS Instructor
Mike Nentwig RN ACLS Instructor
Medical Director
FORMS
THE FOLLOWING FORMS AND DOCUMENTS ARE TO BE SIGNED, DATED, AND
RETURNED TO:
EXTENDLIFE
ADMINISTRATION
209 BROOKWOOD DRIVE
CHATTANOOGA, TN 37411-1804
NOTE
IF YOU HAVE PREVIOUSLY SUBMITTED ANY OF THE FORMS
CONTAINED IN THE FORMS SECTION, IT WILL NOT BE NECESSARY
TO SUBMIT THE AGAIN.
RETAIN COPIES FOR YOUR RECORDS
© COPYRIGHT EXTENDLIFE 2012
24
Administrative Decontamination Policy
All equipment used in the delivery of instruction shall be maintained and decontaminated in
accordance with the guidelines set forth by the American Heart Association ®, the product
manufacturer and approved by OSHA and the CDC.
Any instructor(s) utilizing manikins, barrier devices, AED’s, or other teaching adjuncts, shall
clean all surfaces and internal areas of said equipment with an approved cleaning solution
(sanitizer). Decontamination of all equipment shall be completed at the conclusion of each
course, so as to reduce the risk of cross contamination.
Documentation of TC approved policy for decontamination shall be maintained by each
instructor. Upon signing completed post course documents for processing, the lead
instructor(s) assumes all liability associated with any further action resulting from deviation of
this policy, regardless of equipment ownership.
Upon agreement of this policy, sign below and maintain a copy for your files.
Signature
Date
SIGN AND RETURN COPY
Rev. 11/01/2009
© COPYRIGHT EXTENDLIFE 2012
25
PROHIBITED ACTIVITIES (STANDARDS OF CONDUCT)
Extendlife, Inc wishes to create a work environment that promotes job satisfaction, respect, responsibility, and
value for all of our employees, clients, customers and other stakeholders. Every employee at Extendlife, Inc. has a
shared responsibility toward improving the quality of the work environment. By agreeing to work at Extendlife,
Inc., you have agreed to follow the company’s rules and to refrain from conduct which is detrimental to our goals.
The prohibited conduct that is listed below is not an inclusive list, as the company cannot, with foresight,
determine what inappropriate conduct under every circumstance is. Moreover, the company does not limit its right
to discipline or discharge employees to the prohibited conduct listed below. Remember that, while we value our
employees, the company maintains the right to terminate its employees at any time and for any reason, with or
without notice.
Violation of the prohibited conduct set forth below, or any other conduct deemed inappropriate by management,
may subject you to disciplinary action, including oral or written warnings, suspension without pay, transfer or
possible termination. If you have any questions about your personal conduct or that of any fellow employee,
immediately consult your supervisor for clarification.
The following list contains examples of conduct considered improper which may result in discipline, including
termination. Again, note this is not a complete list and understand that other behaviors may also result in
discipline.
1.
Possessing, using, selling, negotiating the sale of, or being under the influence of alcohol, drugs or other
controlled substances during working hours, on company property (including company vehicles), in
company uniform or on company business.
2.
Falsification of the hours worked by you or any other employee.
3.
Falsification of any other employment related document including, but not limited to, personnel files,
employment review documents, intra-company communication, communications with those outside the
company, expense records, etc.
4.
Theft or destruction of company property or that of visitors, clients or fellow employees.
5.
Possession of potentially hazardous or dangerous property, such as firearms, weapons, chemicals, etc.,
without prior authorization.
6.
Fighting with, or harassment of, any fellow employee or customer.
7.
Unauthorized or excessive use of company property or property of any visitors, customers, fellow
employees, including but not limited to, vehicles, supplies, telephones, mail and computers.
8.
Disclosure of company trade secrets or any other confidential or proprietary information of the company,
its customers or fellow employees.
9.
Insubordination, including but not limited to, refusal to perform a requested or required job task.
10.
Failure to follow, or general neglect of, safety rules and procedures.
11.
Excessive tardiness or absences.
12.
Smoking in non-designated areas.
CONTINUED
© COPYRIGHT EXTENDLIFE 2012
26
13.
The taking of unauthorized overtime.
14.
Solicitation of fellow employees on the company premises.
15.
Failure to dress appropriately.
16.
Failure to keep your workplace in a neat and sanitary condition.
17.
Use of obscene or otherwise inappropriate language or conduct in the work place.
18.
Failure to provide medical authorizations for medical absences in excess of two days.
19.
Inappropriate horseplay which is either distracting to fellow employees or which could create dangers to
others.
20.
Criminal activity at, or outside of, the workplace.
21.
Off-duty conduct which can affect the company’s credibility or reputation.
22.
outside employment which interferes with your ability to perform your job at this company including, but
not limited to, that with a competitor of the company.
23.
Gambling on company premises.
24.
Sleeping or neglect of job duty.
25.
Taking unauthorized gratuities in connection with company business.
26.
Lending keys to company property to unauthorized persons or allowing duplicate keys to be made.
27.
Being away from the work area without prior authorization.
28.
Harassment of, or discrimination against, an employee, customer or visitor because of that person’s race,
religion, color, sex, age, disability or national origin.
29.
Bad-mouthing or spreading rumors.
DISCIPLINARY ACTION
As indicated earlier, violation of company policies or procedures may result in disciplinary action, including but
not limited to, demotion, transfer, suspension with or without pay, or termination. The company encourages a
system of progressive discipline depending on the type of prohibited conduct. The company is not required to
engage in progressive discipline and may discipline or terminate an employee where he or she violates the rules of
conduct, or where the quality or value of their work fails to meet expectations. Again, our attempt at progressive
discipline does not imply a contract with you or that your employment is anything other than on an “at will” basis.
This means that both the company and the employee may terminate the employment relationship at any time, for
any reason, or no reason at all.
As part of our progressive discipline system, and based on the nature of the employee violation, management will
attempt to provide the employee first with a verbal warning, then one or more written warnings, and if the conduct
is not sufficiently altered, eventual demotion, transfer, forced leave or termination. Your supervisor will make very
effort possible to allow you to respond to any disciplinary action taken. Understand that the company is not
obligated to follow any disciplinary or grievance procedure and that you may be disciplined or terminated without
going through any procedure.
SIGNITURE
DATE
SIGN AND RETURN COPY
© COPYRIGHT EXTENDLIFE 2012
27
Educator Candidate Requirement Policy
ExtendLife Training Systems offers BLS Instructor courses once annually, usually in the fourth
quarter of the calendar year.
The BLS Instructor course is primarily for ExtendLife Training Systems personnel only or
designated training sites.
ALL Instructor candidates must have a letter of acceptance by an American Heart Association
Community Training Center or be accepted as an ExtendLife Training Systems instructor (AHA
requirement).
ALL Instructor candidates must purchase the discipline specific AHA Instructor tool kit or have
access to same prior to attending an Instructor Class (AHA requirement).
ALL Instructors candidates must commit to instructing at least four (4) AHA BLS courses within
the two (2) year term of their BLS Instructor card issue date. ACLS and PALS instructors must
commit to one (1) per year. If Extendlife does not request an educator to participate, then the
requirement is waived.
ALL Instructor candidates must verify access to all required teaching aids and equipment as
prescribed by the AHA, NSC, ASHI, ECSI and ExtendLife Training Systems.
ALL Instructor candidates MUST attend all assigned update, rollout, or revision Instructor
Courses conducted by ExtendLife Training Systems.
Issued October 1, 2010, by the Board of Administrative Policy
Bill C. Carter
Executive Administrator
Educator Candidate
Date
SIGN AND RETURN COPY
© COPYRIGHT EXTENDLIFE 2012
28
Educator Code
of
Professional & Ethical Behavior
I Pledge…
To teach assigned discipline curricula that meet national or international standards or guidelines and have been
approved, accepted, recognized, or endorsed by appropriate regulatory authorities or professional/academic
accreditation entities.
To be accurate and conscientious in the presentation of all curricula I utilize and to follow generally accepted
principals of education and training.
To convey all required information and conduct all necessary practical skills sessions in the time frames
determined appropriate and as prescribed in the selected curricula.
To maintain established educator-to-student and student-to-manikin/equipment ratios during all practical skill
sessions.
To truthfully portray my credentials and personal expertise.
To devote the necessary time and effort to prepare an appropriate learning environment, including necessary
printed materials, audio-visual aids and practice material/equipment prior to each class I conduct.
To be informed of, and comply with, all relevant/applicable state, federal and/or local statutes, regulations or
policies regarding initial emergency care preparedness and training.
To encourage students to maintain their knowledge and skills through regular retraining sessions, including
emergency care drills, simulations, scenarios, skill practice sessions, and required refresher training.
To maintain professional appearance and demeanor during each class I teach.
To promote and encourage integration of on-site emergency medical response plans (including AED & PAD
programs) with community EMS Systems.
To issue course completion cards and certificates only to those individuals who have attended and successfully
completed all program requirements.
To maintain and enhance my abilities as an initial emergency care educator by participating in professional
development programs and continuing education opportunities.
To respect the individual and diverse abilities, backgrounds, and needs of all my students.
To adhere to fair and honest business practices and demonstrate personal and professional integrity in all
transactions with clients, colleagues, manufacturers, and competitors.
To the best of my ability, assist all students develop the reasonable and appropriate knowledge, skills and
confidence needed to respond to sudden illness and injury events.
Signature of Educator
Date
SIGN AND RETURN COPY
© COPYRIGHT EXTENDLIFE 2012
29
INSTRUCTOR DRESS CODE
“First impressions are lasting impressions…” Extendlife Training Systems requires ALL instructors
representing it in the classroom, on-site, or in the general public arena to present themselves with a
professional image. The nature of our profession dictates an appearance of authority and yet
maintains a sense of approachability. To achieve that goal, the company offers a variety of acceptable
attire.
CLASS A Uniform:
Includes a “tunic” style officer’s coat displaying the corporate badge, logo patch, nametag, and
Star of Life or Caduceus patch. A white uniform shirt with black tie and the aforementioned accessories
will be worn with navy uniform pants, black belt, black or navy socks, and black oxford style shoes. A
military type officer’s hat is optional.
CLASS B Uniform:
Includes a white uniform shirt displaying the corporate badge, logo patch, name tag, and Star of
Life or Caduceus patch will be worn with black, navy or khaki TDU, EMS, Cargo pants or class “A”
uniform trousers. Footwear will consist of duty boots, oxfords, or dark colored athletic shoes…shined
and/or clean. Ball caps should NOT be worn with this class of uniform.
CASUAL UNIFORM:
Includes a company issued “Golf” style shirt or an open collar button down shirt bearing the
company logo. Acceptable trousers will be with black, navy or khaki TDU, EMS, Cargo pants or class
“A” uniform trousers. Footwear will consist of duty boots, oxfords, or dark colored athletic
shoes…shined and/or clean. Ball caps bearing the company logo are acceptable.
ALTERNATIVE ATTIRE:
Alternative clothing is acceptable as long as they are clean, neat and representive of the our
profession or have a “business” look about them. Company logo ball caps are acceptable. Apparal is
to be clean, neat and shirt tails are to be tucked inside trousers.
PROHIBBITED APPAREL
Istructors are not to wear shorts, tank tops, or clothing displaying commercial, political, athletic,
or lewed messages. Flip-flops, sandles, soiled or damaged athletic shoes are to be avoided. Generally
any apparell that is not conducive with our profession should not be worn while representing Extendlife.
NOTE: Certain female attire is exempt from the above restrictions, i.e. a uniform blouse or jacket
which may be designed to be worn outside of slacks or skirts.
_________________________
___________________
SIGNED
DATE
SIGN AND RETURN COPY
© COPYRIGHT EXTENDLIFE 2012
30
To All Educators – All Disciplines:
There are occasions when it is conveniently expedient to physically touch a student in order to
correct the misplacement of one’s hand position or to more exactly position one’s self to more
effectively execute a technique. If done appropriately, this is acceptable.
However, in a day of “political correctness and a litigation crazed society”, we have been
advised by our legal staff to be extremely vigilant in this area. Effective immediately, the
following policy is issued.
Educator/Student Physical Contact Policy
Preferably, a manikin will be used to demonstrate the majority of techniques and procedures
requiring physical contact during training. However, when an educator deems it advantageous
to involve class participation in such demonstrations, the following procedure will be
implemented:
Instructors of the opposite gender will NOT touch a student on any part of the anatomy for the
purpose of demonstrating hand placement or other body positioning. To properly execute this
style of practice, the instructor will ask for two volunteers of the same gender from the class.
The educator will advise the two volunteers they will be demonstrating the proper execution for
a specific technique and that they will be making physical contact with one another in order to
accomplish that feat. Upon agreement by both volunteers, the educator will proceed to provide
instruction, utilizing the consenting volunteers to demonstrate. If it is necessary to correct
positioning, the educator will demonstrate the proper technique on his or her own person. At
no time is the educator to have direct physical contact with any student.
EDUCATOR SIGNATURE
DATE
SIGN AND RETURN COPY
REVISED 11/01/2009
© COPYRIGHT EXTENDLIFE 2012
31
©
© Copyright Envision SBS. 2004. All rights reserved. Protected by the copyright laws of the United States and
Canada and by international treaties. IT IS ILLEGAL AND STRICTLY PROHIBITED TO DISTRIBUTE, PUBLISH,
OFFER FOR SALE, LICENSE OR SUBLICENSE, GIVE OR DISCLOSE TO ANY OTHER PARTY, THIS PRODUCT IN
HARD COPY OR DIGITAL FORM. ALL OFFENDERS WILL AUTOMATICALLY BE SUED IN A COURT OF LAW.
C
o
p
MEDIA RELATIONS POLICY
y
r
i
To remain competitive, better serve our customers and provide our employees with the best g
tools to do their jobs, EXTENDLIFE, Inc. (“the Company”), it is important that inquiries by the h
media in relation to our company be handled in accordance with the following policy:
t
1. All inquiries should be referred to Bill C. Carter, Executive Administrator (the
“Spokesperson”).
2. As the Company’s chief spokesperson, the Spokesperson will respond directly or
designate another party to serve as spokesperson.
3. The Spokesperson also will direct the process by which a response is determined or
position taken.
E
n
v
i
s
i
o
n
4. If the Spokesperson is not available, inquiries should be referred to John Reed.
S
5. EXTENDLIFE, Inc. encourages the use of media and associated services as they make B
communication more efficient and effective; they are valuable sources of information S
regarding vendors, customers, technology, new products and services.
.
6. It is imperative to display professionalism and a controlled demeanor in all
communications with media sources.
2
0
0
This policy is applicable to any and all responses with the media, including “off the record” and
4
anonymous statements.
.
I have read, understand, and agree to comply with the foregoing policies, rules, and conditions
A
governing relations with the media. I understand that I have a responsibility to maintain a
l
positive representation of the company. Furthermore, I understand that this policy can be
l
amended at any time.
Date: _____________________
Signature of employee
Printed name of employee
SIGN AND RETURN COPY
© COPYRIGHT EXTENDLIFE 2012
r
i
g
h
t
s
r
e
s
e
r
v
e
d
.
32
P
r
Electronic Reproduction Policy
Training Site (TS) Agreement Version
TS acknowledges that TS and any attendees are prohibited from recording, taping, transmitting,
copying or photographing any part of educational programs outlined in this agreement including, but
not limited to, lectures, presentations, demonstrations, exercises, or printed material, without the
express written consent of Extendlife, Inc., and shall not distribute, transfer or otherwise make the
content available to or accessible by any third party. Extendlife, Inc. reserves the right to deny, alter or
limit access as the event is the proprietary property of Extendlife, Inc.
Evaluation Version
NO PHOTOGRAPHY/VIDEO/AUDIO RECORDING
I acknowledge that by attending this event I am prohibited from recording, taping, transmitting, copying
or photographing any part of said event including, but not limited to, lectures, presentations,
demonstrations, exercises, or printed material, without the express written consent of Extendlife, Inc.
and shall not distribute, transfer or otherwise make the content available to or accessible by any third
party. Extendlife, Inc. reserves the right to deny, alter or limit access as the event is the proprietary
property of Extendlife, Inc.
Roster Version
I acknowledge by my registration that video/audio/photographic reproduction of class content is
prohibited.
Signature
Date
SIGN AND RETURN COPY
© COPYRIGHT EXTENDLIFE 2012
33
Administrative Decontamination Policy
All equipment used in the delivery of instruction shall be maintained and decontaminated in a
suitable fashion in accordance with the guidelines set forth by the American Heart
Association®, approved by OSHA and the CDC.
Any instructor(s) using manikins, barrier devices, AED’s, or other teaching adjuncts, shall clean
all surfaces and internal areas of said equipment with an approved sanitizing solution.
Decontamination of all equipment shall be completed at the conclusion of each course in order
to reduce the risk of cross contamination.
Documentation of CTC approved policy for decontamination shall be maintained by each
instructor. Upon signing completed documentation for processing, the lead instructor(s)
assumes all liability associated with any further action that may result from variations of this
policy, regardless of equipment ownership.
Upon agreement of this policy which was adopted and approved by the Administrative Board,
please sign below and maintain a copy for your files.
Signature
Date
SIGN AND RETURN COPY
Rev. 11/01/2009
© COPYRIGHT EXTENDLIFE 2012
34
INDEPENDENT CONTRACTOR
AGREEMENT
THIS AGREEMENT made and entered into by and between:
ExtendLife, Incorporated dba ExtendLife Training Systems
, herein
after called the Contractor and
hereinafter called the Independent Contractor WITNESSETH:
The Contractor, for the full, complete and faithful performance of this agreement agrees to pay to the Independent
Contractor, in accordance herewith, the contracted rate for the specific assignment accepted by the Independent Contractor,
which shall be the sum of One Hundred Dollars ($100.00) per training session (6 hour maximum) for Lead Educator(s) and the
sum of Seventy Five Dollars ( $75.00) per training session (6 hour maximum) for Assisting Educator(s) or a day rate which shall
be determined by the Contractor and agreed to by the Independent Contractor, payable as follows:
To be paid a sum as agreed to in advance of the service rendered by the Contractor and
the Independent Contractor. Any modification and/or changes must be in writing and agreed to
by all concerned parties.
In consideration therefore, the Independent Contractor agrees as follows:
1.
To furnish all supervision, presentation, demonstration and required instructional skills as prescribed by the
specific course content further described in Paragraph 3 hereof, for the consideration of the previously agreed
remuneration by the Contractor to the Independent Contractor dated the___day of_______________,
________(year) and is automatically renewed on an annual basis. In accordance with the training entity and the
Contractor and special conditions of the Contract between the training entity and the Contractor and in accordance
with the specifications, regulations and addenda of said Contract hereinafter referred to as the Main Contract.
2.
To be bound by the terms of said Main Contract with the Training Entity (including every part of and all the
general and special conditions, specifications, regulations, and addenda), in any way applicable to this Agreement, and
also by the PROVISIONS PRINTED ON THE REVERSE SIDE HEREOF, which are hereby referred to and made a
part of this Agreement, Independent Contractor certifies that the Main Contract has been made available to him/her.
3.
That the services to be furnished and the work to be performed by the Independent Contractor are as follows:
To teach the courses assigned under the guidelines of the Training Entity designated on
the date and at the time prescribed under the Standards and Practices of the CONTRACTOR.
IN WITNESS WHEREOF the Contractor and Independent Contractor have executed this agreement in
duplicate this _______ day of _______________, __________ (year).
Agent for Contractor
Subcontractor
(PROVISIONS PRINTED ON REVERSE SIDE HEREOF ARE PART OF THIS AGREEMENT AND BINDING
UPON THE PARTIES)
SIGN AND RETURN COPY
(Over)
© COPYRIGHT EXTENDLIFE 2012
35
THE INDEPENDENT CONTRACTOR AGREES:
(a) To assume toward the CONTRACTOR, so as far as the Subcontract work is concerned, all the obligations and
responsibilities which the CONTRACTOR assumed toward the TRAINING ENTITY by the MAIN CONTRACT
which includes the special conditions thereof, and the specifications, regulations, and addenda, and all modifications
thereof incorporated in the documents before their execution (which documents will be available to the
INDEPENDENT CONTRACTOR) agrees not to assign or sublet said work or any portion thereof without the written
consent of the CONTRACTOR.
(b) To start work (assignment) when designated by the CONTRACTOR and to complete the several portions and the
whole of the work (assignment) herein sublet, at such times as will enable the CONTRACTOR to fully comply with the
contract with the Training Entity and agreed times as established between the CONTRACTOR and the CLIENT
(student) and to be bound by provisions in the MAIN CONTRACT with the TRAINING ENTITY for damages, if
caused by the INDEPENDENT CONTRACTOR.
(c) To submit to the CONTRACTOR applications (Pay Voucher) for payment at such reasonable times to enable the
CONTRACTOR to apply for and obtain payment from the CLIENT (student) and to receive as progress payments
from the CONTRACTOR the amounts allowed to the CONTRACTOR by the CLIENT (student) on account of the
INDEPENDENT CONTRACTOR’S work to the extent of the INDEPENDENT CONTRACTOR’S interest therein.
Final payment shall be made in a reasonable time period after the completion and acceptance of the subcontract work
unless a definite time for final payment(s) is fixed on the face thereof.
(d) The INDEPENDENT CONTRACTOR has the status of an employer as defined by the Unemployment
Compensation Act of the State and all similar acts of the National Government and including all Social Security Acts;
that he will withhold from his payrolls the necessary Social Security and Unemployment reserves, and pay the same;
that the CONTRACTOR shall in no way be liable as an employer to or on account of any of the employees of the
INDEPENDENT CONTRACTOR; that the INDEPENDENT CONTRACTOR will as an employer, to the extent of any
of his employees under this contract, conform to all rules and regulations of Social Security Acts and Unemployment
Commissions created by said laws, and that he will furnish satisfactory evidence to the CONTRACTOR that he is
conforming to said laws, rules, and regulations. The INDEPENDENT CONTRACTOR hereby releases and
indemnifies the CONTRACTOR from any and all liabilities under said laws.
(e) That the INDEPENDENT CONTRACTOR will pay any and all federal, state and, municipal taxes and licenses,
including sales taxes, if any, for which the INDEPENDENT CONTRACTOR may be liable in connection with the
services rendered herein, or in carrying out the SUBCONTRACT, prior to final payment being made to him.
(f) To furnish satisfactory proof of Health Educator insurance, including both Professional Liability and Commercial
General Liability coverage, as well as, if applicable, all other payments required under Workman’s Compensation laws
as the same becomes due, and to furnish the CONTRACTOR with evidence that the same has been paid before final
payment is made on this SUBCONTRACT.
(g) In the event the contract herein is upon a day rate (unit price), it is understood and agreed that any multiples, and
amounts mentioned are approximate only and may be more or less at the same day rate subject to change as ordered
and directed by the CONTRACTOR.
(h) To indemnify and save harmless the CONTRACTOR from and against any and all suits, claims, actions, losses,
costs, penalties, and damages, of whatsoever kind or nature, including attorney’s fees, arising out of, in connection with,
or incidental to the INDEPENDENT CONTRACTOR’S performance of this SUBCONTRACT.
(i) To commence and at all times to carry on, perform and complete this SUBCONTRACT to the full and complete
satisfaction of the CONTRACTOR, and or the CLIENT (student). It is specifically understood and agreed that in the
event the CONTRACTOR shall at any time be of the opinion that the INDEPENDENT CONTRACTOR is not
proceeding with diligence and in such a manner as to satisfactorily complete said service within the required time, then
and in that event the CONTRACTOR shall have the right, after reasonable notice, to take over said service and to
complete the same at the cost and the expense of the INDEPENDENT CONTRACTOR, without prejudice to the
CONTRACTOR’S other rights or remedies for any loss or damage sustained.
Upon final completion of the service thereof, the INDEPENDENT CONTRACTOR will submit any and all required
documentation in a timely and legible fashion to the Administrative Office of the CONTRACTOR, and shall be,
without exception, responsible for all necessary records of service rendered under this AGREEMENT.
REVISED NOV 1, 2009
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Procedural Guidelines Manual
Acknowledgement
I acknowledge I have received, read, and understand, in its entirety, the
contents of this package.
Furthermore, I agree to abide by the procedures and guidelines contained
herein.
_______________________________
Signature
_______________________________
Print Name
_______________________________
Date
Sign, date and return this receipt to:
EXTENDLIFE, INC.
ADMINISTRATION
209 BROOKWOOD DRIVE
CHATTANOOGA, TN 37411-1904
© COPYRIGHT EXTENDLIFE 2012
37