RBR Alliance CPR/First Aid/AED/PDT Scheduling Request

Employee MUST successfully complete the American Red Cross Online Learning course for CPR/First Aid/AED PRIOR to attending the monthly "Skill Session" class AND the "Proceed to Skill Session" Certificate must be submitted to the instructor upon arrival to class.

Employee Name

First Name

Last Name

What Type of session will the employee be scheduled for:

Scheduled Monthly Skill-Out

Department Arranged Skill-Out

Month of Skill-Out Session to be scheduled for:

Program Code:

Location Code:

Employee Email:

IN-PERSON SKILL SESSION NEEDED: (check all that apply)

ADULT CRP/AED

INFANT (Pediatric) CPR

FIRST AID

PDT

Requester's Name:

Requester's Email

Requester's E-Signature