Answer Sheet Student Name
Instructor Name
Test Date
Instructor Number
Basic First Aid
Adult CPR
Student Agreement By initialing below you agree to the following:
Using an AED
I understand that emergency situations are inherently dangerous. I recognize the need to ensure my safety as well as that of the victim.
I understand the mode of transmission for bloodborne pathogens and recognize the need for gloves and CPR barrier devices. I have seen them demonstrated by a certified EMS Safety Services instructor.
I understand how the Good Samaritan Law covers me when I respond to an emergency.
I have practiced and feel comfortable with the skills and techniques taught in this EMS Safety Services training course.
Child/Infant CPR
Student Initials:_______________
Section
Adult CPR
Adult CPR + AED
Adult CPR + Child CPR
Adult CPR + AED + Child CPR
Basic First Aid
Minimum Passing Score
80% (12/15)
80% (16/20)
80% (16/20)
80% (20/25)
80% (16/20)
Student Score
____/15
____/20
____/20
____/25
____/20
Instructor Initials
©2012 EMS Safety
CPR/AED/Basic First Aid
Version B