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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:_______________


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






Instructor Initials

©2012 EMS Safety

CPR/AED/Basic First Aid

Version B