The code block below illustrates how one might use # and // as comments in your logic and calculations.

# Text can be put here to explain what the logic/calculation does and why.
if ([field1] = '1' and [field2] > 7,

	// This comment can explain what the next line does.
	[score] * [factor],

	// Return '0' if the condition is False.
	0
)

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Working...

This value you provided is not a number. Please try again.

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The value entered is not a valid Vanderbilt Medical Record Number (i.e. 4- to 9-digit number, excluding leading zeros). Please try again.

The value you provided must be within the suggested range

The value you provided is outside the suggested range

This value is admissible, but you may wish to double check it.

The value entered must be a time value in the following format HH:MM within the range 00:00-23:59 (e.g., 04:32 or 23:19).

This field must be a 5 or 9 digit U.S. ZIP Code (like 94043). Please re-enter it now.

This field must be a 10 digit U.S. phone number (like 415 555 1212). Please re-enter it now.

This field must be a valid email address (like joe@user.com). Please re-enter it now.

The value you provided could not be validated because it does not follow the expected format. Please try again.

Required format:

Trainer Request Form

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today's Date

M-D-Y

I would like to request:

* must provide value

Approval for training

Equipment (includes training materials)

Lead/Requesting Instructor:

* must provide value

Email address

* must provide value

Phone Number

* must provide value

Training Request

Expected Number of Participants

* must provide value

In compliance with COVID-19 guidelines, if more than 6 participants are scheduled to be in attendance, another Project SAVE instructor is required to support the training or the training times must be staggered. Please use this section to either list additional instructors that you have enlisted to be present, indicate here that you would like to request instructor(s) to support your training, or that you will be staggering your training schedule.

* must provide value

Type of training:

* must provide value

First Aid/CPR/AED

BLS

Hands Only

Will this training be blended or conducted in a traditional format?
A "blended" class is one in which the instruction portion of the training is conducted online and participants are only in-person for the skills portion. The "Traditional" course style will follow the pre-COVID-19 format where all learning is done in-person.

* must provide value

Blended

Traditional

Will this training take place at a school?

* must provide value

Yes

No

Will you be training school personnel (i.e. students, staff, coaches)?

* must provide value

Yes

No

At what type of school will your training take place?

* must provide value

Individual Schools (Elementary/Middle/High School)

Entire School District

Will there be public and/or private schools?

* must provide value

Only public school(s)

Only private school(s)

Both public and private schools

Public School

How many public schools will be trained?

* must provide value

1

2

3

4

5

Public School 1 in attendance

* must provide value

Public School 1 District

* must provide value

Please specify

* must provide value

Public School 2 in attendance

* must provide value

Public School 2 District

* must provide value

Public School 3 in attendance

* must provide value

Public School 3 District

* must provide value

Public School 4 in attendance

* must provide value

Public School 4 District

* must provide value

Public School 5 in attendance

* must provide value

Public School 5 District

* must provide value

Private School

How many private schools will be trained?

* must provide value

1

2

3

4

5

Private School 1 in attendance

Private School 1 County

* must provide value

Private School 2 in attendance

Private School 2 County

* must provide value

Private School 3 in attendance

Private School 3 County

* must provide value

Private School 4 County

* must provide value

Private School 4 in attendance

Private School 5 County

* must provide value

Private School 5 in attendance

District Level

How many districts will be trained?

* must provide value

1

2

3

4

5

District Name 1

District Name 2

District Name 3

District Name 4

District Name 5

College Trainings

How many colleges will you be training?

* must provide value

1

2

3+

College 1 in attendance:

* must provide value

College 1 County

* must provide value

College 2 in attendance:

* must provide value

College 2 County

* must provide value

College 3 in attendance:

* must provide value

College 3 County

* must provide value

Location (ex. YMCA of Metro Atlanta):
Address	County
Zip Code

Date of training

* must provide value

M-D-Y

Please certify adherence to the Project SAVE attendance policy by selecting the choice below:

* must provide value

I, ______, attest that by selecting this box I will upload the class roster and enter participant email addresses in the Red Cross Learning Center within 10 days of class completion.

Instructor Training Request

Estimated number of attendees:

* must provide value

Type of training:

* must provide value

First Aid/CPR/AED Instructor

BLS Instructor

County

* must provide value

Zip Code

* must provide value

Please provide your top 3 choices for training dates, in order of preference. We will do our best to accommodate your request.

Please note that trainings are 2 days in length. The dates selected below signify the first date you would like the training to start. Both training days last from 8am - 4pm.

Date 1:

Date 2:

Date 3:

Equipment Request

Please select the equipment you are looking for: (Select all that apply)

* must provide value

Adult Mannequins with lungs

Infant Mannequins with lungs

AED Trainer

How many adult mannequins do you need to check out?

* must provide value

How many infant mannequins do you need to check out?

* must provide value

How many face shields do you need to check out?

* must provide value

How many one-way valves do you need to check out?

* must provide value

How many AED trainers do you need to check out?

* must provide value

Training Date:

Return Date for Materials:

Thank you for completing the Project SAVE equipment request form. Pick-up and drop-off locations for all equipment is at Children's Healthcare of Atlanta Support Center, Building 1
(1575 Northeast Expressway, Atlanta, GA 30329)

Equipment is requested back within 3 days of the training date.

How many AED pads do you need to replace?
Note: AED pads can only be replaced for Project SAVE machines

* must provide value

Were the AED pads used?

* must provide value

Yes

No

Date of incident

* must provide value

M-D-Y

Where did incident happen?

* must provide value

Public school

Private school

Community organization

Please select the public school where the incident took place:

Please select the district in which the incident took place:

* must provide value

Please indicate the private school where the incident took place:

* must provide value

Please select the county in which the incident took place:

* must provide value

What is the name of the community organization where the incident took place?

* must provide value

Please select the county in which the incident took place:

* must provide value

Victim's age:

* must provide value

Event was:

* must provide value

Witnessed by a bystander

Witnessed by a CPR-trained rescuer

Not witnessed

Was CPR provided prior to defibrillation?

* must provide value

Yes

No

Was a shock advised?

* must provide value

Yes

No

How many shocks were given?

* must provide value

Please provide any additional comments about the event:

Expand

Victim outcome at incident site:

* must provide value

Became responsive

Return of pulse and breathing

Return of pulse with no breathing

No return of pulse or breathing, remained unresponsive

Transported to hospital, outcome unknown

Thank you for completing this incident report. A copy will remain on file with Children's Healthcare of Atlanta Project S.A.V.E should you need a copy.

INTERNAL USE ONLY

Date AED pads replaced

M-D-Y

All rented equipment returned?

Yes

No

Equipment Return Date Lapse

View equation

7 Days or more lapse from Return Date

View equation

You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.