EMT Policy and Procedure

EMT COURSE – STUDENT REMEDIATION PROGRESS REPORT/COUNSELING FORM

0s STUDENT NAME COURSE LOCATION: START DATE:

6 DIGIT ID:

EMT LEAD INSTRUCTOR

AGENCY IF ANY:

REMEDIATION

PROGRESS REPORT / COUNSELING

ISSUE TYPE:

ATTENDANCE:

TARDINESS:

WRITTEN

PSYCHOMOTOR

AFFECTIVE

No missed sessions 1-3 missed sessions 4+ missed sessions

None

MODULE IN QUESTION

Sporadic <10% Chronic >10%

TYPE OF REMEDIATION:

REVIEWED SKILLS SHEET

WRITTEN EXAMS:

DEMONSTRATED/PRACTICED SKILL

No apparent difficulties

REVIEWED WRITTEN TEST

Sporadic difficulties (1-2 retests) Chronic difficulties (3+ retests)

OTHER

TO DO BEFORE ADDITIONAL ATTEMPT:

PSYCHOMOTOR SKILLS EXAMS:

READ BOOK PAGES: No apparent difficulties SELF-TEST ONLINE WITH >8000pt score Sporadic difficulties (1-2 retests) PEER PRACTICE WITH STUDENT Chronic difficulties (3+ retests) COMPLETE WORKBOOK PAGES: OTHER

AVAILABLE RESOURCES: Y N Available to audit CEU/Refresher with LSIS Has access to mentor at agency for practice Has access to online content from publishers Willing to prioritize time for EMT class Other

Student at Risk for Failure/Dismissal:

Yes

No

Additional Notes / Counseling / Recommendations:

INSTRUCTOR PROVIDING REMEDIATION :

STUDENT ACKNOWLEDGEMENT:

Name:

Name:

Date:

Date:

Signature:

Signature:

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