POLICE SERVICE FIRST AID / CPR REPORT

The requires a valid Standard First Aid and a basic level Cardio Pulmonary Resuscitation (CPR) certificate, prior to an offer of employment. Please have the form (on the reverse side of this paper) completed by an organization whose standards are recognized as equivalent under the Workplace Safety and Health First Aid Regulation 140/98R or under the Occupational Health and Safety Regulations. This form must be accompanied by the original certificates.

The program must contain the following elements:

First Aid - Emergency Scene Management Shock, Unconsciousness & Fainting Artificial Respiration Choking Severe Bleeding Bone & Joint Injuries – Upper Limbs Muscle Strains Medical Conditions Bone & Joint Injuries – Lower Limbs Head/Spinal and Pelvic Injuries Chest Injuries Wound Care Environmental Illnesses & Injuries Burns

CPR - Signs, Symptoms & Actions 1 Rescuer CPR (Adult) Risk Factors Healthy Heart Habits Choking 2 Rescuer CPR (Adult) CPR for Infants to one-year old CPR for Children (1-8 years) Artificial Respiration for Infants & Children (PLEASE SEE REVERSE) FIRST AID / CPR REPORT

APPLICANT’S NAME: ______NAME OF ORGANIZATION: ______ORGANIZATION ADDRESS: ______PHONE NUMBER ______CURRENT DATE: ______

I HEREBY CERTIFY that the applicant ______has successfully completed a First Aid Certification Program and a Basic Rescuer Cardiopulmonary Resuscitation Program, which contains the following elements:

First Aid - CPR -  Emergency Scene Management  Signs, Symptoms & Actions  Shock, Unconsciousness & Fainting  1 Rescuer CPR (Adult)  Artificial Respiration  Risk Factors  Choking  Healthy Heart Habits  Severe Bleeding  Choking  Bone & Joint Injuries – Upper Limbs  2 Rescuer CPR (Adult)  Muscle Strains  CPR for Infants to one-year old  Medical Conditions  CPR for Children (1-8 years)  Bone & Joint Injuries – Lower Limbs  Artificial Respiration for Infants & Children  Head/Spinal and Pelvic Injuries  Chest Injuries Certification Date: ______Year / Month / Date  Wound Care  Environmental Illnesses & Injuries Expiry Date: ______ Burns Year / Month / Date

Certification Date: ______Year / Month / Date

Expiry Date: ______Year / Month / Date

PERSON CERTIFYING EQUIVALENCY: ______Please print Signature

Please validate the results with an official office stamp.