Get Doh Form 530-010- Application For Ongoing Training And ... - Doh Wa

Filling out the DOH Form 530-010 is an essential step for agencies seeking approval for ongoing training and evaluation programs. This guide provides clear instructions to help users complete the form accurately and efficiently.

Follow the steps to complete your application successfully.

1. Select the ‘Get Form’ button to access the application form, ensuring it opens correctly for completion.
2. Begin by entering the training agency name and credential number in the designated fields at the top of the form.
3. Fill in the mailing address, including the street address, city, and zip code.
4. Provide the name of the OTEP coordinator in the specified section.
5. Indicate the number of participants in the program.
6. Check the boxes next to the relevant training levels included in the OTEP, such as EMR, EMT, AEMT, or PM.
7. List the number of DOH approved EMS skills evaluators, and attach a separate list containing their names and EMS registry numbers.
8. In the provided space, provide a brief description of the OTEP program. Ensure additional documents, like the OTEP plan and a three-year schedule with topics, instructors, and dates, are attached.
9. If applicable, include the agency license number, agency name, and certification levels for any additional EMS agencies participating in the OTEP.
10. Renewal applications should be signed and dated by the OTEP coordinator or agency head, ensuring any significant changes are noted.
11. Finally, obtain all required signatures, including the county MPD or designee, before submitting the completed form to the specified address.
12. After filling out the form, save any changes, and consider downloading or printing a copy for your records before submission.

Complete your DOH Form 530-010 application online today to ensure your training program is approved!