State of California EMT-1 Skills Competency Verification Form EMSA SCV 07/03 1a. Name as shown on EMT-1 Certificate 1b. Certificate Number 1c* Signature 1d. Certifying Authority 1e. Date I certify under the penalty of perjury that the information contained on this form is accurate. Skill Verification of Competency 1. Patient examination trauma patient Affiliation Date Signature of Person Verifying Competency Print Name Certification / License Number 3. Airway emergencies 4. Breathing emergencies 5. Automated external defibrillation 6. Circulation emergencies 7. Neurological emergencies 8. Soft tissue injury 9. Musculoskeletal injury 10. Obstetrical emergencies. Certificate Number 1c* Signature 1d. Certifying Authority 1e. Date I certify under the penalty of perjury that the information contained on this form is accurate. Skill Verification of Competency 1. Patient examination trauma patient Affiliation Date Signature of Person Verifying Competency Print Name Certification / License Num....
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How to fill out the Emt Skills Competency Verification Form online
Completing the Emt Skills Competency Verification Form is vital for demonstrating your skills as an emergency medical technician. This guide will walk you through the process of filling out the form online, ensuring you provide all necessary information accurately.
Follow the steps to complete the form efficiently.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- In section 1a, enter your name exactly as it appears on your EMT-1 Certificate. Ensure correctness as this is important for verification.
- For each skill listed from 1 to 10, fill in the following details: a.) skill name, b.) affiliation, c.) the date of competency verification, d.) signature of the person verifying your competency, e.) printed name of the verifier, and f.) certification or license number of the verifier.
- After completing the form, you can save the changes, download it, print a hard copy, or share the form as necessary.
Complete your Emt Skills Competency Verification Form online today to ensure your skills are recognized.
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