UK St. Claire Training Request Form
Please grant a 30 day notice for education.
Name
*
First Name
Last Name
Email
*
example@example.com
Educational Request for:
*
Please Select
Policy (New/Change)
Protocol (New/Change)
Process (New/Change)
Equipment (New/Change)
Standardized Class: AHA, CPI, etc.
Description of Education Needed:
Preference for education
Classroom
HealthStream
Flyers
In-Service
On Unit/Dept
Other
Has the policy/procedure been revised and approved through service lines/committees?
Please Select
Yes
No
Is the related policy or protocol finalized and ready to Go Live?
Please Select
Yes
No
Please list approvers, service lines or committee requests have been through.
If EMR updates required, have these been completed and are ready to Go Live?
Please Select
Yes
No
If for new equipment or product, when will these arrive and be ready for distribution?
Who is the contact person for this request (project leader, owner, etc.)?
Proposed Go Live Date?
Who is the education target audience (include departments and/or roles)?
Submit
Should be Empty: