“OPERATIONS LEVEL” HANDS-ON TRAINING REGISTRATION

“OPERATIONS LEVEL” HANDS-ON TRAINING REGISTRATION

Upon passing the “Operations Level” Exam or the “Operations Level Refresher” Exam, participants are eligible to take the Hands-On training. Participants must be pre-registered to participate in hands-on training. A list of available dates is shown below.

Please note:

ü This year personnel needing refresher training must complete the “Operations Level Refresher” Exam before being allowed to register for hands-on training.

ü In order for a hospital to register participants in hands-on training the facility must be compliant with NIMS elements 7,9,10 and 11.

Please choose your preferred first, second, and third choices for location, date, and AM/PM classes.

***Only 15 participants per class***

Dates for May Locations:

¨ 7^th Stillwater Medical Center

¨ 12^th Medical Center of Southeastern Oklahoma (Durant)

¨ 13^th Muskogee Regional Medical Center

¨ 14^th Hillcrest Medical Center (Tulsa)

¨ 20^th Mercy Health – Love County (Marietta)

¨ 29^th McAlester Regional Health Center

Dates for June Locations:

¨ 3^rd Duncan Regional Hospital

¨ 4^th Purcell Municipal Hospital

¨ 9^th Southwestern Medical Center (Lawton)

¨ 10^th Jackson County Memorial Hospital (Altus)

¨ 12^th Ponca City Medical Center

¨ 17^th Integris Clinton Regional Hospital

¨ 18^th Southwestern Memorial Hospital (Weatherford)

¨ 25^th Share Medical Center (Alva)

¨ 26^th Memorial Hospital of Texas County (Guymon)

Dates for July Locations:

¨ 8^th Community Hospital (OKC)

¨ 10^th St. Francis Hospital (Tulsa)

¨ 11^th Jane Phillips Medical Center (Bartlesville)

¨ 16^th Pushmataha Hospital (Antlers)

¨ 22^nd& 23^rd Mercy Hospital (OKC)

HOSPITAL NAME____________________________________________

1. Name_________________________ Initial/Refresher Class _______________

1^st) Date_______________ AM/PM____________ Location_______________________

2^nd) Date_______________ AM/PM____________ Location_______________________

3^rd) Date_______________ AM/PM____________ Location_______________________

2. Name_________________________ Initial/Refresher Class _______________

1^st) Date_______________ AM/PM____________ Location_______________________

2^nd) Date_______________ AM/PM____________ Location_______________________

3^rd) Date_______________ AM/PM____________ Location_______________________

3. Name_________________________ Initial/Refresher Class _______________

1^st) Date_______________ AM/PM____________ Location_______________________

2^nd) Date_______________ AM/PM____________ Location_______________________

3^rd) Date_______________ AM/PM____________ Location_______________________

4. Name_________________________ Initial/Refresher Class _______________

1^st) Date_______________ AM/PM____________ Location_______________________

2^nd) Date_______________ AM/PM____________ Location_______________________

3^rd) Date_______________ AM/PM____________

5. Name_________________________ Initial/Refresher Class _______________

1^st) Date_______________ AM/PM____________ Location_______________________

2^nd) Date_______________ AM/PM____________ Location_______________________

3^rd) Date_______________ AM/PM____________ Location_______________________

6. Name_________________________ Initial/Refresher Class _______________

1^st) Date_______________ AM/PM____________ Location_______________________

2^nd) Date_______________ AM/PM____________ Location_______________________

3^rd) Date_______________ AM/PM____________ Location_______________________

7. Name_________________________ Initial/Refresher Class _______________

1^st) Date_______________ AM/PM____________ Location_______________________

2^nd) Date_______________ AM/PM____________ Location_______________________

3^rd) Date_______________ AM/PM____________ Location_______________________

8. Name_________________________ Initial/Refresher Class _______________

1^st) Date_______________ AM/PM____________ Location_______________________

2^nd) Date_______________ AM/PM____________ Location_______________________

3^rd) Date_______________ AM/PM____________ Location_______________________

9. Name_________________________ Initial/Refresher Class _______________

1^st) Date_______________ AM/PM____________ Location_______________________

2^nd) Date_______________ AM/PM____________ Location_______________________

3^rd) Date_______________ AM/PM____________ Location_______________________

10. Name_________________________ Initial/Refresher Class _______________

1^st) Date_______________ AM/PM____________ Location_______________________

2^nd) Date_______________ AM/PM____________ Location_______________________

3^rd) Date_______________ AM/PM____________ Location_______________________

11. Name_________________________ Initial/Refresher Class _______________

1^st) Date_______________ AM/PM____________ Location_______________________

2^nd) Date_______________ AM/PM____________ Location_______________________

3^rd) Date_______________ AM/PM____________ Location_______________________

12. Name_________________________ Initial/Refresher Class _______________

1^st) Date_______________ AM/PM____________ Location_______________________

2^nd) Date_______________ AM/PM____________ Location_______________________

3^rd) Date_______________ AM/PM____________ Location_______________________

13. Name_________________________ Initial/Refresher Class _______________

1^st) Date_______________ AM/PM____________ Location_______________________

2^nd) Date_______________ AM/PM____________ Location_______________________

3^rd) Date_______________ AM/PM____________ Location_______________________

14. Name_________________________ Initial/Refresher Class _______________

1^st) Date_______________ AM/PM____________ Location_______________________

2^nd) Date_______________ AM/PM____________ Location_______________________

3^rd) Date_______________ AM/PM____________ Location_______________________

15. Name_________________________ Initial/Refresher Class _______________

1^st) Date_______________ AM/PM____________ Location_______________________

2^nd) Date_______________ AM/PM____________ Location_______________________

3^rd) Date_______________ AM/PM____________ Location_______________________

16. Name_________________________ Initial/Refresher Class _______________

1^st) Date_______________ AM/PM____________ Location_______________________

2^nd) Date_______________ AM/PM____________ Location_______________________

3^rd) Date_______________ AM/PM____________ Location_______________________

17. Name_________________________ Initial/Refresher Class _______________

1^st) Date_______________ AM/PM____________ Location_______________________

2^nd) Date_______________ AM/PM____________ Location_______________________

3^rd) Date_______________ AM/PM____________ Location_______________________

18. Name_________________________ Initial/Refresher Class _______________

1^st) Date_______________ AM/PM____________ Location_______________________

2^nd) Date_______________ AM/PM____________ Location_______________________

3^rd) Date_______________ AM/PM____________ Location_______________________

19. Name_________________________ Initial/Refresher Class _______________

1^st) Date_______________ AM/PM____________ Location_______________________

2^nd) Date_______________ AM/PM____________ Location_______________________

3^rd) Date_______________ AM/PM____________ Location_______________________

20. Name_________________________ Initial/Refresher Class _______________

1^st) Date_______________ AM/PM____________ Location_______________________

2^nd) Date_______________ AM/PM____________ Location_______________________

3^rd) Date_______________ AM/PM____________ Location_______________________

21. Name_________________________ Initial/Refresher Class _______________

1^st) Date_______________ AM/PM____________ Location_______________________

2^nd) Date_______________ AM/PM____________ Location_______________________

3^rd) Date_______________ AM/PM____________ Location_______________________

22. Name_________________________ Initial/Refresher Class _______________

1^st) Date_______________ AM/PM____________ Location_______________________

2^nd) Date_______________ AM/PM____________ Location_______________________

3^rd) Date_______________ AM/PM____________ Location_______________________

23. Name_________________________ Initial/Refresher Class _______________

1^st) Date_______________ AM/PM____________ Location_______________________

2^nd) Date_______________ AM/PM____________ Location_______________________

3^rd) Date_______________ AM/PM____________ Location_______________________

24. Name_________________________ Initial/Refresher Class _______________

1^st) Date_______________ AM/PM____________ Location_______________________

2^nd) Date_______________ AM/PM____________ Location_______________________

3^rd) Date_______________ AM/PM____________ Location_______________________

25. Name_________________________ Initial/Refresher Class _______________

1^st) Date_______________ AM/PM____________ Location_______________________

2^nd) Date_______________ AM/PM____________ Location_______________________

3^rd) Date_______________ AM/PM____________ Location_______________________

26. Name_________________________ Initial/Refresher Class _______________

1^st) Date_______________ AM/PM____________ Location_______________________

2^nd) Date_______________ AM/PM____________ Location_______________________

3^rd) Date_______________ AM/PM____________ Location_______________________

27. Name_________________________ Initial/Refresher Class _______________

1^st) Date_______________ AM/PM____________ Location_______________________

2^nd) Date_______________ AM/PM____________ Location_______________________

3^rd) Date_______________ AM/PM____________ Location_______________________

28. Name_________________________ Initial/Refresher Class _______________

1^st) Date_______________ AM/PM____________ Location_______________________

2^nd) Date_______________ AM/PM____________ Location_______________________

3^rd) Date_______________ AM/PM____________ Location_______________________