CBRF Certification Courses - Blackhawk Technical College

CBRF Certification CoursesEffective April 1, 2010, the Department of Health Services began implementation of its changes to the requirements for training andregistry services for CBRFs. Among the changes are new requirements for both instructors and students of the four departmentapprovedface-to-face training topics, outlined in DHS 83.20: Fire Safety, First Aid & Choking, Medication Administration, andStandard Precautions.Changes include: A public access registry of CBRF staff, who have successfully completed required courses is available to providers, surveystaff and other interested parties. This registry is the sole verification of classes completed on or after April 1, 2010. Curriculum for all four topics has been standardized and must be taught beginning April 1, 2010.Blackhawk Technical College is now offering three new/revised courses to meet your trainingrequirements as a Community-Based Residential Facility (CBRF): Fire Safety Medication Administration Standard PrecautionsFire Safety, Standard Precautions and Medication Administration training will now be delivered inseminar format. Classes will be scheduled in advance and participants will be required to register and pay for theclass prior to the class date. Each class includes classroom instruction and reference material, followed by an open book test. Upon successful completion, the participant must remit a check or money order only for $25.00made payable to UW-Oshkosh CCDET to have their name posted on the state registry. Blackhawkinstructors will then forward the required fees and documentation to UW-Oshkosh for processing. The training table on page 2 indicates the dates, times, locations, and Blackhawk Technical Collegefees for the scheduled classes. (These fees do not include the $25 state registry fee.) These classes are delivered in seminar format by Blackhawk’s DHS certified instructors: Sue Anema – Standard Precautions & Medication Administration Loren Lippincott – Fire Safety First Aid & Choking is not currently available at Blackhawk Technical College. Contact SouthCentral Wisconsin Red Cross at (608) 754-4497 for information on scheduled classes.For more detailed information contact:Gail Pauletto at gpauletto@blackhawk.edu or (608) 757-7650To access the Wisconsin Department of Health Services CBRF Training & Registry websitehttp://www.uwosh.edu/ccdet/CBRFInterested in CBRF Client Related or Dietary training? Call Sue Anema (608) 743-4426 to discussBlackhawk Technical College’s contracted services of video-based instruction and individual testing.6004 S County Road G • PO Box 5009 • Janesville, WI 53547-5009 • www.blackhawk.edu • (608) 757-7650BTC is an equal opportunity/equal access, affirmative action educator/employer

Indicate course selection below ()All Materials Provided • Testing IncludedPrice does not include $25 state registry fee per course(State registry fee required on training date by bringing a check or cashier check only- no cashmadepayable to UW-Oshkosh CCDET.)STANDARD PRECAUTIONS$32.002 hour course + test MEDICATION ADMINISTRATION$102.0010 hours (2-day course) + test Friday, Jan 7 (8am-2:30pm) &Friday, Jan 14 (8am-11am)CRN 39411Saturday, Jan 8 (8am-1:30pm)CRN 39407Friday, Feb 18 (8am-11am)CRN 39412Friday, March 25 (8am-11am)CRN 39413Friday, May 13 (8am-11am)CRN 39414Friday, Feb 11 (8am-2:30pm) &Saturday, Feb 12 (8am-1:30pm)CRN 39408Friday, April 1 (8am-2:30pm) &Saturday, April 2 (8am-1:30pm)CRN 39409Friday, May 6 (8am-2:30pm) &Saturday, May 7 (8am-1:30pm)CRN 39410All classes held at Central Campus in JanesvilleFIRE SAFETY$44.004 hour course + testWednesday, Feb 2 (12:30-5:00pm)CRN 39415Wednesday, Mar 30 (12:30-5:00pm)CRN 39416Wednesday, May 18 (12:30-5:00pm)CRN 39417To keep the classes cost effective, there are a minimum number of participants required for each class. If the minimum registrations are not met one week prior to the class, it is subject tocancellation. If cancelled, registered participants will be given the option to register for a future class or receive a refund.SOCIAL SECURITY NUMBER ORSTUDENT ID NUMBER (Optional)CBRF Certification CoursesRegistration NumbersPhone: 608 757-7661REGISTRATION FORMFax: 608 743-4407To register, complete this registration form and fax (608-743-4407) or mail the form with credit card information, check, or money ordermade payable to Blackhawk Technical College. Registration available on line at www.blackhawk.eduLAST NAME FIRST NAME MIDDLESTREET ADDRESS CITY OR TOWN STATE ZIP CODECOUNTY OF RESIDENCE CITY ofHOME PHONE ( ) VILLAGE of TOWNSHIP ofWORK PHONE ( )DATE OF BIRTH (Required) SEX RACE (check all that apply) Female □ American Indian or Alaskan Native □ AsianMonth Day Year Male□ Black or African American□ White□ Native Hawaiian or Other Pacific IslanderCOMPANYFor more detailed information contact:Gail Pauletto at gpauletto@blackhawk.edu or (608) 757-76506004 S County Road G • PO Box 5009 • Janesville, WI 53547-5009 • www.blackhawk.edu • (608) 757-7650BTC is an equal opportunity/equal access, affirmative action educator/employerASIAN ORIGIN□ Vietnam □ Laos□ Cambodia□ Other_________________ETHNIC CODEHispanic/Latino□ Yes□ No HIGH SCHOOL GRADUATE YEAR NAME OF HIGH SCHOOL CITY AND STATE OF HIGH SCHOOL GED 19________ 20________ HSEDHIGHEST GRADE COMPLETED AT ENROLLMENT(Circle One) BELOW 6 6 7 8 9 10 11 12 13 14 15 16 17 Over 17MasterCard _____ Visa ______ Include 3 digit code in Signature Block _________Credit Card No. ________________________________________________________Expiration Date ___________________ Signature ____________________________________________________ Amount ________________