Training Institution Certifications & Forms for PI’s
BLS/ALS Training Institution Information
Paramedic Training Institution Information
Training Institution Applications
General Course Applications
EMR Forms & Information
EMT Forms & Information
Practical Skills Examination Report Form (Skills Sheets)
Statement of Remediation
Paramedic Training Forms & Information
Primary Instructor (PI) Forms & Information
To become an Indiana PI instructor, there are certain processes that you must follow. Below is an outline of those processes.
Pre-Requisites (836 IAC 4-5-1)
- Must have been certified, registered, or licensed as an EMT for no less than one year before being admitted to PI course.
- Must have at least 1 year of experience in pre-hospital setting.
- Before entering a class, student must submit a letter of intent to affiliate from at least one (1) Indiana certified training institution.
- Must be at least a current Indiana EMT.
Course and After Course
- Before entering a class, potential PI should have a Training Institution who will affiliate him/her for the internship portion of the course.
a. If the Training Institution who is teaching the class will have each student intern at their institution or will be setting up internships, then they must fill out this form on every student.
b. All students should have this form turned upon class starting. This should be submitted to State with initial course roster.
- Successfully pass the Indiana basic emergency medical services written and practical skills examinations within one (1) year prior to applying for certification as a primary instructor. The application date for certification as a primary instructor will be the end date of the primary instructor course as stated on the official course report of training.
- Student must successfully pass the course.
- Student must successfully pass the primary instructor state exam within one (1) year of completion of the primary instructor course as stated on the official course report of training.
- Within one (1) year of successful primary instructor course completion, candidate must fill out this form and return it an all the other required documents to the Office of EMS to obtain full certification.
Procedure Guide for Completing EMS Course Paperwork
PI pre-testing verification
PI course completion
Statement of Remediation
PI Internship Checklist
PI Internship Checklist Part 2
PI Internship Affiliation
Emergency Vehicle Operators Course
Extrication Forms & Information