Training Institution Certifications & Forms for PI’s
BLS/ALS Training Institution Information
Paramedic Training Institution Information
Training Institution Applications
Training Reference Manual
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 one 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 must have a Training Institution who will mentor and 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 must 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.
- After successfully completing the primary instructor cognitive examination and within one (1) year of successful primary instructor course completion, candidate will complete the Standardized Indiana Primary Instructor Mentorship supervised by the affiliated training institution.
- The Standardized Indiana Primary Instructor Mentorship will consist of the candidate being evaluated on a minimum of five (5) teaching presentations on five (5) different topics and five (5) psychomotor skills teaching five (5) psychomotor skills. Candidates must choose from skills evaluated on the Indiana Practical Skills Certification Examination.
- Evaluations must be done by an experienced primary instructor chosen by the candidate’s affiliated certified training institution official.
- Upon completion of the Mentorship the training institution will submit a letter to the EMS Training Section of the Indiana Department of Homeland Security verifying that the mentorship of the candidate has been completed successfully.
- The training institution’s letter must state that it affiliates and accepts responsibility for the candidate while the candidate teaches for them.
- All documentation regarding the candidate must be kept on file by the training institution for a period of seven (7) years.
- In lieu of the Commission approved Primary Instructor Course a candidate may elect to complete the National Association of EMS Educator’s Level 1 Course.
- In lieu of the EMS Commission approved Primary Instructor Certification Examination, the candidate may elect to complete the National Certified EMS Educator (NCEE) Certification Examination.
- Individuals electing to become Primary Instructors using alternate methods must still complete the mentorship phase of the certification process.
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