DSHS Form 02-692 "Community Instructor Class List Tracking Log" - Washington

What Is DSHS Form 02-692?

This is a legal form that was released by the Washington State Department of Social and Health Services - a government authority operating within Washington. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on September 1, 2019;
  • The latest edition provided by the Washington State Department of Social and Health Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of DSHS Form 02-692 by clicking the link below or browse more documents and templates provided by the Washington State Department of Social and Health Services.

ADVERTISEMENT
ADVERTISEMENT

Download DSHS Form 02-692 "Community Instructor Class List Tracking Log" - Washington

1353 times
Rate (4.6 / 5) 68 votes
Community Instructor Class List
This form required by
contract.
Tracking Log
See Special Terms and
Required per contract Special Terms and Conditions (3), Record
Conditions – Record
Maintenance.
Use a separate sheet for each training.
Maintenance.
TRAINING PROGRAM NAME
TRAINING PROGRAM NUMBER
COURSE
DATE(S)
PHYSICAL ADDRESS OF CLASS
INSTRUCTOR NAME(S)
STUDENT PHONE NUMBER
STUDENT NAME
STUDENT EMAIL ADDRESS
(INCLUDE AREA CODE)
COMMUNITY INSTRUCTOR CLASS LIST TRACKING LIST
DSHS 02-692 (09/2019)
Community Instructor Class List
This form required by
contract.
Tracking Log
See Special Terms and
Required per contract Special Terms and Conditions (3), Record
Conditions – Record
Maintenance.
Use a separate sheet for each training.
Maintenance.
TRAINING PROGRAM NAME
TRAINING PROGRAM NUMBER
COURSE
DATE(S)
PHYSICAL ADDRESS OF CLASS
INSTRUCTOR NAME(S)
STUDENT PHONE NUMBER
STUDENT NAME
STUDENT EMAIL ADDRESS
(INCLUDE AREA CODE)
COMMUNITY INSTRUCTOR CLASS LIST TRACKING LIST
DSHS 02-692 (09/2019)
Instructions
This form, or one that collects the same information, is required per your contract in the Special Terms and Conditions
section on Records Maintenance. It must be filled out by someone from the training program for each class taught and
then maintained by your business per contract Terms and Conditions.
Training Program Name:
The primary business name of your training program. Depending on your contract, it may be the “doing business as”
name.
Training Program Number:
Your training program number that appears on approval letters and certificates.
Course:
The name of the course as it appears on the certificate (i.e. Orientation and Safety, Core Basic, etc.)
Date(s):
The date, or dates, the class was taught.
Physical Address of Class:
The location that the class was taught. Must provide the physical address (including city) on this form.
Instructor Name(s):
The person, or persons, who actually taught the class.
Student Name, Phone Number, Email Address:
Contact information of the students, not the facility or business for which they work.
COMMUNITY INSTRUCTOR CLASS LIST TRACKING LIST
DSHS 02-692 (09/2019)
Page of 2