EVENT CAPTAIN SUMMARY
Event Name & Discipline
Event Start Date
Event End Date
Number of participants who fulfilled education
How many participants passed?
How many participants failed?
Event Roster, Safety Meeting & Scorecards/Feedback Forms
Captains are responsible for submitting the rosters, safety meeting sheets, pass/fail results and scorecards/feedback forms for ALL staff in their event group.
Please Read Carefully - The following information has recently changed...
***Attachments to this document have caused our website to crash*** Instead, please use a scanner app (i.e. Camscanner) to change the photos into a clear pdf. and email ALL forms to: Office@psia-w.org
Event Participant Names
Enter your participants names AND pass/fail status if you do not have a roster to send. Please try to provide correct spelling of names and member numbers.
Were there participants that attended that are not on the original roster?
# of Day of Registrants
Day of Registrants info
Please provide the name (first and last) and PSIA # if available of any day of registrants.
Any issues or concerns? No shows or late attendance? Additional certificates or pins needed?
Suggestions on how to make the event better.
PSIA/AASI Western Division
phone: (530) 587-7642
fax: (530) 240-6252
9709 Highway 267, Truckee CA 96161
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