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Emt skills verification form

See attached for instructions for completion 2026

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The document is the 'EMT Skills Competency Verification Form' for the State of California, which is used to verify the skills of Emergency Medical Technicians (EMTs) for certification renewal or reinstatement. It includes sections for the EMT to certify their competency in various skills and for approved verifiers to confirm this competency through direct observation. The form outlines specific skills that need verification, such as trauma assessment and medical assessment, and provides instructions on how to complete the form.

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Click ‘Get Form’ to open it in the editor.
In the first section, enter your name as shown on your California EMT Certificate, followed by your EMT Certificate Number. Ensure you provide your signature to certify that you have performed the listed skills.
For the verifier's section, the approved verifier must fill in their name, date of verification, and approval details. They should also sign to confirm competency after direct observation.
Proceed to list each skill verified by the approved verifier. For each skill, ensure that the verifier provides their certification or license information along with their signature.
Review all entries for accuracy before saving or submitting the form. Make sure all required fields are completed to avoid delays in processing.

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Versions	Form popularity	Fillable & printable
2017	4.2 Satisfied (43 Votes)
2010	4.8 Satisfied (163 Votes)
2007	4.1 Satisfied (30 Votes)

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