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These forms are to be used by certified Clean Air trainers.
- Checklist
A list of duties and responsibilities you should complete before, during and following a training. - Disclosure Form
A Yellow UPMC Disclosure Form for Continuing Medical Education Credits that MUST be created and present at the time of the training to qualify for CME/CEU credit. Clean Air will create the Disclosure form form you. - Initial Follow-Up Form
For use when conducting follow-up with providers at 2, 6, and 12 months. - Office Implementation Plan
This worksheet assists the office manager in assigning tasks to staff when implementing the intervention. - Training Materials Order Form
Complete this form if you are a trainer and need to order materials to conduct a training. - Training Summary Form
Following a training complete this form and returned with the required paper work.
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