Rescue Diver Training Form

Rescue Diver Course Training Documentation and Referral Form
Student Name______________________________________ Birth Date (D/M/Y) ______/______/______

Student Mailing Address___________________________________________________________________
City___________________________________________________ State/Province_____________________
Country____________________________________________ Zip/Postal Code______________________
Phone (______) _________________________ Business Phone (______)_________________________
Fax (______)____________________________ Email_ _________________________________________

Presentation
Presentation
Presentation
Presentation
Presentation
I. Knowledge Development Presentations
Knowledge Review
Completed
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Completed
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Initials
Student / Instructor
PADI No.
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II. Rescue Training Exercises Indicate location of Training Exercises

Pool Open Water
Self Rescue Review

Exercise 1 Tired Diver
Exercise 2 Panicked Diver
Exercise 3 Response from Shore, Boat
Excerise 4 Distressed Diver Underwater
Exercise 5 Missing Diver
Exercise 6 Surfacing the Unresponsive Diver
Exercise 7 Unconscious Diver at the Surface
Exercise 8 Exiting the Unresponsive Diver
Exercise 9 First Aid for Pressure-related

Injuries and Oxygen Administration
Exercise 10 Response from Shore/Boat

Unresponsive Diver
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III. Open Water Rescue Scenarios

Open Water Rescue Scenario One

Open Water Rescue Scenario Two
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_____/_____/_____ _______/_______ ____________
Final Examination
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Emergency First Response Primary Care (CPR) and Secondary Care (First Aid)
PADI Member Name________________________________________ Signature______________________________________
PADI No. __________________ Dive Center/Resort No. ____________________ Date
(D/M/Y)
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Phone (______)_____________________ Fax (______)____________________ Email ________________________________
PADIInstructors Involved in Training

PADI Instructor Name_______________________________________ Signature______________________________________
(D/M/Y)
_______/________/_______
Phone (______)_____________________ Fax (______)____________________ Email ________________________________

PADI Instructor Name_______________________________________ Signature______________________________________
(D/M/Y)
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Phone (______)_____________________ Fax (______)____________________ Email ________________________________

Product No. 10295 (Rev. 5/10) Version 2.04
PADI 2010
Referral Procedure
The purpose of this procedure is to allow a student diver
to complete a PADI Rescue Diver course with more than
one PADI Instructor. A PADI Rescue Diver student may be
referred to another PADI Instructor after completing any
knowledge development session, training exercise and/
or open water rescue scenario. The student diver must
complete the entire session, exercise or scenario
to receive referral credit for that session, exercise,
or scenario.
To refer a PADI Rescue Diver student, use this PADI
Rescue Diver Course Training Documentation and
Referral Form found in the Appendix of the PADI Rescue
Diver Instructor Guide. This form, along with the divers
completed Medical Statement, may be given directly to
the diver to continue PADI Rescue Diver training with
another PADI Instructor.
A PADI Rescue Diver Course Training
Documentation and Referral Form is valid for 12
months from the last training segment completion date. Prior to conducting a Rescue Diver
exercise for a referred student, a preassessment
and the administrative requirements as outlined
in PADI General Standards and Procedures
must be completed (i.e. signed Medical Statement,
Standard Safe Diving Practices Statement
of Understanding, and Liability Release and
Assumption of Risk Agreement.) All PADI
Instructors involved in the referral process, initial
training or subsequent training, must retain a
copy of the administrative paperwork, as well as
the Rescue Diver Course Training Documentation
and Referral Form. The instructor who conducts
the student divers final open water training
ensures that the diver has met all certification
requirements and certifies the diver.
When you receive a Rescue Diver referral student, you
may check the status of PADI Instructors who previously
signed off on the training documentation form by calling
your PADI Office.
Important Points for the Diver

1. Verify that the PADI Instructor(s) who will complete
your training is in Teaching Status.
2. Take this form, along with a copy of your completed
PADI Medical Statement and a photograph to the
PADI Dive Center, PADI Resort or PADI Instructor completing your training.
3. This referral form is valid for 12 months after the last
training session completion date, however you should
complete your training as soon as possible.
4. Retain this form until you have completed all required

training sessions.
5. The PADI Instructor(s) continuing your training will
preassess your skills and knowledge and review anything that may be unclear.
6. Upon completion of all required training, you and the
PADI Instructor will complete a Positive Identification
Card (PIC) envelope. This envelope must be submitted
to PADI along with your photo to obtain a certification card.
Important Points for the Referring Instructor(s)

1. Fill in the requested information on this form, including the divers name and address and your contact
information. Also, fill in the appropriate areas of
training completed before referring the diver.
2. Attach a copy of the divers PADI Medical Statement
to this form. Also advise the diver of the need for a
photo for certification card processing.
3. Give the diver the entire form. If possible, assist the
diver in making arrangements with a PADI Dive
Center, PADI Resort or PADI Instructor for completing
training as additional local requirements may apply.
Keep a photocopy for your records.
4. Encourage the diver to complete the training as soon
as possible. Advise the diver that the form is only
valid for 12 months after the last training session
completion date.
Important Points for the Receiving Instructor(s)

1. Preassess the divers knowledge and skills. Be certain
that the diver is adequately prepared to continue
training.
2. A diver may be referred after completing any knowledge development session, training exercise and/or
open water rescue scenario.
3. Upon completion of each component, initial and date
this form in the appropriate area. The diver retains
the referral form until the completion of all certification requirements. Retain a photocopy of this form for
your records.
4. If you conduct the final open water rescue scenario
you are the certifying instructor. Complete and submit
a PADI Positive Identification Card (PIC) envelope to
PADI for processing. Retain a copy of the completed
referral form for your records and forward a copy to
the original instructor for his records.
QUESTIONS About how to use the form?

Call PADI.

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Rescue Diver Course Training Documentation and Referral Form

Student Name______________________________________ Birth Date (D/M/Y) ______/______/______

I. Knowledge Development Presentations

II. Rescue Training Exercises Indicate location of Training Exercises

Pool Open Water

Self Rescue Review

_____/_____/_____ _______/_______ ____________

_____/_____/_____ _______/_______ ____________

_____/_____/_____ _______/_______ ____________

_____/_____/_____ _______/_______ ____________

III. Open Water Rescue Scenarios

Open Water Rescue Scenario One

_____/_____/_____ _______/_______ ____________

_____/_____/_____ _______/_______ ____________

Phone (______)_____________________ Fax (______)____________________ Email ________________________________

PADIInstructors Involved in Training

Phone (______)_____________________ Fax (______)____________________ Email ________________________________

Phone (______)_____________________ Fax (______)____________________ Email ________________________________

Important Points for the Diver

4. Retain this form until you have completed all required

Important Points for the Referring Instructor(s)

Important Points for the Receiving Instructor(s)

QUESTIONS About how to use the form?

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Student Name________________________________ Birth Date (D/M/Y) //

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Phone ()_ Fax () Email ____________________

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