Minnesota Statutes § 245A.40 and § 245A.50 require that license holders, staff persons, caregivers and helpers who assist in the care of infants in a licensed program must document their training on AHT / SBS.
NOTE: Indicate below the viewing date and title of the Abusive Head Trauma video(s) that you viewed. AHT training (course and video) is required every year.
I, the undersigned, hereby confirm the following:
I am a . . . (Please check appropriate box below)
[ ] License holder
[ ] Staff person; caregiver; helper for License holder
working in which of the following kind of care situations:
[ ] Day Care or [ ] Foster Care or [ ] Adoption
PRINT License holder's name or Program's name
PRINT Address of License holder or Program's address
Date of viewing
[ ] Video # 1: What is the Period of PURPLE Crying?
[ ] Video # 2: MN Hospital Association's Shaken Baby Syndrome
[ ] Video # 3: Never Shake a Baby: What Caregivers and Parents Need to Know!
[ ] Video # 4: (Optional) Shaken Baby - by Epilepsy Foundation of Central Florida.
My signature confirms I viewed the video(s) check marked above and have requested a copy of this confirmation be made part of the License holder's file.
Video Viewer's Name
Video Viewer's Signature