CPS Training Sign-off Sheet

Name: _______________________________________________ Date:_________

Make of Car: __________________________________ Model Year: __________

Rear Seat Outboard: Rear Seat Center:

Belt System Belt System

Lap Only Lap/Shoulder Lap Only Lap/Shoulder

Type of Latch Plate Type of Latch Plate

Locking Sliding Locking Sliding
Lightweight Switchable Lightweight Switchable

Type of Retractor Type of Retractor

None Emergency Locking None Emergency Locking
Switchable Automatic Locking Switchable Automatic Locking

Type of Airbag Type of Airbag

None Front Side None Front Side

LATCH System: LATCH System:

Tether Lower Anchors Tether Lower Anchors

Instructor Initials: _________________ Instructor Initials: ______________

Child Restraint System:

Rear Facing Seat Forward Facing Seat

Infant Seat RF Convertible Five Point Harness Tray Shield

Demonstrated Correct Installation:__________ Demonstrated Correct Installation:___