Appendix A – Form 11

Alabama Board of Examiners of Nursing Home Administrators

4156 Carmichael Road, Montgomery, Alabama  36106

1. (334) 271-2342

   AIT PROGRAM OUTLINE - 2000 HOUR

   (Please print clearly or type all answers - if there is not sufficient space, use additional sheets and number accordingly).

   NAME OF AIT:                                                 Date

   (Title)     (Last)         (First)     (Middle)

   NAME OF FACILITY WHERE TRAINING IS TAKING PLACE:

   ADDRESS:

   TELEPHONE:                                    FAX:

   Proposed AIT Beginning Date:              Proposed date of Completion:

   CARE, SUPPORTS, AND SERVICES:  (A minimum of 880 hours)         TOTAL HOURS

   Topics in this area should include nursing services, social services, food service, medical services, therapeutic services, recreational and activity programs, medical records, pharmaceutical program and rehabilitation services.

   NURSING                                      SOCIAL SERVICES

   DIETARY                                      RECREATION/VOLUNTEER

   MEDICAL RECORDS                              REHABILITATION SERVICES

   MEDICAL/ALLIED HEALTH                        PHARMACEUTICAL PROGRAM

   OPERATIONS:  (A minimum of 540 hours)                     TOTAL HOURS                  

   Topics in this area should include recruitment, interviewing, employee selection, training, personnel policies, employee health and safety program, employee retention, accounting, budgeting, financial planning and asset managing, auditing, organizational structures, leadership principles, mission, vision and value statements, strategic planning, government relations and advocacy, and public relations.

   ADMINISTRATION                               BUSINESS

   ENVIRONMENT AND QUALITY: (A minimum of 520 hours)         TOTAL HOURS                  

   Topics in this area should include safety procedures, fire, disaster and emergency programs, building and environmental management, compliance with laws and regulations and governing entities, risk management, communication, survey, certification, enforcement, quality improvement models and management information systems.

   HOUSEKEEPING/LAUNDRY                         MAINTENANCE

   OTHER (60 hours):                                              TOTAL HOURS             

   TOTAL NUMBER OF HOURS IN AIT TRAINING PROGRAM

   TO BE COMPLETED BY THE SUPERVISING LICENSED NURSING HOME ADMINISTRATOR:

   I certify that the AIT whose signature appears below has agreed to complete this AIT program of             hours under my personal supervision.

   (Signature of Preceptor)

   AL NHA License #

   (Signature of AIT)

Author: Lana Davis, Chairman

Statutory Authority: Code of Ala. 1975, §34-20-9.

History: Amended: January 16, 2001; effective February 20, 2001. Amended: Filed September 11, 2003; effective October 16, 2003. Amended: Filed July 21, 2017; effective September 4, 2017. Amended: Published January 31, 2022; effective March 17, 2022.