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www.erie.gov/fire County of Erie Department of Homeland Security & Emergency Services Division of Fire Safety 2017 NYS OFPC BEFO BASIC EXTERIOR FIREFIGHTING OPERATIONS SCBA/IFO SELF-CONTAINED BREATHING APPARATUS/ INTERIOR FIREFIGHTING OPERATIONS BLENDED LEARNING INTERNET BASED FIREFIGHTER 1 BOOT CAMP STUDENT PACKET V.170418 [PUBLISHED] CONTENTS: Course Details Course Preparation Suggestions Task Oriented Air Consumption Test Details SCBA Face Piece Seal Protection Policy Course Syllabus Letter to Chief and/or Training Officer BEFO/IFO/SCBA/Firefighter 1 Skills Sheet List Student Learning Agreement-BEFO & SCBA/IFO NYS OFPC Training Authorization Form Confidential Medical Information Form Request for Reasonable Accommodations Form

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Page 1: County of Erie Department of Homeland Security & Emergency ... Student... · County of Erie Department of Homeland Security & Emergency Services Division of Fire Safety 2017 NYS OFPC

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w.erie.gov/fire

County of Erie Department of Homeland Security & Emergency Services Division of Fire Safety

2017 NYS OFPC

BEFO BASIC EXTERIOR FIREFIGHTING OPERATIONS

SCBA/IFO SELF-CONTAINED BREATHING APPARATUS/ INTERIOR FIREFIGHTING OPERATIONS

BLENDED LEARNING INTERNET BASED

FIREFIGHTER 1 BOOT CAMP STUDENT PACKET V.170418

[PUBLISHED] CONTENTS:

Course Details

Course Preparation Suggestions

Task Oriented Air Consumption Test Details

SCBA Face Piece Seal Protection Policy

Course Syllabus

Letter to Chief and/or Training Officer

BEFO/IFO/SCBA/Firefighter 1 Skills Sheet List

Student Learning Agreement-BEFO & SCBA/IFO

NYS OFPC Training Authorization Form Confidential Medical Information Form Request for Reasonable Accommodations Form

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2017 Erie County Blended Learning Two-Week Firefighter 1 Boot Camp

BEFO / SCBA/IFO–2016 Edition ERIE COUNTY COURSE#: 1S17005B / NYS OFPC COURSE#: 01-05-0066

COURSE DETAILS:

Course Name This course shall be referred to as the “Erie County Blended Learning Firefighter 1 Boot Camp” course or; alternately as the Blended Learning Two Week BEFO & SCBA/IFO 2016 Edition course.

NOTE: This student packet applies specifically only to the 2017 offering of this two-week blended learning delivery in Erie County NY. While much of the information is similar to the traditional offerings of BEFO / SCBA/IFO; much of it is tailored to this compressed blended learning offering only. Course Description Effective September 1, 2016, the Firefighter 1 course no longer exists as a single course in its entirety. The New York State OFPC Firefighter-1 certification is now delivered in two (2) separate courses. Both will be delivered in succession during this Blended Learning Boot Camp Delivery.

This course is designed for entry level fire department members seeking to become interior structural firefighters who are highly motivated, self-directed student with access to high-speed internet and who can commit to a very aggressive training schedule in a compressed time format.

Students must be available to attend a four-hour orientation session (Week#1), weekend units at Week#3; and two consecutive full weeks of units in Weeks# 8 and 9. Final written and skills evaluation will be performed at the end of Week#9 in person at the Training & Operations Center.

Students will be expected to read three chapters, complete the three respective on-line interactive slide shows and score 80% on three on-line chapter tests each week. On-line assignments must be completed at the specific deadlines and before participation in the in-person skills units. Students will be monitored and assisted by an instructor through email and online forum course contact.

As the initial entry program for firefighting personnel, this combined course introduces firefighting concepts, practices and techniques necessary for the new member to become an interior structural firefighter who can perform under direct supervision of a company officer.

Completion of this course achieves the 21 objectives of Function#4.2 of the NYS OFPC “Recommended Best Practices for FD Training Programs” (01/15) document: (http://www.dhses.ny.gov/ofpc/training/firefighting-best-practices.cfm).

1. BEFO w/HMFRO: ALL students begin with Basic Exterior Firefighting Operations with Hazardous Materials First Responder Operations (Most often represented as “BEFO w/HMFRO”).

This part of the course is designed to prepare students to respond to emergencies as EXTERIOR FIREFIGHTERS. The completion certificate for this course will state: “Basic Exterior Firefighting Operations w/HMFRO”.

2. SCBA/IFO: Students will then progress directly into the SCBA/Interior Firefighting Operations portion of the course (Most often represented as ”SCBA/IFO or SIFO”) to be trained as an Interior Structural Firefighter who will wear a self-contained breathing apparatus. The completion certificate for this course will state: “SCBA/Interior Firefighting Operations-Firefighter 1”.

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NOTE FOR STUDENTS WISHING TO BRIDGE FROM LEGACY COURSES:

Due to the Blended Learning/Boot Camp style of delivery of this course, there is NO bridge available into the SCBA/IFO portion of this course for students who previously completed either the 2015 BEFO; SSO-Scene Support Operations; Basic Firefighter or Firefighting Essentials curriculums. However, they can bridge into a traditional delivery model of the SCBA/IFO course. Course Length This blended learning delivery consists of twenty-six (26) units of on-site skills training and twenty-two (22) units of independent on-line learning; all conducted over a 9-week period. Class Size The minimum number of students required to conduct this course shall be 16. The maximum course size shall be 24. Student Pre-requisites All roster-confirmed students enrolling in this course must:

Obtain the Required Student Textbook prior to attending the first class.

Attend the first (orientation) unit of the course or their seat will be forfeited. Contact the instructor if you are unable to attend the first unit.

Provide proof of completion of an approved CPR course

Provide proof of completion of the Introductory Incident Command Course IS-100 course online at: http://training.fema.gov/emiweb/is/is100b.asp and the Introduction to the National Incident Management System (NIMS) IS-700 course at:https://emilms.fema.gov/IS700aNEW/index.htm and bring both certificates of completion with you to class.

Be physically capable of wearing SCBA and possess medical clearance for SCBA use. Students not possessing the pre-requisite will not be allowed to participate, for their own safety. A completed and signed “Training Authorization Letter” submitted with your course application will meet this requirement.

Have a device to access the internet: desktop, laptop, smart phone, tablet or any device capable of running a web based program.

Bring a completed and signed NYS OFPC Training Authorization Letter with you to the first (orientation) class. (Form is included in this Student Packet or can be downloaded from www.erie.gov/fire).

Students who do not meet the above requirement shall not be enrolled in this course. Syllabus A course syllabus is included in this student packet. Any changes or updates shall be distributed to every student during the first course meeting. Required Student Text Book

The new Firefighter 1 (and Firefighter 2 and BEFO-Basic Exterior Firefighting Operations courses) curriculum are based on the IFSTA/Brady Essentials of Firefighting and Fire Department Operations-6th Edition. This book is required at the first class and they may be purchased at the Fire Safety Office at a cost of $85 each, where your fire company or fire district will be billed by the Erie County Fire Chiefs Mutual Aid Organization. If you are purchasing from other sources – be sure that you are buying the version that includes “Fire Department Operations.”

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Computer Use and Online (Out-of-Class) Activities This course relies heavily on computer use during instructor-monitored online sessions and for completion of online quizzes and activities outside of the classroom.

Required Online Registration: Students must register at the IFSTA Resource1 Learning Management System (LMS) web site: r1.ifsta.org in order to complete required online activities and exams. There is a $40 fee for registration and content on this site, payable thru IFSTA’s Resource 1 website. Students will receive a login confirmation once registered.

Online assignments must be completed by the specific deadlines and before participation in the corresponding in-person skills instruction and evaluation that will occur at the Training & Operations Center during weeks 3, 8 and 9. Any student that does not complete all of the required activities shall not be permitted to take the final exam. Course activities shall be graded as complete or incomplete.

Discussion forum participation is not mandatory but allows the lead instructor to develop a sense of classroom community and make the course content more specific to the students enrolled.

NOTE: Computer use is not required during in-person instruction and evaluation sessions. Therefore, students are asked to be respectful of the instructors and other students, and limit their use of electronic devices during instructional time. Students that are unable to refrain from non-course usage may, solely at the instructor’s discretion, be asked to close, turn off or put away their mobile device and to use it only when necessary.

Grading The following grading policy will be used in this Blended Learning Firefighter 1 course: The minimum passing grade for all tests and exams is 70.00%.

Skill Demonstration and Practice: Is scheduled in proximity to the completion of the appropriate on-line chapters. Online videos of each skill are available on Resource1 for viewing by each student and are linked to the respective chapters.

Tests: Students are required to take a total of nine (9) tests during this course. Each test is

completed online at r1.ifsta.org and allows multiple attempts for students to achieve the highest grade possible. The online program automatically scores the test and enters the score in a downloadable spreadsheet accessible by the lead instructor.

Final Exam: Final written and skills evaluation will be performed at the end of Week#9 in-person at the Training & Operations Center. The course final exam is completed in-classroom and is proctored by a NYS OFPC representative.

Students must pass the final exam with a raw score of 70.00% or higher to pass the course. No student shall be issued a certificate for this course that has not passed the final exam.

Course Failure: A student who fails to achieve a minimum score of 70% will be deemed to have failed the course. The instructor will meet individually with the student to identify and discuss the student’s grade deficiency.

In the event that a student fails the final exam (with a raw score of lower than 70%) the student will be afforded one opportunity to retest at a later date.

Failure to successfully complete the course after one (1) attempted re-test will require the student to have to retake portions of the course. Certificates will not be issued to students who do not successfully complete the course.

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Attendance Students are expected to be in attendance for all class sessions. Students should contact the lead instructor immediately if an absence is anticipated. Individual Training Records An individual training record which denotes completion of each activity and out-of-class activity shall be kept. This record shall also accurately record the average for all tests, scores for each exam, final exam score, and the final course average. Reasonable Accommodations Any student who may need an accommodation for testing based upon the impact of a disability must complete the NYS Division of Homeland Security and Emergency Services “Application to Request Reasonable Accommodation of a Disability” and submit it, with the required supporting documentation, as soon as possible. Accommodations will not be provided without submission of the “Application to Request Reasonable Accommodation of a Disability” and the necessary supporting documentation.

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County of Erie MARK C. POLONCARZ

County Executive

DEPARTMENT OF EMERGENCY SERVICES Division of Fire Safety

3359 Broadway – Cheektowaga NY 14227 716/681-7111 – FAX/681-3645

www.erie.gov/fire

2017 Blended Learning

BEFO/SCBA/IFO/Firefighter 1 Course Preparation Suggestions:

Delivery of this Blended Learning BEFO / SCBA/IFO / Firefighter 1 course will be very labor intensive for both the students and the instructors. Some sections of this course are very physically and intellectually challenging.

If you are not conditioned, you may struggle to get through the evolutions necessary to pass the course. If you are not committed to completing the online and out-of-class activities, you may struggle to demonstrate competency in the required areas of study. While everyone involved is dedicated to ensuring your success, you must be equally dedicated and prepared.

If you have any physical or learning limitations that may impact your successful completion of the course, please make the lead instructor aware of the situation prior to, or at the start of the course.

Following is a list of suggestions to better prepare you before coming to your assigned course:

1. Practice donning/doffing (putting on and taking off) your Personal Protective Equipment (PPE), including gloves and hood. Make sure that the PPE is good fitting and compliant for the fire service.

2. Practice donning and doffing your SCBA on top of your PPE. The national standard we will be striving for is for you to don your complete PPE and SCBA in less than two minutes.

JAMES H. REGER Deputy Commissioner

Fire Safety

EARL R. SCHMITTENDORF Deputy Fire Coordinator

DANIEL J. NEAVERTH JR. Commissioner

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3. All Task Oriented Air Consumption (TOAC) tests are held at the Erie County Emergency Services Training & Operations Center in Cheektowaga.

The air consumption test is not a race, but a test of physical abilities and endurance that establishes a personal benchmark for you to understand just how long a nominal 30 minute air bottle may last you under firefighter working conditions. Instructors will work with you to prepare you to be successful in this training scenario. It consists of eight (8) stations that simulate real firefighter tasks to be completed on the fireground:

1. Hose Carry/Stair Climb 2. Hose Stretch & Hose Pull 3. Tool Lift/Carry 4. Ladder Raise 5. Forcible Entry 6. Search 7. Rescue 8. Ceiling Push/Pull

Recruit Firefighters must complete all eight (8) stations and stay on breathing air for a minimum of 10 minutes. Once all eight (8) stations are completed and the student still has air left in their SCBA cylinder, they will continue to rotate through each station until such time that their air is completely breathed down from their cylinder. Each firefighter is partnered with a shadow/escort who monitors them frequently and records their air consumption and time after each station. Watch this video to learn what will be expected of you and what you should start practicing for: http://www.youtube.com/watch?v=lRo2SnrR9cg&feature=youtu.be

4. View this physical fitness training tip from SFI Scott Janowski at http://www2.erie.gov/fire/index.php?q=content/training-tips-preparing-success-firefighter-1 or download and share this Training Tip with your Chief/Training Officers and Firefighter 1 Candidates.

5. Be sure to always have hydration materials with you and hydrate frequently.

6. All registered students and designated alternates must bring the following items to the first unit of the course:

o Completed and signed NYS OFPC Training Authorization Letter (Form can be downloaded from www.erie.gov/fire)

o IFSTA Essentials of Fire Fighting and Fire Department Operations, 6th Ed. (Available for purchase at the Training & Operations Center)

o Complete set of Personal Protective Equipment including helmet, hood, coat, pants, boots, firefighting gloves in good working condition; and complete SCBA with one extra spare SCBA cylinder (two total). All SCBA bottles must be hydrostatic tested compliant. Face pieces must be fit tested to the student.

o One (1) 15 ft. length of ½” kern mantle rope (no clothes line)

7. Fire departments sending recruits to the Firefighter 1 course are expected to provide equipment, manpower and/or apparatus as requested to assist in the course delivery. Please be sure all equipment has been properly inspected and certified including hose, ladders, pumps etc. See attached class schedule/reading assignments for list of needed equipment.

As of: 3/9/2017

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NYS OFPC Firefighter‐1 Task Oriented Air Consumption Evolution Erie County Training and Operations Center Equipment List 

 

   

Station #1 – Stair Climb – Using indoor tower stairs participants will climb to the top of the 3rd set of stairs 

and return back to the entry door while carrying a 50ft. section of 2 ½” hose packed into a dual stack 

shoulder load approximately 3ft in length.  

Needs: 2 – 50’ sections of 2 ½” hose and duct tape to secure the hose  Participants will read their remote pressure gauge and report their air pressure to their escort who will document the reading and the time after completion of each station’s task.  The escort will need to start the stop watch when the participant begins breathing air from their cylinder and only stops it when the participant exhausts the air from the cylinder and steps off the course. 

 

After the completion of each station, participants will then walk a recovery lap around two cones placed 40’ apart located in the middle of the course.  It is not required to walk a recovery lap between stations 2a and 2b. 

 

Station #2a‐ Hose stretch – The participants will drag an 1 3/4” hose and “sled” to a cone 35’ away and return it to the starting point.  The “sled” contains the remaining 40’ of hose and an additional 30 lbs. of weight in a reinforced milk crate.  The participant will place the attached nozzle and 8’ of hose over their shoulder and across their chest to drag the sled the required distance.  They will then proceed directly to Station 2b without a recovery lap around the cones. 

 

Needs: 1‐ 50’ section of 1 ¾” hose, automatic fog nozzle, milk crate, 30 lbs of weight, two cones and method to secure hose to milk crate 

 

Station #2b – Hose pull – The participant will go down on at least one knee and pull the 1 ¾” hose until the coupling returns to them.  The 1 ¾” hose will be connected to itself and looped around the base of the hydrant located near the North overhead apparatus door.  The coupling will be placed at the furthest distance away from the hydrant. 

 

Needs: 1‐50’ section of 1 ¾” hose and secured fire hydrant or bollard with room for the hose 

coupling to clear as it passes around.  

Station #3 – Saw Carry – The participant approaches the simulated apparatus cabinet and removes each saw from  the  cabinet and places  it on  the ground.  The participant then carries both  saws and walks 75’  to  a marked cone and  returns  to  the  simulated cabinet.  The participant then  returns each of  the  saws  to  the cabinet one at a time. 

 

Needs: 1 – rotary/ rescue saw (preferred 30 lbs  + or – 3 lbs.), fire chain vent saw (preferred 28 lbs. + or – 3 lbs.), simulated apparatus cabinet with shelf 4’ from the ground, one cone located 75’ from the cabinet. 

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Station #4 – Ladder raise – Participant approaches the secured 24’ extension ladder (secured to the simulated window at the end of the floor collapse simulator) and hoists the fly of the ladder all the way up using a hand over hand method without stopping and returns it to the ground in a controlled manner without allowing it to drop. 

 

Needs: 1 ‐24’ fire service extension ladder, brackets to secure the ladder to the wall that would allow the 

fly section to be extended completely out using the halyard.  

Station #5 – Forcible Entry – participants will approach the table with mounted and inflated tire and 

strike the tire with an ten pound sledgehammer until the tire moves from one end of the table and 

returns to its starting point.  

Needs: reinforced table, mounted and inflated truck tire, ten pound sledgehammer.  Station #6 – Search – participants will approach the first floor of the SCBA Maze and follow a right or left hand search pattern preceding 64’ through a darkened search area with obstacles. 

 

Needs: simple pattern arranged in the first floor of the SCBA maze with some obstacles.  The area 

needs to be darkened.  (see attached document for guides to creating obstacles)  

Station #7 – Rescue – Participant approaches the 165 lb. mannequin and drags it 35’ around a cone and 

returns it to the starting point.  

Needs: 165 lb. mannequin, one cone to mark the 35’ distance  Station #8 – Ceiling push/ pull – participant will approach the ceiling breech simulator and complete 2‐ sets 

of 3 repetitions of pushing the ceiling plate up and 5 repetitions of pulling the hook down using a 6’ pike 

pole.  

Needs: ceiling breech simulator, 6 ‘ pike pole without handle. (ceiling push up plate is 60 lbs. and the pull down mechanism is 80 lbs.) 

 

When the participants complete all 8 stations they proceed to station #1 and continue working the course until they run nearly out of air. When they completely expend all of the air in their cylinder, the evolution ends for them.  Each participant’s escort will document the time and air pressure readings and return the document to the Participant for review. Once the participant reviews the document they will give it to the lead instructor. 

 

To keep the flow of participants moving, assign the participants to 5 companies of 4 – 5 participants each. The first company to run the course will be escorted by company 3 members.  This allows company 2 to be prepared to begin the course as soon as company 1 clears the course.  Company 2 will be escorted by company 4.  Company 3 will be escorted by company 5.  Company 4 will be escorted by company 1 who should be ready after their period in rehab.  Company 5 will be escorted by company 2. 

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ERIE COUNTY DIV. OF FIRE SAFETY – TRAINING GUIDELINES SOG# SUPERSEDES CREATED LAST UPDATED REVISION#

1009 --- 03/02 --- 0

SECTION AREA

Training SCBA Face-piece Seal Protection

1009.01 Scope:

This training procedure establishes guidelines for ensuring the safety of training participants with facial hair or other conditions that may impede the SCBA face-piece to face seal.

1009.02 Background:

While it is the responsibility of each firefighter’s employer to ensure their compliance with appropriate OSHA regulations, it is ultimately the responsibility of Erie County Fire Safety Instructors to ensure the safety of all participants.

Thus, it is this division’s policy to enforce compliance with OSHA Respiratory Protection Standard 29 CFR 1910.134 of students participating at county training facilities or under the direction of county fire instructors.

This policy is a reiteration of the above mentioned OSHA standard and OSHA’s standard interpretations of this policy.

1009.03 Seal Protection Policy:

Per the above referenced OSHA standard, students shall not be allowed to wear SCBA or be permitted to participate in evolutions which may expose them to smoke or toxic environments (live fire):

1. If they have facial hair (including beard, goatee or moustache) that comes between the sealing surface of the face-piece and the face, and/or

2. If they have any other condition that may interfere with a proper face to face-piece seal or valve function

This is applicable to fire training situations as well as confined-space training programs.

NYS OFPC Training Administrative Guide

Appendix B-4

Training Policy: Students with Facial Hair (Beards)

Date of Issue: 08/01/96 Current Revision: 9/20/2005

Students with beards or facial hair that may interfere with a proper face mask seal shall not be allowed to wear SCBA or be permitted to participate in evolutions which may expose them to smoke or toxic environments. This is applicable to fire training situations, as well as confined space training programs. State Fire Instructors shall advise students at the start of any class that may involve SCBA use of this policy.

Reference Standards:

29CFR 1910.134 – Facepiece and seal protection.

1910.134(g)(1)(i) – The employer shall not permit respirators with tight-fitting facepieces to be worn by employees who have:

1910.134(g)(1)(i)(A) – Facial hair that comes between the sealing surface of the facepiece and the face or that interferes with valve function; or

1910.134(g)(1)(i)(B) – Any condition that interferes with face-to-facepiece seal or valve function.

NFPA 1500 7.11.8* – Members who have a beard or facial hair at any point where the facepiece is designed to seal with the face or whose hair could interfere with the operation of the unit shall not be permitted to use respiratory protection at emergency incidents or in hazardous or potentially hazardous atmospheres.

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COURSE SYLLABUS

In-Class Unit

Date Topic Reading/ On-line Tests

SFIs Due Date Regular Course

Unit #1

3 hours Saturday 05/20/17

Orientation, registration; Sign on Resource1

2 1

On-Line Assignment

Intro to Fire Service/FD Organization; FF Safety;

Personal Protective Equipment

Ch 1, 2, & 6

One Week after

Orientation Monday 05/29/17

0800

2

On-Line Assignment

FD Communication;

Building Construction; Fire behavior

Ch 3, 4, & 5

Two weeks after

Orientation Monday 06/05/17

0800

4, 5, 6

On-Line Assignment

Portable Fire Extinguishers; Webbing, Ropes & knots; Ground

Ladders

Ch 7, 8, & 12

Three Weeks after

Orientation Saturday 06/10/17

0730

7 & 8

#2 & 3 8 hours

Saturday 06/10/17

0800

PPE Skills; SCBA Donning/Doffing; Fire Extinguisher Skills;

General Review

On-Line assignment due by start

of class

3 Three Weeks

after Orientation

3 & 7

#4, 5, & 6 9 hours

Sunday 06/11/17

0800

Ground Ladder and Rope Skills

3 Three Weeks

after Orientation

9, 10, & 11

On-Line Assignment

Water Supply; Fire Hose;

Fire Streams Ch 14, 15, &

16

Four Weeks after

Orientation Monday 06/19/17

0800

12

On-Line Assignment

Loss Control; Origin &

Cause; Life Safety Initiatives

Ch 10,18, 19, & 21

Five Weeks after

Orientation Monday 06/26/17

0800

15, 16, & 17

On-Line Assignment

Forcible Entry; tactical ventilation; Emergency

Medical Care

Ch 11, 13, & 22

Six Weeks after

Orientation Monday 07/10/17

0800

18 & 20

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In-Class Unit

Date Topic Reading/ On-line Tests

SFIs Due Date Regular Course

Unit

#7 & 8 6 hours

Monday 07/10/17

0800

Hose, water supply, fire stream skills; Hose

Skills 3/4

7 weeks after

Orientation 13 & 14

#9 & 10 6 hours

Tuesday 07/11/17

0800

Forcible Entry Skills; BEFO Final Written &

Skills 3

7 Weeks after

Orientation 19 & 21

#11 & 12 7 hours

Wednesday 07/12/17

0800

Hazardous Materials Activities & Skills; carry

over Skills 3

7 weeks after

Orientation

25 & 3 added

On-Line Assignment

Hazardous Materials Ch 23 & 24

7 weeks after

Orientation Wednesday

07/12/17 0800

22, 23, & 24

On-Line Assignment

Structural Search Ch 9

7 Weeks after

Orientation 07/13/17

0800

IFO 3

IFO- 1 & 2 6 hours

Thursday 07/13/17

0800

Orientation to IFO, PPE Skills; Structure Fire

Search, victim removal 3

7 Weeks after

Orientation IFO 1 & 4

IFO 3, 4, & 5

9 hours

Friday 07/14/17

0800

PPE-Air Consumption #1, Victim removal

down ladder; Survival Skills; Forcible Entry,

tactical vent skills

3/4/3 7 weeks

after Orientation

IFO 5, 6, & 8

On-Line Assignment

Fire Control Ch 17

8 Weeks after

Orientation 07/17/17

0800

IFO 2

Page 13: County of Erie Department of Homeland Security & Emergency ... Student... · County of Erie Department of Homeland Security & Emergency Services Division of Fire Safety 2017 NYS OFPC

In-Class Unit

Date Topic Reading/ On-line Tests

SFIs Due Date Regular Course

Unit

IFO 6 & 7 6 hours

Monday 07/17/17

0800

SCBA Emergencies, TOAC; hose, hose advancement Skills

4/3 8 weeks

after Orientation

IFO 7 & 9

IFO 8 & 9 6 hours

Tuesday 07/18/17

0800

TOAC make-up, Skills review; Vehicle fires

3/4 8 Weeks

after Orientation

IFO 10 & 11

IFO 10 & 11 8 hours

Wednesday 07/19/17

0800 Structural Fires 1 & 2 4

8 Weeks after

Orientation

IFO 12 & 13

IFO 12 & 13 6 hours

Thursday 07/20/17

Initial Company Ops; Final Skills Evaluation

4/3 8 Weeks

after Orientation

IFO 14 & 15

IFO 14 3 hours

Friday 07/21/17

SCBA/IFO Final Written Evaluation/

make-up skills

3 8 Weeks

after Orientation

IFO 16

Friday

07/21/17 1830

GRADUATION

AS OF: 3/9/2017

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County of Erie

MARK POLONCARZ COUNTY EXECUTIVE

DEPARTMENT OF EMERGENCY SERVICES Division of Fire Safety

EMERGENCY SERVICES TRAINING & OPERATIONS CENTER 3359 Broadway – Cheektowaga NY 14227

www.erie.gov/fire – [email protected] 716/681-7111 – FAX/681-3645

Dear Fire Chief and/or Training Officer:

Your firefighter has enrolled in a BEFO/IFO/SCBA Blended Learning Firefighter 1 Boot Camp training course conducted by the New York State Office of Fire Prevention and Control at the Erie County Emergency Services Training & Operations Center.

Together, we strive to give your firefighter the best fire training experience and we are asking for your support during this course to accomplish that goal. Your leadership and guidance will help your firefighter succeed.

A chief or training officer is requested to attend the first two (2) hours [only] of the first orientation unit which provides the student with course requirements, instructor expectations and course completion policies to prepare the student firefighter for the educational tasks ahead. The instructor will also explain any need for your department to occasionally supply equipment, apparatus and/or experienced firefighters to assist in the training of your new firefighter. If you are unable to attend, please send an assistant chief, training officer or other appropriate representative.

Accompanying your firefighter to this orientation lesson will demonstrate your commitment to your firefighter’s training and demonstrate the importance you place on your firefighter being well trained and prepared to perform the best, but most dangerous job in the world.

Please ensure that your firefighter brings a completed and signed New York State Office of Fire Prevention and Control Training Authorization letter. That letter must be signed by a chief officer stating the student has completed a mask fit test and received medical clearance for S.C.B.A. use. This form is included in the 2017 Firefighter 1 Student Packet or can be downloaded from the Erie County Fire Safety web site at http://www.erie.gov/fire.

JAMES H. REGER Deputy Commissioner

Fire Safety

EARL R. SCHMITTENDORF Deputy Fire Coordinator

DANIEL J. NEAVERTH JR. Commissioner

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REGARDING THE AIR CONSUMPTION TEST:

Details of what is included in the Task Oriented Air Consumption test are included in this 2017 Firefighter 1 Student Packet. We encourage you and your student to watch the video we created to learn what will be expected of each student and what they should start practicing for: http://www.youtube.com/watch?v=lRo2SnrR9cg&feature=youtu.be

The air consumption test is not a race, but a test of physical abilities and endurance that establishes a personal benchmark for the firefighter to understand just how long a nominal 30 minute air bottle may last them under firefighter working conditions. Instructors will work with each student to prepare them to be successful in this training scenario.

Recruit Firefighters must complete all eight (8) stations and stay on breathing air for a minimum of 10 minutes. Once all eight (8) stations are completed and the student still has air left in their SCBA cylinder, they will continue to rotate through each station until such time that their air is completely breathed down from their bottle. Each firefighter is partnered with a shadow/escort who monitors them frequently and records their air consumption and time after each station.

Review the student packet, check out the video and start preparing your candidate. Please share with all existing and future Firefighter 1 students.

REGARDING SKILLS: There are a total of (68) skills to be completed during the Firefighter 1 program. We encourage you to use these skill sheets as a tool to make your Firefighter 1 candidate a better firefighter for you. You and your firefighter can also access videos of the skills and other free training resources online at www.r1.ifsta.org. Please take the time to ensure your candidate knows the skills. The instructors may choose to evaluate the candidates on a portion of these skills during the course and any of these skills may be chosen for the final skills evaluation to be held at the end of the course.

In the meantime, please do not hesitate to contact us or the lead instructor should you have any questions or require further information. Thanks in advance for your cooperation and commitment to the success of your firefighter student.

Course Coordinators: Bill Taylor – Fire Protection Specialist Tiger Schmittendorf – Deputy Fire Coordinator NYS Office of Fire Prevention & Control Erie County Division of Fire Safety 518.380.0547– [email protected] 716.681.7111 – [email protected]

As of: 3/15/2017

Page 16: County of Erie Department of Homeland Security & Emergency ... Student... · County of Erie Department of Homeland Security & Emergency Services Division of Fire Safety 2017 NYS OFPC

NYS Basic Exterior Firefighting Operations 2016 Edition w/ HMFRO

Skills Sheets by BEFO Unit [2016 Edition]  

TO BE COMPLETED AT HOME DEPARTMENT  

Skill 2-I-1 Respond on an Apparatus to an Emergency Scene- Due Unit 4 Skill 2-I-2 Operate in Established Work Area at Emergency Scene- Due Unit 4 Skill 6-I-8, 9 Filling SCBA Cylinder Due Unit 4 Skill 8-I-1 Clean and Inspect Rope Due Unit 8 Skill 10-I-1 Emergency Scene Illumination Due Unit 16 Skill 11-I-1 Hand Tool Maintenance Due Unit 19 Skill 11-I-2 Power Tool Maintenance Due Unit 19 Skill 12-I-1 Clean, Inspect, and Maintain a Ladder Due Unit 9 Optional Skill 15-I-10, 14 Loading/ Advancing a Triple-Layer Load (use if FD utilizes Load) Due Unit 14 Optional Skill 15-I-11, 14 Loading/ Advancing a Pre-Connected Minuteman Load (use if FD utilizes Load) Due Unit 14  

UNIT 3  

Skill 6-I-1 Donning Personal Protective Equipment Skill 6-I-6, 7 Inspection, Cleaning, and Sanitizing of SCBA Skill 6-I-10 One-person SCBA bottle change Skill 6-I-11 Two-person SCBA bottle change   

Unit 7  

Skill 7-I-1, 2, 3 Operating Portable fire extinguishers  

  

Unit 9, 10, & 11  

Skill 8-I-2 to 12 Knots Skill 8-I-13 to 18 Hoisting Tools and Equipment Skill 12-I-2 Single FF- Single Ladder- Low Shoulder Carry Skill 12-I-3 Two Firefighter – Low Shoulder Carry Skill 12-I-4 Three FF- Flat Shoulder Carry Method Skill 12-I-5 Three FF – Flat Arm Carry Skill 12-I-6 Two FF Arm’s Length on Edge Carry Method Skill 12-I-8, 17 One FF Beam Raise a Ladder, leg lock Skill 12-I-7, 9 Two FF Flat Ladder Raise, Tie a Halyard Skill 12-I-10, 16 Two FF Beam Raise, Heel a Ladder   

Unit 13  

Skill 15-I-1, 2 Basic Hose Use Skill 15-I-3, 4 Rolling Hose

   

Unit 14  

Skill 14-I-1, 2; 15-I-12, 13 Hydrant Connection & Operation Skill 14-I-3, 4 Deploy a Portable Tank and Static Suction Line Skill 15-I-5 Loading a Flat Load Skill 15-I-9, 14 Loading/ Advancing a Pre-Connected Flat Load Skill 15-I-24, 25 Large Hose Line Operation Skill 15-I-26, 27 Replacing a Burst Hoseline/ Extend a Hoseline Skill 16-I-1, 2, 3 Operating a Nozzle Skill 17-I-7 Deploy Master Stream Device 

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Unit 15 Skill 18-I-1, 2, 3 Roll, Spread, Clean and Inspect a Salvage Cover- 1 FF Method Skill 18-I-6, 7 Salvage Cover Fold and Balloon Toss Spread- 2 FF Method Activity 18-I-8 Construct a Water Chute Activity 18-I-9 Construct a Water Chute with pike poles Activity 18-I-10 Construct a Catchall Activity 18-I-11 Attach a chute into a catchall  

Unit 19

Skill 11-I-3 to 8 Forcible Entry Skills

Unit 20

Skill 9-I-3, 5, 6, 7 Victim carries and drags Skill 9-I-17 Placing a patient on a backboard and stokes basket

Unit 24

Activity 24-I-7 Diversion Activity 24-I-8 Retention Activity 24-I-9 Dilution Activity 24-I-10 Vapor Dispersion Activity 24-I-11 Remote Valve Shut Off

Unit 25

Skill 24-I-1 Identify hazards using NAERG Skill 24-I-2 Perform emergency decontamination of victim Skill 24-I-12 Using air monitor   

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ANDREW M. CUOMO Governor 

JOHN P. MELVILLE Commissioner, DHSES 

BRYANT D. STEVENS State Fire Administrator 

 

 1220 Washington Avenue, Bldg. 7A, Fl. 2, Albany, NY 12226 │ 518.474.6746 │www.dhses.ny.gov/ofpc

Dear Chief or Training Officer, 

The 2016 edition of Basic Exterior Firefighting Operations (BEFO) has been updated to meet the PESH Best Practices for 

exterior firefighter and the 2013 Ed. of NFPA 1001.  In order to accomplish this task, more time was added to skills nights 

to accommodate necessary skills.  However, nine of these skills are better accomplished at your fire station using the 

firefighter’s home equipment in a manner that best suits the guidelines of their department.  Skills 15‐I‐10 and 15‐I‐11 

[hose loads] are optional and do not have to be completed if the department does not use them.  We encourage you to 

use these skill sheets as a tool to make your BEFO candidate a better firefighter for you.   

The skills are explained in the skill sheets that each candidate will receive in Unit 1 and further explained in the IFSTA 

Essentials of Fire Fighting and Fire Department Operations, 6th Ed. textbook.  You and your firefighter can also access 

videos of the skills online at www.r1.ifsta.org.  

Please contact the lead State Fire Instructor if there are any questions regarding these skill sheets or the means used to 

complete them.  Please take the time to ensure your candidate knows the skills.  The Instructors may choose to evaluate 

the candidates on a portion of these skills during the course and any of these skills may be chosen for the final skills 

evaluation to be held at the end of the course. 

Skill 2‐I‐1    Respond on an Apparatus to an Emergency Scene    Due Unit 4 Skill 2‐I‐2    Operate in Established Work Area at Emergency Scene  Due Unit 4 Skill 6‐I‐8, 9    Filling SCBA Cylinder          Due Unit 4 Skill 8‐I‐1    Clean and Inspect Rope          Due Unit 8 Skill 10‐I‐1    Emergency Scene Illumination        Due Unit 16 Skill 11‐I‐1    Hand Tool Maintenance          Due Unit 19 Skill 11‐I‐2    Power Tool Maintenance          Due Unit 19 Skill 12‐I‐1    Clean, Inspect, and Maintain a Ladder      Due Unit 9 Skill 15‐I‐10, 14    Loading/ Advancing a Triple‐Layer Load [OPTIONAL]    Due Unit 14 Skill 15‐I‐11, 14    Loading/ Advancing a Pre‐Connected Minuteman Load [OPTIONAL]  Due Unit 14 

 

    

 

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NYS SCBA/ Interior Firefighting Operations  

Skills Sheets by SCBA/ IFO Unit [2016 Edition]  

 

UNIT 4  

Skill 6‐I‐2, 3, 4    Donning Self‐Contained Breathing Apparatus Skill 6‐I‐5    Doffing Personal Protective Equipment and SCBA Skill 9‐I‐1    Conduct a primary search in a structure Skill 9‐I‐4    Interior firefighter drags   

Unit 5  

Skill 6‐I‐12    Air Consumption Exercise Part 1 Skill 12‐I‐18    Assist a Conscious Victim Down a Ground Ladder Skill 12‐I‐19    Cradle Carry an Unconscious Victim down a Ground Ladder  

 

Unit 6  

Skill 9‐I‐8    Calling the Mayday Skill 9‐I‐11    Low Profile Wall Breach Skill 9‐I‐11 A    Full Escape Maneuver  Skill 9‐I‐12    Reverse Swim Dive Maneuver Skill 9‐I‐12 A    Swim Dive Maneuver  Skill 9‐I‐14    Disentanglement Maneuver Skill 9‐I‐15    Follow Hoseline Skill 9‐I‐16    Window Hang and Drop  

Unit 7  

Skill 6‐I‐12    Air Consumption Exercise Part 2 Skill 9‐I‐9    SCBA Emergency Procedures  

 Unit 8 

 

Skill 11‐I‐3 to 8    Forcible Entry Skills Skill 13‐I‐1, 2    Negative Pressure Ventilation Skill 13‐I‐3    Positive Pressure Ventilation Skill 13‐I‐5 to 8    Vertical Roof Ventilation Skill 12‐I‐12    One FF Roof Ladder Deployment  

Unit 10‐ Skills Review  

Skill 6‐I‐12    Air Consumption Exercise Part 2 – MAKE‐UP if necessary   

Unit 11  

Skill 17‐I‐8    Passenger Vehicle Fire  

Unit 12  

Skill 17‐I‐1B    Company Operations/ Coordinated Attack‐ Structure Fire #1  

Unit 13  

Skill 17‐I‐1A    Transitional to Interior Attack‐ Structure Fire #2 

 

Page 20: County of Erie Department of Homeland Security & Emergency ... Student... · County of Erie Department of Homeland Security & Emergency Services Division of Fire Safety 2017 NYS OFPC

 

ANDREW M. CUOMO Governor 

JOHN P. MELVILLE Commissioner, DHSES 

BRYANT D. STEVENS State Fire Administrator 

 

 1220 Washington Avenue, Bldg. 7A, Fl. 2, Albany, NY 12226 │ 518.474.6746 │www.dhses.ny.gov/ofpc

NYS Office of Fire Prevention and Control

Combined Basic Exterior Firefighting Operations (BEFO) & SCBA/ Interior Firefighting Operations-Firefighter-1- Blended Learning (Internet based)

Learning Agreement

The combined blended learning course is designed to prepare entry-level department members to respond to emergencies and perform as interior-structural firefighters under the direct supervision of a company officer. Completion of both courses is designed to accomplish the objectives of the PESH Best Practices document, NFPA 1001 and NFPA 472 and trains the entry level firefighter as an interior structural firefighter as defined by OSHA regulations 1910.156 Fire Brigade Standard, 1910.120 Emergency Response to Hazardous Materials, 1910.146 Confined Space Entry Standard (awareness level) and the 1910.147 Control of Hazardous Energy Standard. A student enrolled in this course must be a highly motivated, self-directed student with access to high speed internet who can commit to a very aggressive training schedule in a compressed time format. Students are expected to read three chapters, complete the respective on-line interactive slide shows and score at least 70% on three on-line chapter tests each week for 8 weeks. Students will be monitored and assisted by an instructor through email and on-line course contact. Corresponding skills instruction and evaluation will occur at a training facility during weeks three, eight and nine. Students must be available to attend a four-hour orientation session, weekend units at week three and full week of units in week eight and nine. Final written and skills evaluation will be performed at the end of week nine in person at the training facility.

Successful completion of this course requires that the student complete all portions of the course as assigned to include passing the on-line course testing and on-site written testing (on-line interactive lessons, on-line end of chapter tests, Hazardous Materials First Responder Operations exam, BEFO final exam and SCBA/ IFO final exam) with at least a 70% passing grade, successfully demonstrate all associated skills, and attend all hands-on and testing sessions.

Student Attendance: All sessions must be attended. It is critical that the student attend the course sessions on time as scheduled due to the time frame required to accomplish all skill requirements. The Lead Instructor must be notified in the event of non-attendance or lateness,

Student Obligations: Students are provided with a copy of the Combined BEFO & SCBA/ IFO- Firefighter-1- Blended Learning course Schedule. Students shall arrive on time having completed the required reading, online work, and skills practice for each lesson. All students shall bring with them to class: personal protective equipment including SCBA and other designated items as listed below. On-line Assignments: Students will read the assigned chapter in the textbook, complete the respective chapter SCORM package lesson on the Resource One website, and score at least 70% on the corresponding on-line IFSTA chapter test. On-line assignments must be completed by the specified date and time as indicated on the course schedule. Students will NOT be allowed to participate in the on-site skills sessions unless they have completed the respective on-line assignments.

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ANDREW M. CUOMO Governor 

JOHN P. MELVILLE Commissioner, DHSES 

BRYANT D. STEVENS State Fire Administrator 

 

 1220 Washington Avenue, Bldg. 7A, Fl. 2, Albany, NY 12226 │ 518.474.6746 │www.dhses.ny.gov/ofpc

The following non-OFPC courses are out of class assignments required to be completed by SCBA/ IFO Unit 12 to receive a course completion certificate:

FEMA ICS-100b Basic Incident Management http://training.fema.gov/emiweb/is/is100b.asp FEMA IS-700a National Incident Management System course

http://training.fema.gov/emiweb/is/is700a.asp Current Cardio Pulmonary Resuscitation (CPR) course certification NYS OFPC accepts CPR courses

conducted by the American Red Cross (ARC), American Heart Association (AHA), the American Safety and Health Institute (ASHI), and the National Safety Council (NSC). Other CPR courses may be approved by the Fire Operations and Training branch Deputy Chief.

On-site Written Evaluations: All students will be given three on-site written evaluations. The BEFO final written evaluation will be administered in BEFO unit 10. The Hazardous Materials First Responder Operations evaluation will be given during BEFO Unit 12 of the course. The SCBA/ IFO- Firefighter-1 final written evaluation will be administered during the final unit 14 of the SCBA/ IFO section of the course. All of these evaluations must be completed with a grade of 70% or better. Students must pass these three evaluations to receive credit for the course. If a student fails any of the written evaluations, they will be allowed to re-test at the convenience of the instructor. If the instructor cannot provide a make-up evaluation, the student will have to retake the evaluation in another class. Physical Fitness: All students must be fit enough to safely demonstrate the required skills. Students must have been determined to be fit for interior structural firefighting and have medical clearance to use Self-Contained Breathing Apparatus (SCBA) in accordance with 29 CFR 1910.134 which includes passing an SCBA mask fit test for their assigned face piece (OFPC Training Authorization Letter). Students will be training in an IDLH atmosphere during the course. Practical Skills Evaluations: Every student shall successfully demonstrate all skills. If a student cannot successfully demonstrate a skill, the instructor may elect to provide another opportunity to demonstrate that particular skill before the end of IFO unit 14. Additionally, the student’s fire company or department will be required to support the student through providing apparatus, operators, and EMS support at designated lessons. I __________________________________, understand that I am responsible for the following and that I agree to do my best to meet and exceed these performance expectations:

Bring these items to class as directed- - Complete Firefighter’s personal protective clothing

- Self-Contained Breathing Apparatus (SCBA) with 1 spare cylinder

- FD specific SCBA Inspection form

- At least 32 oz. of water in sport bottle or similar

Page 22: County of Erie Department of Homeland Security & Emergency ... Student... · County of Erie Department of Homeland Security & Emergency Services Division of Fire Safety 2017 NYS OFPC

 

ANDREW M. CUOMO Governor 

JOHN P. MELVILLE Commissioner, DHSES 

BRYANT D. STEVENS State Fire Administrator 

 

 1220 Washington Avenue, Bldg. 7A, Fl. 2, Albany, NY 12226 │ 518.474.6746 │www.dhses.ny.gov/ofpc

- Pen or pencil and notebook or other materials for note-taking

- 1- 8 ft. piece of rope ( not firefighter self-escape rope) 1/2” in diameter

- 1- 15 ft. piece of 1” tubular webbing

- IFSTA/ Brady Essentials of Firefighting and Fire Department Operations, 6th edition

Performance Expectations:

• Make reasonable, safe decisions when attempting to accomplish a task or solve a problem

• Be courteous and respectful; use the appropriate tone of voice • Handle interpersonal conflicts effectively • Articulate in a clear, logical and understandable manner • Display confidence • Be persuasive and makes a positive impression • Effectively work with others in order to accomplish tasks or solve problems • Consistently demonstrate safe practices for self and others • Approach problems in a safe, logical, and well thought-out fashion • Seek pro-active solutions to problems • Accomplish tasks or goals without being ordered, coerced or motivated by

others • Actively seek academic and technical knowledge for self-improvement • Adapt behavior in order to deal with changing situations in a safe manner • Adapt behavior in order to accomplish individual and or/organizational goals • Be sincere and honest when dealing with others • Keep commitments • Respect personal property of others/their departments • Obey all policies of the Office of Fire Prevention & Control and the hosting

agency

I have read and understand all the above policies. I also understand that I will be removed from class and not be able to continue in the course if I do not abide by these performance expectations. Student Signature_____________________________________ Date_____________ Instructor Signature____________________________________ Date_____________ Chief Officer Signature_________________________________ Date_____________ 

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Respond on an Apparatus to an Emergency Scene

 NFPA 1001 [2013] - 5.3.2, 5.3.3

 

 

NYS DIVISION OF HOMELAND SECURITY & EMERGENCY SERVICES NYS Skill Sheet 2-I-1  

Candidate's Name Date Evaluator's Name Evaluator's Signature  

The firefighter, given a set of turnout gear, shall demonstrate safely responding to an emergency scene aboard a fire

department apparatus and correctly dismount the apparatus at a high flow traffic emergency scene, as outlined in

IFSTA Essentials of Fire Fighting and Fire Department Operations, 6TH ed.  

 

Criteria: DEPT INSTR

Mounting    

Determine that vehicle is NOT in motion    

Mount fire apparatus using handrails and steps keeping three points of contact    

Close door, safety bar, gate top cab or compartment    

Secure loose items according to FD SOP    

Sit, fasten seat belt and notify driver    

Dismounting    

Wait for orders before leaving the apparatus    

Ensure that vehicle is completely stopped before disconnecting restraints and preparing to leave the apparatus

   

Prepare to dismount on the downstream or curb side of the apparatus if possible    

LOOK for traffic approaching from both directions through window    

Partially open the door and check for traffic before dismounting    

Exit apparatus when safe to do so and safely dismount from apparatus using handrails and steps keeping three points of contact

   

Close door [if present] assuring that you are in a protected area    

  INITIAL INITIAL

  

REQUIRES HOME DEPARTMENT SIGN OFF 

Evaluator Notes: 

01‐2015 

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Operate in Established Work Areas at an

Emergency Scene  

NFPA 1001 [2013] - 5.3.3  

 

NYS DIVISION OF HOMELAND SECURITY & EMERGENCY SERVICES NYS Skill Sheet 2-I-2  

Candidate's Name Date Evaluator's Name Evaluator's Signature  

The firefighter will demonstrate scene management at roadway incidents using traffic and scene control devices while wearing appropriate PPE, including reflective vest as outlined in IFSTA Essentials of Fire

Fighting and Fire Department Operations, 6TH ed. 

 

Criteria: DEPT INSTR

Firefighter dons appropriate Personal Protective Equipment (PPE), including Reflective vest and exits the apparatus after observing traffic and continually observes upstream vehicle traffic.

   

Set up traffic cones and/or flares and scene control devices appropriate to the assignment following local procedures (must first check area for flammable material before using flares).

   

Set up established work areas.  

Performs tasks as directed to complete the assignment.  

Follows local procedures for highway incidents.  

Remove traffic cones and scene control devices.  

  INITIAL INITIAL

  

REQUIRES HOME DEPARTMENT SIGN OFF 

Evaluator Notes: 

01/2015

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Inspection, Cleaning and Sanitizing of SCBA

  NFPA 1001 [2013] - 5.3.2, 5.5.1 

 

NYS DIVISION OF HOMELAND SECURITY & EMERGENCY SERVICES NYS FFI Skill Sheet 6-I-6, 6-I-7  

Candidate's Name Date Evaluator's Name Evaluator's Signature  

The candidate, given an SCBA, shall inspect the SCBA, identify and correct any problems found, and state the cleaning procedures for the SCBA as outlined in IFSTA Essentials of Fire Fighting and Fire Department Operations, 6TH ed.

 

Criteria: DEPT INSTR

Identify all components are present: harness assembly, cylinder, facepiece and PASS device

   

Inspect all components of SCBA for cleanliness and damage    

Immediately clean dirty components if found. If damage is found, remove from service and report to company officer

   

Check that cylinder is full [90‐100 percent of capacity]    

Open cylinder valve slowly:  verify operation of low pressure alarm[if equipped] and no audible air leaks

   

Verify that gauges and indicators [heads‐up display] provide similar results within manufacturer’s recommendations

   

Check function of all modes of PASS device.    

Don facepiece over the head and securely tighten the straps, pulling straight back. *     

Test facepiece for seal and proper operation of exhalation valve. *     

Don regulator and check function by taking several breaths. Check bypass and purge. *     

Remove facepiece and prepare all components for immediate reuse. *     

Prepare cleaning solutions, buckets etc. According to manufacturer’s recommendations and department policies 

   

Clean all components of SCBA unit according to manufacturer’s recommendations and department policies 

   

Place all components in a manner and location so they will dry     

Assemble components so they are in a state of readiness     

* NOT FOR BEFO STUDENTS  INITIAL INITIAL

  

REQUIRES HOME DEPARTMENT SIGN OFF 

Evaluator Notes:

Page 26: County of Erie Department of Homeland Security & Emergency ... Student... · County of Erie Department of Homeland Security & Emergency Services Division of Fire Safety 2017 NYS OFPC

Filling a SCBA Cylinder  NFPA 1001 [2013] – 5.3.1

 

NYS DIVISION OF HOMELAND SECURITY & EMERGENCY SERVICES NYS Skill Sheet 6-I-8, 6-I-9  

Candidate's Name Date Evaluator's Name Evaluator's Signature  

The candidate, given an SCBA, shall demonstrate the correct procedure for filling an SCBA cylinder, both by using a

compressor and a cascade system, as outlined in IFSTA Essentials of Fire Fighting and Fire Department Operations,

6TH ed. 

 

Criteria: DEPT INSTR

ALL CYLINDERS  

Checks hydrostatic test date of cylinder; removes from service if out of date    

Inspects cylinder for physical damage and place in fragmentation containment device    

Connects fill hose to cylinder; closes bleed valve, if equipped    

Opens SCBA cylinder valve [if necessary]    

COMPRESSOR SYSTEM FILL  Operates compressor/purifier system according to manufacturer's instructions and specifications

   

Opens compressor/purifier system outlet valve    

Sets cylinder pressure on compressor/purifier system to correct pressure for cylinder    

Opens manifold valve and confirms cylinder pressure setting    

Opens fill station valve to begin filling cylinder    

Observes cylinder gauge to ensure fill rate of 300-600 psi per minute and control to avoid overheating/chattering.

   

CASCADE SYSTEM FILL  

Opens cascade system manifold or fill hose valve    

Opens cascade system valve with lowest pressure    

Observes cylinder gauge to ensure fill rate of 300-600 psi per minute and control to avoid overheating/chattering

   

Closes cascade valve when pressure equalizes    

If cylinder is not full, opens cascade valve on cylinder with next highest pressure. Continue until cylinder is full

   

ALL CYLINDERS    

Closes SCBA cylinder valve [if necessary]    

Opens system filler hose bleeder valve and bleeds-off excess pressure    

Disconnects system fill hose from cylinder    

Removes SCBA cylinder from fragmentation containment and returns to service    

Evaluator notes:  INITIAL INITIAL

 

REQUIRES HOME DEPARTMENT SIGN OFF 

01‐2015 

Page 27: County of Erie Department of Homeland Security & Emergency ... Student... · County of Erie Department of Homeland Security & Emergency Services Division of Fire Safety 2017 NYS OFPC

Clean and Inspect Ropes  

NFPA 1001 [2013] - 5.5.1  

 

NYS DIVISION OF HOMELAND SECURITY & EMERGENCY SERVICES NYS Skill Sheet 8-I-1 

Candidate's Name Date Evaluator's Name Evaluator's Signature  

The firefighter, given fire department ropes and cleaning supplies, shall demonstrate properly cleaning and visually checking fire department life safety or utility rope, in accordance with the manufacturer’s directions and as outlined in IFSTA Essentials of Fire Fighting and Fire Department Operations, 6TH ed. JPR 8‐I‐1 

 

Criteria: DEPT INSTR

Examine entire surface of the rope for cuts, abrasions, stains, or fraying.    

Examine the inner component of the rope by twisting the rope for laid rope OR feeling for bunching and narrowing of rope diameter for kernmantle constructed rope.

   

Verbally explain how to tag and/ or remove damaged rope from service when asked by the evaluator.

   

Clean rope using clear water only if synthetic rope.    

Allow rope to dry completely, or state rope must be allowed to dry.    

Perform additional inspection after drying.    

Properly store rope using coil method or rope bag storage.    

  INITIAL INITIAL

 

 

REQUIRES HOME DEPARTMENT SIGN OFF 

Evaluator Notes 

01/2015 

Page 28: County of Erie Department of Homeland Security & Emergency ... Student... · County of Erie Department of Homeland Security & Emergency Services Division of Fire Safety 2017 NYS OFPC

Emergency Scene Illumination

 NFPA 1001 [2013] - 5.3.17

 

 

NYS DIVISION OF HOMELAND SECURITY & EMERGENCY SERVICES NYS Skill Sheet 10-I-1  

Candidate's Name Date Evaluator's Name Evaluator's Signature  

The candidate, given a complete set of PPE and a portable electric generator, electric extension cords, and portable lighting equipment, employing all safety precautions and operating individually, shall illuminate an area(s) as directed by the evaluator in accordance with IFSTA Essentials of Fire Fighting and Fire Department Operations, 6th ed.

 

Criteria: DEPT INSTR

Considers grounding of generator [may be verbalized]    

Assures generator readiness and performance [checks fuel/oil]    

Identifies limitations of power supply equipment [load cannot exceed amperage of circuit breaker, total load cannot exceed output of generator, and fuel dependent]

   

Identifies hazards associated with electric generating equipment [wet environment, tight connections, and ventilation of exhaust]

   

Operates equipment within manufacturer’s guidelines    

Illuminates area(s) as directed    

Clean equipment as needed and remove damaged equipment from service and report to company officer.

   

Refuel powered equipment as needed and return to service.    

  INITIAL INITIAL

  

REQUIRES HOME DEPARTMENT

Evaluator Notes: 

01‐2015

Page 29: County of Erie Department of Homeland Security & Emergency ... Student... · County of Erie Department of Homeland Security & Emergency Services Division of Fire Safety 2017 NYS OFPC

Hand Tool Maintenance  

NFPA 1001 [2013] - 5.5.1

 

 

NYS DIVISION OF HOMELAND SECURITY & EMERGENCY SERVICES NYS Skill Sheet 11-I-1  

Candidate's Name Date Evaluator's Name Evaluator's Signature  

The firefighter, given fire department selected hand tools and cleaning and maintenance supplies, shall demonstrate properly cleaning and visually checking fire department hand tools, in accordance with the manufacturer’s directions and as outlined in IFSTA Essentials of Fire Fighting and Fire Department Operations, 6TH ed.  

 

Criteria: DEPT INSTR

Wood handles    

Check for cracks, blisters, or splinters    

Sand off any splinters, if needed    

Clean with soapy water, rinse, and dry after use    

Apply coat of boiled linseed oil to the handle if needed    

Check to ensure head of tool is on tight    

Fiberglass handles    

Wash with warm soapy water    

Dry with soft, dry cloth    

Check to ensure head of tool is on tight    

Metal heads and parts    

Checks to ensure cutting edge and striking surfaces are free of chips, burrs or unintended flat spots

   

Files the edges by hand using a flat file (does NOT over sharpen cutting edge)    

Remove any dirt or rust with steel wool or emery cloth    

Applies light machine oil to metal surfaces not used for striking surface    

Check to ensure head of tool is on tight    

  INITIAL INITIAL

  

REQUIRES HOME DEPARTMENT SIGN OFF 

Evaluator Notes 

01‐2015 

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01/2015

Power Tool Maintenance  

NFPA 1001 [2013] - 6.5.2

 

 

NYS DIVISION OF HOMELAND SECURITY & EMERGENCY SERVICES NYS Skill Sheet 11-I-2  

Candidate's Name Date Evaluator's Name Evaluator's Signature  

The candidate, given a complete set of PPE shall demonstrate cleaning and maintenance of given power equipment, according to manufacturer’s recommendations and in accordance with IFSTA Essentials of Fire Fighting and Fire Department Operations, 6TH ed.  

 

Criteria: DEPT INSTR

Can operate all supplied equipment within manufacturer’s guidelines [changing saw blades/chains]

   

Identifies correct fuel and lubricants for supplied power equipment    

Demonstrates fueling and lubricating supplied power equipment    

Demonstrates cleaning procedures for supplied power equipment    

Identifies procedures for reporting defective equipment [verbalized]    

Performs rudimentary preventative maintenance [filter replacement, spark plug replacement, belt replacement, and tightening nuts/bolts]

   

  INITIAL INITIAL

  

REQUIRES HOME DEPARTMENT SIGN OFF 

Evaluator Notes:

Page 31: County of Erie Department of Homeland Security & Emergency ... Student... · County of Erie Department of Homeland Security & Emergency Services Division of Fire Safety 2017 NYS OFPC

Clean, Inspect, and Maintain a Ladder

 NFPA 1001 [2013] - 5.5.1

 

 

NYS DIVISION OF HOMELAND SECURITY & EMERGENCY SERVICES NYS FFI Skill Sheet 12-I-1  

Candidate's Name Date Evaluator's Name Evaluator's Signature  

Description: Students will clean, inspect, and maintain a ladder as described in IFSTA Essentials of Fire Fighting and Fire Department Operations, 6TH ed. following their departmental procedures and manufacturer’s guidelines when cleaning, inspecting, and maintaining ladders. Students can refer to pages 690 & 691 for reference.

Equipment Needed: Ladder[s] to be cleaned and inspected, Manufacturer-recommended cleaners and lubricants, Stiff-bristled brush, garden hose, wash bucket, sawhorses, dry cloths, chalk or grease pen, and ladder log.

 

 

Criteria: DEPT INSTR

Clean    

Place the ladder flat on the sawhorses, lifting and carrying appropriately.    

Clean all parts of the ladder with scrub brush and cleaning solution, removing greasy residues with approved cleaners.

   

Rinse the ladder thoroughly with clean water. Dry the ladder thoroughly with clean, dry cloths.

   

Inspect   Inspect each part of the ladder, noting any: a. Looseness b. Cracks or dents c. Unusual wear d. Bent rungs or beams e. Heat damage, deformities or change in sensor label.

   

Circle any defects found with chalk or grease pen.

Inspect the ladder halyard (extension ladders) for: a. Fraying or kinking b. Snugness of cable when in bedded position

Inspect all movable parts (extension, roof, and pole ladders).

Maintain

Lubricate parts as needed and per manufacturer’s guidelines.

Replace halyard if necessary.

Tag and remove from service for any conditions that cannot be corrected with cleaning, inspection, and simple maintenance. Notify office.

Record cleaning, inspection, and maintenance performed.

INITIAL

Evaluator notes on back: 01/2015

REQUIRES HOME DEPARTMENT SIGN OFF 

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01/2015 

Basic Hose Use 

NFPA 1001 [2013] - 5.3.10, 5.5.2, 5.1.1.2, 5.3.1  

 

NYS DIVISION OF HOMELAND SECURITY & EMERGENCY SERVICES NYS Skill Sheet 15-I-1, 15-I-2  

Candidate's Name Date Evaluator's Name Evaluator's Signature  

The candidate, given appropriate PPE, will couple and uncouple hose in both a one and two firefighter method, inspect

and maintain hose, and drain and carry the hose in accordance with IFSTA Essentials of Fire Fighting and Fire

Department Operations, 6TH ed. JPR 5.3.10, 5.5.2  

The lime limit for this skill is 30 minutes:

Criteria: DEPT INSTR

COUPLE – ONE-FIREFIGHTER METHOD    

Braces male coupling    

Attaches female coupling    

COUPLE – TWO-FIREFIGHTER METHOD    

FF 1 holds the male coupling with Higbee indicator visible    

FF 2 holds the female coupling, aligns Higbee indicators    

FF 2 connects the couplings while FFI holds the male coupling still    

UNCOUPLE    

Reverse above tasks    

HOSE INSPECTION AND MAINTENANCE    

Check couplings: gaskets, debris, threads, damage    

Check hose surface (both sides): debris, abrasion, burns, other damage    

SINGLE HOSE SECTION DRAIN AND CARRY    

Picks up one coupling and places in belly area

Coupling rests approximately at the hips

Holds hose in front of self with both hands

Feeds hose over shoulder, alternating loops in front and back, while walking

Candidate walks under hose without dragging hose

Each loop does not extend past candidate’s knee

Both couplings are held in front of body when finished

Hose remains on candidate’s shoulder throughout procedure

INITIAL INITIAL

Evaluator Notes on back: 

REQUIRES HOME DEPARTMENT SIGN OFF 

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01/2015 

Rolling Hose 

NFPA 1001 [2013] - 5.5.2  

 

NYS DIVISION OF HOMELAND SECURITY & EMERGENCY SERVICES NYS Skill Sheet 15-I-3, 15-I-4  

Candidate's Name Date Evaluator's Name Evaluator's Signature  

The candidate, given appropriate PPE, will demonstrate a straight roll and a donut roll in accordance with IFSTA

Essentials of Fire Fighting and Fire Department Operations, 6TH ed. JPR 5.5.2  

 

Criteria: DEPT INSTR

STRAIGHT HOSE ROLL    

Lays hose out straight and flat    

Rolls male coupling onto hose, starting the roll, leaving an opening large enough to insert fingers

   

Continues rolling, forming an even roll    

As hose roll increases in size, edges are kept aligned    

Checks for uniformity, and any protruding coils are gently tamped into coil    

Finished hose roll is neat and tight, and stays together when lifted    

DONUT HOSE ROLL    

Lays hose out flat and straight, or doubles the hose with couplings even, and hose flat and parallel

   

There are no twists in the hose    

Starts roll at a point off-center of hose, toward the male coupling    

Rolls hose toward female coupling [straight method], or toward male coupling [parallel method]

   

Leaves sufficient space to insert fingers in roll    

When complete, male coupling is enclosed within roll by one layer of hose only and is behind the female coupling by a minimum of 12”

Finished hose roll is neat and tight, and stays together when lifted

INITIAL INITIAL

Evaluator Notes on back: 

REQUIRES HOME DEPARTMENT SIGN OFF 

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01/2015 

Load and Advance Accordion Load 

NFPA 1001 [2013] - 5.5.2  

 

NYS DIVISION OF HOMELAND SECURITY & EMERGENCY SERVICES NYS Skill Sheet 15-I-6  

Candidate's Name Date Evaluator's Name Evaluator's Signature  

The candidate, given appropriate PPE, will demonstrate the procedure for loading and advancing an accordion load in accordance with IFSTA Essentials of Fire Fighting and Fire Department Operations, 6TH ed. JPR 5.5.2 

 

Criteria: DEPT INSTR

   

LOADING

Lays first length in bed against partition, on edge, with female coupling in front corner

Lays additional lengths parallel to first, on edge, from back to front of hose bed

First bend of hose is even with back edge of hose bed

Every other bend is recessed approximately 2" from adjacent bend

Hose is laid so that all couplings will pull straight out of hose bed without turning

Hose is loaded so that couplings are not adjacent

ADVANCING

Ensures proper appliance is attached at end of hose

Selects proper amount of hose to be pulled

Pulls proper amount of hose halfway out and places it on shoulder with the appliance on the bottom

Pulls additional hose allowing it to be dragged prior to using shoulder load

At the point where shoulder load is to be deployed, allows hose to flake off one fold at a time while moving forward

INITIAL INITIAL

Evaluator Notes on back: 

REQUIRES HOME DEPARTMENT SIGN OFF 

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01/2015 

Load and Advance Triple Layer Load 

NFPA 1001 [2013], 5.5.2; 5.3.10  

 

NYS DIVISION OF HOMELAND SECURITY & EMERGENCY SERVICES NYS Skill Sheet 15-I-10, 15-I-14  

Candidate's Name Date Evaluator's Name Evaluator's Signature  

The candidate, given appropriate PPE, will demonstrate the procedure for loading and advancing the triple layer load in accordance with IFSTA Essentials of Fire Fighting and Fire Department Operations, 6TH ed. JPR 5.5.2, 5.3.10 

The time limit for this station is 15 minutes

Criteria: DEPT INSTR

LOADING

Assures all sections of hose are joined

Connects nozzle to hose

Attach the female coupling to the discharge outlet

Extends hose in a straight line away from engine

Picks up hose at a point 2/3 of distance to nozzle end

Carries fold toward engine and lays carried hose on top of first part of hose

Forms three layers of hose, stacked one on the other, with fold at each end

Uses assistants to help simultaneously load all three layers into engine hose bed

Three layers stay together throughout loading

Staggers folds

Continues laying hose into the bed until the entire length is loaded, slips fold thru bail of nozzle (if bail is large enough)

ADVANCING

Places first fold with nozzle over the shoulder while facing in the direction of travel

Advances hose until entire load has cleared the bed

Drops fold and advances nozzle to objective

INITIAL INITIAL

Evaluator Notes on back: 

REQUIRES HOME DEPARTMENT SIGN OFF 

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01/2015 

Load and Advance Minuteman Load 

NFPA 1001 [2013] - 5.5.2; 5.3.10  

 

NYS DIVISION OF HOMELAND SECURITY & EMERGENCY SERVICES NYS Skill Sheet 15-I-11, 15-I-14  

Candidate's Name Date Evaluator's Name Evaluator's Signature  

The candidate, given appropriate PPE, will demonstrate the procedure for loading and advancing the minuteman load in accordance with IFSTA Essentials of Fire Fighting and Fire Department Operations, 6TH ed. JPR 5.5.2, 5.3.10 

The time limit for this station is 15 minutes

Criteria: DEPT INSTR

LOADING

Attaches the female coupling to the discharge outlet

Flat lays the first half of the total hose length providing a pulling loop near the bottom of the load and leaving the last few feet outside of the bed

Attaches the nozzle to the remaining hose and continues the flat load with the nozzle end of the hose extended out the rear to be used as a pulling handle

At the completion of the flat load, connects the last section of hose to the end of the bottom section of hose left outside the bed in step #2 so that the connected sections are on the top layer

ADVANCING

Lifts up the nozzle and layers above it while pulling them out of the bed and placing

Steps away to remove the remainder of the top layers

Turns around and pulls the loop to remove the remaining layers while walking

When the bottom layers are fully stretched, allows the shoulder load to flake out while

INITIAL INITIAL

Evaluator Notes on back: 

REQUIRES HOME DEPARTMENT SIGN OFF 

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01/2015 

Roll, Deploy, Clean and Inspect a Salvage Cover

 NFPA 1001 [2013] - 5.5.1

 

 

NYS DIVISION OF HOMELAND SECURITY & EMERGENCY SERVICES NYS Skill Sheet 18-I-1, 2, 3 

Candidate's Name Date Evaluator's Name Evaluator's Signature  

The firefighter, given fire department salvage covers and cleaning supplies, shall demonstrate properly rolling, deploying, cleaning and visually checking fire department salvage covers, in accordance with the manufacturer’s directions and as outlined in IFSTA Essentials of Fire Fighting and Fire Department Operations, 6TH ed. JPR 18-I-1

Criteria: DEPT INSTR

Salvage Cover Roll [2 Firefighters]

Grasp the cover with the outside hand midway between the center and edge to be folded.

Place other hand on the cover as a pivot midway between the outside hand and center. Bring the fold over to the center of the cover to create an inside fold at the center and an outside fold

Grasp the cover corner with the outside hand and place the other hand as a pivot on the cover over the outside fold.

Bring the outside edge over to the center and place it on top of the previous first fold.

Repeat above steps on other half of cover.

Fold over about 12” at each end to make clean ends; neatly and tightly roll cover to one end

Single FF deploys salvage cover

Unroll starting from one end of object[s]

Starting at one end, grasp corners and cover the object by snapping both hands up and out. Open other end in similar fashion and tuck in all loose edges.

Clean and Inspect Salvage Cover

Wash salvage cover with clean water and detergent using a scrub brush. Hang to dry.

Inspect salvage cover by raising salvage cover at each corner and firefighter walks under cover to inspect for light coming through holes in the cover

Mark holes with chalk or marker.

Patch according to manufacturer or departmental guidelines.

Put away cleaning supplies and salvage cover according to departmental procedures.

INITIAL INITIAL

Evaluator notes on back 

REQUIRES HOME DEPARTMENT SIGN OFF 

Page 38: County of Erie Department of Homeland Security & Emergency ... Student... · County of Erie Department of Homeland Security & Emergency Services Division of Fire Safety 2017 NYS OFPC

Salvage Cover Fold and Balloon Toss Spread - 2 FF Method 

NFPA 1001 [2013] – 5.3.14  

 

NYS DIVISION OF HOMELAND SECURITY & EMERGENCY SERVICES NYS Skill Sheet 18-I-6, 18-I-7 

Candidate's Name Date Evaluator's Name Evaluator's Signature  

The firefighter, given fire department salvage covers, an assistant and simulated furniture to protect, shall demonstrate properly folding and deploying salvage covers using the 2 FF method to protect furniture from damage, in accordance with the manufacturer’s directions and as outlined in IFSTA Essentials of Fire Fighting and Fire Department Operations, 6TH ed. JPR 18‐I‐6 and 18‐I‐7 

 

Criteria: DEPT INSTR

Salvage Cover Fold [18-I-6]    

Folds cover in half lengthwise [2 times] with assistant    

Folds cover in half widthwise [2 times] with assistant    

Folds cover in half widthwise again [2 times] with an assistant    

Finished and secured per departmental procedures    

2 FF Balloon Toss [18-I-7]    

Firefighter unfolds cover, with an assistant, next to the furniture to be protected 

Deploys salvage cover over furniture using ballooning method

Cover deployed correctly with assistant [fully covers furniture and edges tucked 

under furniture] 

  INITIAL INITIAL

 

 

REQUIRES HOME DEPARTMENT SIGN OFF 

Evaluator Notes

01/2015 

Page 39: County of Erie Department of Homeland Security & Emergency ... Student... · County of Erie Department of Homeland Security & Emergency Services Division of Fire Safety 2017 NYS OFPC

INSERT

STUDENT LEARNING AGREEMENT

FOR

BEFO – BLENDED LEARNING

HERE

Page 40: County of Erie Department of Homeland Security & Emergency ... Student... · County of Erie Department of Homeland Security & Emergency Services Division of Fire Safety 2017 NYS OFPC

INSERT

STUDENT LEARNING AGREEMENT

FOR

SCBA/IFO – BLENDED LEARNING

HERE

Page 41: County of Erie Department of Homeland Security & Emergency ... Student... · County of Erie Department of Homeland Security & Emergency Services Division of Fire Safety 2017 NYS OFPC

SIGNATURE OF AUTHORIZED LEGAL GUARDIAN DATE

PRINTED NAME RELATIONSHIP TO FIREFIGHTER

New York State

Department of State

Office of Fire Prevention and Control

Training Authorization LetterDOS-1654 (5/04)

To the Office of Fire Prevention and Control:

The firefighter listed below is an active member of _________________________________ Fire Department and isauthorized to attend the course indicated below. I understand this training course may contain certain evolutions thatsimulate and/or create actual firefighting or rescue conditions. The Office of Fire Prevention and Control is notresponsible and/or liable for any malfunction or damage to any equipment used during this training program.

SIGNATURE OF FIREFIGHTER DATE

PRINT NAME OF FIREFIGHTER

PRINT

And, if firefighter is under the age of 18, the following consent must be provided:

Additional copies of this form are available at http://www.dos.state.ny.us/fire/pdfs/authorization.pdf

PRINT NAME OF FIREFIGHTER

Fire FDID # Date

Department

Fill in YES or NO YES NO

The firefighter listed below has medical clearance to use Self Contained

Breathing Apparatus, (SCBA), in accordance with 29 C.F.R. part 1910.

The firefighter listed below is authorized to use SCBA

and participate in interior /exterior firefighting evolutions.

If you cannot answer the questions above because you do not know the requirements of 29 C.F.R. Part 1910 or do not know

whether the firefighter listed below is authorized to use SCBA, please contact your County Fire Coordinator or OFPC.

PLEASE PRINT ALL INFORMATION

Fire Chief Authorization

Course Information

Student Information

Last First MIName

Address City State

Home Work ZipPhone Phone

Course CourseCode # Title

( ) ( )

Print Chief’s

Chief’s Name Signature

PRINT NAME OF FIREFIGHTER

I, , parent or legal guardian ofconsent to his/her participation in the training listed above. I have read, fully understand, and agree with the above information. I understand andacknowledge that safety is important during the training course and further authorize the instructor to removefrom the simulation or course if the instructor believes that his/her behavior or abilities may cause a safety risk to himself/herself or another.

I, , have read, fully understand and agree with above information. I understandand acknowledge the importance of safety during the training course and further acknowledge that if an instructor believes that my behavior orabilities may cause a safety risk to myself or another, the instructor has the authority to remove me from the simulation or course.

Page 42: County of Erie Department of Homeland Security & Emergency ... Student... · County of Erie Department of Homeland Security & Emergency Services Division of Fire Safety 2017 NYS OFPC

Please use back of form for further detail.

New York State Firefighter I Medical History Form

Personal Information Last Name

Middle Name

First Name

Gender

Home address

Home Telephone

Date of Birth (MM/DD/YYYY)

Medical Information Doctor’s name

Address

Telephone number

Blood type

Current Medical Conditions

Past Medical Conditions

Allergies

Current Medications

Emergency Information Emergency Contact Name

Relationship

Address

Telephone number(s)

NOTE: The information contained on this document is confidential medical and personal information. It will be placed in a sealed envelope with your name only on the outside. It will be opened only in the event that you require medical attention arising out of and during the course of your participation in the Firefighter I course in which you are enrolled and the sealed envelop will be opened only by emergency medical services personnel or hospital Emergency Room personnel. At the conclusion of the course, this information, if not used, with be returned in the envelope, unopened. By signing below, you are agreeing to this disclosure of this information for the stated purpose. _____________________________________________ Signature _____________ Date

Page 43: County of Erie Department of Homeland Security & Emergency ... Student... · County of Erie Department of Homeland Security & Emergency Services Division of Fire Safety 2017 NYS OFPC

Application to RequestReasonable Accommodation of a Disability

Fire Prevention and Control

Fire Prevention and Control

Fire Prevention and Control

Section A - (To be completed by student and returned via email)Student Name

Student Signature

I am requesting the following reasonable accommodation(s):

It is necessary for me to have this accomodation for the following reason(s):

q Required: Attach documentation to support request. Documentation should indicate an assessment was conducted or diagnosis rendered to support request for reasonable accommodation.

The student should retain a copy of this form. The original is filed by the New York State Office of Fire Prevention and Control.

ANDREW M. CUOMOGovernor

JOHN P. MELVILLECommissioner

BRYANT D. STEVENSState Fire Administrator

Sponsoring Agency County

Phone # Email Address Preferred Method of Communication q Telephone q Email

Course Name and Number

Date

Application for reasonable accommodations for state fire training may be made using this form and submitted via email to the Division’s Designee for Reasonable Accommodation (DRA), Deputy State Fire Administrator William R. Davis, Jr. at [email protected] or by mail to: 1220 Washington Avenue, Bldg. 7A, Floor 2 • Albany, NY 12226. If the request is made to the instructor, the instructor will forward the request to the DRA. All confidential information received by OFPC pertaining to your request shall be handled as such. All medical information is confidential and maintained separately from your training records.