Employee Work Capacity Test Record
Employee Work Capacity Test Record
Part One To be completed by employee prior to testing:
|Name (Last, First) | |Date | |
| | |
|Unit (Forest, District, Field Office)| |
| | |
|Employee Supervisor | |
| | |
|ICS Position for which test is required (highest needed) | |
Performance Level Needed (check one) Arduous ____ Moderate ____ Light ____
Type of Test Taken (check one) Pack Test ____ Field Test ____ Walk Test ____
Part Two To be completed by test administrator prior to testing:
| |Pack Test |Field Test |Walk Test |
|Pack Weight |45 lbs. |25 lbs. |None |
|Distance |3 miles |2 miles |1 mile |
|Time (adjusted for elevation) |_____ miles |____ minutes |____ minutes |
Test Result (check one) Pass ____ Fail ____ Not Completed ____
Comments (Note first-aid treatments required, problems observed, or complaints made by individual)
| |
| |
| |
| |
| |
I Certify The Work Capacity Test Was Administered According To WCT Administration Guidelines.
Signed:
|Test Administrator | |Date | |
Distribution: Unit Fire Program Manager (for Fire Qualification Record), Employee’s Official Personnel Record, Test Administrator
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