Division of Emergency Medical Services



Division of Emergency Medical ServicesVolunteer Firefighter Practical Skills SheetsEFFECTIVE JANUARY 1, 2018INDEX OF PRACTICAL SKILL SHEETS – VOLUNTEER FIREFIGHTER SKILL #OBJECTIVESKILLTESTMETHODSTATE MAXIMUM ALLOTTED1-25.1.2Personal Protective Equipment - Donning PPEM1 Minute1-35.3.1Personal Protective Equipment - Donning SCBAM1 Minute1-45.3.15.2.4Personal Protective Equipment - SCBA Emergency ProceduresM5 Minutes2-15.3.20RopesR10 Minutes6-15.3.4Forcible EntryR5 Minutes7-15.3.6Two Firefighter Ladder Carry and RaiseR10 Minutes7-35.3.6One Firefighter Extension Ladder Carry and RaiseM10 Minutes7-65.3.65.3.10Ladders – Using a Leg LockR10 Minutes10-25.3.9Rescue – Victim CarriesR10 Minutes10-35.3.9Rescue – Victim DragsR10 Minutes12-15.3.10Advancing a Charged Line Outdoors M10 Minutes14-15.3.11Horizontal VentilationR15 Minutes17-15.3.15Water Supply – Supply Lay ConnectionsR10 Minutes17-25.3.15Water Supply – Hydrant Supply Lay ConnectionsR10 Minutes18-15.3.16Operating Portable Fire ExtinguishersR3 MinutesOHIO DEPARTMENT OF PUBLIC SAFETYPERSONAL PROTECTIVE EQUIPMENTDONNING PPECANDIDATE NAME (Please Print) FORMTEXT ?????DATE FORMTEXT ?????CHARTER FORMTEXT ?????CHARTER # FORMTEXT ?????VOLUNTEER FIREFIGHTERPRACTICAL SKILL EVALUATIONPrimary TaskPersonal Protective Equipment-Donning PPEJPR(s)5.1.2Reference SourceNFPA 1001 Standard, 2013 EditionSkill No.1-2Candidate InstructionThe candidate, given a complete set of personal protective equipment, shall don full personal protective clothing according to manufacturer’s recommendations within 1 minute. Candidate shall clap hands or verbalize at completion of skill; this will allow the evaluator to stop time when clap of hands or verbal indication is heard.Timing starts when the candidate first touches any article of turnout gear after telling the evaluator he or she is ready to start. Timing will end when all protective clothing is donned and the candidate has clapped hands or verbalized completion of the skill.State Maximum Allotted1 minutePERFORMANCE STEPSTEST 1RETEST 2RETEST 3Safely performs the following steps:PFPFPFDons boots, pants, protective hood, coat, helmet, and gloves. — CRITICAL POINT FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX All personal protective clothing donned properly (no exposed skin except for facial area), helmet strap is tightened, coat collar is up, and all fasteners are secured). — CRITICAL POINT FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Skill shall be completed within 1 minute. — CRITICAL POINT FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Firefighter must have at least 70% pass mark for each skill and perform all critical points (3 / 3 required).Score: FORMTEXT ??/ 3NUMBER OF ATTEMPTSTEST 1RETEST 2RETEST 3SCORE FORMTEXT ?? / 3 FORMTEXT ?? / 3 FORMTEXT ?? / 3TIME FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????EVALUATOR COMMENTS FORMTEXT ????? FORMTEXT ?????PRINT NAME FIRST EVALUATOR FORMTEXT ?????CERT # FORMTEXT ?????SKILL TEST DATE FORMTEXT ?? / FORMTEXT ?? / FORMTEXT ????SIGNATURE FIRST EVALUATORXOverall Skill Sheet Score FORMCHECKBOX Pass FORMCHECKBOX FailPRINT NAME SECOND EVALUATOR FORMTEXT ?????CERT # FORMTEXT ?????SKILL TEST DATE FORMTEXT ?? / FORMTEXT ?? / FORMTEXT ????SIGNATURE SECOND EVALUATORXOverall Skill Sheet Score FORMCHECKBOX Pass FORMCHECKBOX FailPRINT NAME THIRD EVALUATOR FORMTEXT ?????CERT # FORMTEXT ?????SKILL TEST DATE FORMTEXT ?? / FORMTEXT ?? / FORMTEXT ????SIGNATURE THIRD EVALUATORX Overall Skill Sheet Score FORMCHECKBOX Pass FORMCHECKBOX FailOHIO DEPARTMENT OF PUBLIC SAFETYPERSONAL PROTECTIVE EQUIPMENTDONNING SCBACANDIDATE NAME (Please Print) FORMTEXT ?????DATE FORMTEXT ?????CHARTER FORMTEXT ?????CHARTER # FORMTEXT ?????VOLUNTEER FIREFIGHTERPRACTICAL SKILL EVALUATIONPrimary TaskPersonal Protective Equipment-Donning SCBAJPR(s)5.3.1Reference SourceNFPA 1001 Standard, 2013 EditionSkill No.1-3Candidate InstructionThe candidate, wearing personal protective clothing, shall properly don a selfcontained breathing apparatus according to manufacturer’s recommendations within 1 minute. The candidate shall have the hood on and pulled back. The helmet and gloves are not worn to start the practical skill but must be worn to complete the skill. The candidate may use any of the following: Over-the-head method, Coat method, Seat mount method, or Compartment method. Candidate shall clap hands or verbalize at completion of skill; this will allow the evaluator to stop time when clap of hands or verbal indication is heard.Timing starts when the candidate first touches any part of the SCBA after telling the evaluator he or she is ready to start. Timing will end when all protective clothing and SCBA are donned, the PASS device is armed, and the candidate has clapped hands or verbalized completion of the skill.State Maximum Allotted1 minutePERFORMANCE STEPSTEST 1RETEST 2RETEST 3Safely performs the following steps:PFPFPFWearing complete personal protective clothing. — CRITICAL POINT FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Open cylinder valve completely. — CRITICAL POINT FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Dons SCBA using one of the listed methods and ensures unit is secured and adjusted properly. — CRITICAL POINT FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Dons face piece, attaches regulator (if using waist mount regulator, attaches breathing tube to regulator), inhales activating regulator, listens for proper seal ensuring there are no leaks. — CRITICAL POINT FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Ensures exhalation valve is working properly and PASS device is armed. — CRITICAL POINT FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Dons hood, helmet, and gloves and ensures there is no exposed skin. — CRITICAL POINT FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Skill shall be completed within 1 minute. — CRITICAL POINT FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Firefighter must have at least 70% pass mark for each skill and perform all critical points (7 / 7 required).Score: FORMTEXT ??/ 7NUMBER OF ATTEMPTSTEST 1RETEST 2RETEST 3SCORE FORMTEXT ?? / 7 FORMTEXT ?? / 7 FORMTEXT ?? / 7TIME FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????EVALUATOR COMMENTS FORMTEXT ????? FORMTEXT ?????PRINT NAME FIRST EVALUATOR FORMTEXT ?????CERT # FORMTEXT ?????SKILL TEST DATE FORMTEXT ?? / FORMTEXT ?? / FORMTEXT ?????SIGNATURE FIRST EVALUATORXOverall Skill Sheet Score FORMCHECKBOX Pass FORMCHECKBOX FailPRINT NAME SECOND EVALUATOR FORMTEXT ?????CERT # FORMTEXT ?????SKILL TEST DATE FORMTEXT ?? / FORMTEXT ?? / FORMTEXT ?????SIGNATURE SECOND EVALUATORXOverall Skill Sheet Score FORMCHECKBOX Pass FORMCHECKBOX FailPRINT NAME THIRD EVALUATOR FORMTEXT ?????CERT # FORMTEXT ?????SKILL TEST DATE FORMTEXT ?? / FORMTEXT ?? / FORMTEXT ?????SIGNATURE THIRD EVALUATORX Overall Skill Sheet Score FORMCHECKBOX Pass FORMCHECKBOX FailOHIO DEPARTMENT OF PUBLIC SAFETYPERSONAL PROTECTIVE EQUIPMENTSCBA EMERGENCY PROCEDURESCANDIDATE NAME (Please Print) FORMTEXT ?????DATE FORMTEXT ?????CHARTER FORMTEXT ?????CHARTER # FORMTEXT ?????VOLUNTEER FIREFIGHTERPRACTICAL SKILL EVALUATIONPrimary TaskPersonal Protective Equipment-SCBA Emergency ProceduresJPR(s)5.3.1, 5.2.4Reference SourceNFPA 1001 Standard, 2013 EditionSkill No.1-4Candidate InstructionsThe candidate, wearing full personal protective clothing and SCBA, shall demonstrate controlled breathing techniques and be able to demonstrate the ability to perform an emergency procedure check on the SCBA. Warning: No emergency breathing procedure is endorsed by manufacturers, IFSTA, ANSI, or any other regulating agency. These procedures should be used only as a last resort in life threatening situations.State Maximum Allotted5 minutesPERFORMANCE STEPSTEST 1RETEST 2RETEST 3PFPFPFWearing complete personal protective clothing. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Declares MAYDAY, activates PASS device. — CRITICAL POINT FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Notifies partner of SCBA problem. — CRITICAL POINT FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Does not remove face piece. — CRITICAL POINT FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Hand goes to the face piece and regulator, checking by-pass valve. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Uses bypass or cylinder valve to control air flow (depending on free flow or no flow). FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Corrects problem if possible. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Moves to exit as quickly as possible. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Firefighter must have at least 70% pass mark for each skill and perform all critical points(6 / 8 required).Score: FORMTEXT ??/ 8NUMBER OF ATTEMPTSTEST 1RETEST 2RETEST 3SCORE FORMTEXT ?? / 8 FORMTEXT ?? / 8 FORMTEXT ?? / 8TIME FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????EVALUATOR COMMENTS FORMTEXT ????? FORMTEXT ?????PRINT NAME FIRST EVALUATOR FORMTEXT ?????CERT # FORMTEXT ?????SKILL TEST DATE FORMTEXT ?? / FORMTEXT ?? / FORMTEXT ?????SIGNATURE FIRST EVALUATORXOverall Skill Sheet Score FORMCHECKBOX Pass FORMCHECKBOX FailPRINT NAME SECOND EVALUATOR FORMTEXT ?????CERT # FORMTEXT ?????SKILL TEST DATE FORMTEXT ?? / FORMTEXT ?? / FORMTEXT ?????SIGNATURE SECOND EVALUATORXOverall Skill Sheet Score FORMCHECKBOX Pass FORMCHECKBOX FailPRINT NAME THIRD EVALUATOR FORMTEXT ?????CERT # FORMTEXT ?????SKILL TEST DATE FORMTEXT ?? / FORMTEXT ?? / FORMTEXT ?????SIGNATURE THIRD EVALUATORX Overall Skill Sheet Score FORMCHECKBOX Pass FORMCHECKBOX FailOHIO DEPARTMENT OF PUBLIC SAFETYROPESCANDIDATE NAME (Please Print) FORMTEXT ?????DATE FORMTEXT ?????CHARTER FORMTEXT ?????CHARTER # FORMTEXT ?????VOLUNTEER FIREFIGHTERPRACTICAL SKILL EVALUATIONPrimary TaskKnots and Hoisting JPR(s)5.3.20Reference SourceNFPA 1001 Standard, 2013 Edition Skill No.2.1Candidate InstructionThe candidate, wearing protective clothing and given a fire service rope(s), shall tie an appropriate knot and hoist listed equipment. The candidate shall demonstrate each of the following: bowline, clove hitch, figure eight follow through, figure eight on a bight, and becket (sheet) bend with appropriate overhand safety.State Maximum Allotted10 MinutesPERFORMANCE STEPSTEST 1RETEST 2RETEST 3Safely performs the following steps:PFPFPFWearing complete personal protective clothing. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Correctly ties the following knots: bowline, clove hitch, figure eight follow through, figure eight on a bight, becket (sheet) bend. All five (5) knots must be completed with the appropriate overhand safety. — CRITICAL POINT FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Ties a secure and appropriate knot for one of the following pieces of equipment: pick head axe, exhaust fan, uncharged section of 1 ?” or 1 ?”, charged section of 1 ?” or 1 ?”, roof ladder, and pike pole. — CRITICAL POINT FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Hoists tools and equipment without complications. — CRITICAL POINT FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Firefighter must have at least 70% pass mark for each skill and perform all critical points(3/4 required).Score:/ 4NUMBER OF ATTEMPTSTEST1RETEST 2RETEST 3SCORE FORMTEXT ?? / 4 FORMTEXT ?? / 4 FORMTEXT ?? / 4TIME FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????EVALUATOR COMMENTS FORMTEXT ????? FORMTEXT ?????PRINT NAME FIRST EVALUATOR FORMTEXT ?????CERT # FORMTEXT ?????SKILL TEST DATE FORMTEXT ?? / FORMTEXT ?? / FORMTEXT ?????SIGNATURE FIRST EVALUATORXOverall Skill Sheet Score FORMCHECKBOX Pass FORMCHECKBOX FailPRINT NAME SECOND EVALUATOR FORMTEXT ?????CERT # FORMTEXT ?????SKILL TEST DATE FORMTEXT ?? / FORMTEXT ?? / FORMTEXT ?????SIGNATURE SECOND EVALUATORXOverall Skill Sheet Score FORMCHECKBOX Pass FORMCHECKBOX FailPRINT NAME THIRD EVALUATOR FORMTEXT ?????CERT # FORMTEXT ?????SKILL TEST DATE FORMTEXT ?? / FORMTEXT ?? / FORMTEXT ?????SIGNATURE THIRD EVALUATORX Overall Skill Sheet Score FORMCHECKBOX Pass FORMCHECKBOX FailOHIO DEPARTMENT OF PUBLIC SAFETYFORCIBLE ENTRYCANDIDATE NAME (Please Print) FORMTEXT ?????DATE FORMTEXT ?????CHARTER FORMTEXT ?????CHARTER # FORMTEXT ?????VOLUNTEER FIREFIGHTERPRACTICAL SKILL EVALUATIONPrimary TaskForcible EntryJPR(s)5.3.4Reference SourceNFPA 1001 Standard, 2013 EditionSkill No.6-1Candidate InstructionThe candidate, wearing protective clothing and given a selection of forcible entry tools, shall demonstrate procedures for forcing their way into one, or a combination of the following: doors, windows, or through walls. The charter training program may demonstrate and / or perform this skill using props.State Maximum Allotted5 minutesPERFORMANCE STEPSTEST 1RETEST 2RETEST 3Safely performs the following steps:PFPFPFWearing complete personal protective clothing. — CRITICAL POINT FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Selects proper forcible entry tool for task and identifies locking mechanism or obstruction. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Identifies potential hazards. — CRITICAL POINT FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Opens door, window, or wall using approved methods. — CRITICAL POINT FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Props open door or window to prevent closure OR ensures it is safe to force their way through a wall. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Firefighter must have at least 70% pass mark for each skill and perform all critical points(4 / 5 required).Score: FORMTEXT ? / 5NUMBER OF ATTEMPTSTEST 1RETEST 2RETEST 3SCORE FORMTEXT ? / 5 FORMTEXT ? / 5 FORMTEXT ? / 5TIME FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????EVALUATOR COMMENTS FORMTEXT ????? FORMTEXT ?????PRINT NAME FIRST EVALUATOR FORMTEXT ?????CERT # FORMTEXT ?????SKILL TEST DATE FORMTEXT ?? / FORMTEXT ?? / FORMTEXT ????SIGNATURE FIRST EVALUATORXOverall Skill Sheet Score FORMCHECKBOX Pass FORMCHECKBOX FailPRINT NAME SECOND EVALUATOR FORMTEXT ?????CERT # FORMTEXT ?????SKILL TEST DATE FORMTEXT ?? / FORMTEXT ?? / FORMTEXT ????SIGNATURE SECOND EVALUATORXOverall Skill Sheet Score FORMCHECKBOX Pass FORMCHECKBOX FailPRINT NAME THIRD EVALUATOR FORMTEXT ?????CERT # FORMTEXT ?????SKILL TEST DATE FORMTEXT ?? / FORMTEXT ?? / FORMTEXT ????SIGNATURE THIRD EVALUATORXOverall Skill Sheet Score FORMCHECKBOX Pass FORMCHECKBOX FailOHIO DEPARTMENT OF PUBLIC SAFETYTWO FIREFIGHTER LADDER CARRY AND RAISECANDIDATES NAME (Please Print) FORMTEXT ?????DATE FORMTEXT ?????CHARTER FORMTEXT ?????CHARTER # FORMTEXT ?????VOLUNTEER FIREFIGHTERPRACTICAL SKILL EVALUATIONPrimary TaskLadders-Two Firefighter Ladder Carry and RaiseJPR(s)5.3.6Reference SourceNFPA 1001 Standard, 2013 EditionSkill No.7-1Candidate InstructionThe candidate, wearing protective clothing, provided with one assistant, and given a fire service extension ladder (24 to 28 foot extension ladder), shall correctly carry the ladder using an approved carry technique. The candidate shall raise ladder, set proper climbing angle, climb the ladder to a designated point, descend the ladder, and safely lower ladder to ground. The candidate shall be giving all placement and movement commands.State Maximum Allotted10 minutesPERFORMANCE STEPSTEST 1RETEST 2RETEST 3Safely performs the following steps:PFPFPFWearing complete personal protective clothing. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Carries ladder to the building using approved carrying technique (suitcase, shoulder, flat). FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Checks for overhead and ground obstructions before raising and places butt of ladder on ground at a point determined for proper climbing angle. — CRITICAL POINT FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Raises ladder to vertical position using a flat or beam raise. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Fly section is extended to necessary height depending on task. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Ladder is stable and under control at all times. — CRITICAL POINT FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Ensures proper climbing angle to designate task, halyard is secured with clove hitch, and overhand safety and locks are visually checked. — CRITICAL POINT FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Ensures ladder is heeled at all times while on ladder. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Safely climbs to assigned point maintaining three points of contact on ladder. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Safely descends ladder and lowers ladder to ground. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Firefighter must have at least 70% pass mark for each skill and perform all critical points(7 / 10 required).Score: FORMTEXT ?? / 10Note: Candidate must be able to demonstrate pivoting ladder, if required.NUMBER OF ATTEMPTSTEST 1RETEST 2RETEST 3SCORE FORMTEXT ?? / 10 FORMTEXT ?? / 10 FORMTEXT ?? / 10TIME FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????EVALUATOR COMMENTS FORMTEXT ????? FORMTEXT ?????PRINT NAME FIRST EVALUATOR FORMTEXT ?????CERT # FORMTEXT ?????SKILL TEST DATE FORMTEXT ?? / FORMTEXT ?? / FORMTEXT ????SIGNATURE FIRST EVALUATORXOverall Skill Sheet Score FORMCHECKBOX Pass FORMCHECKBOX FailPRINT NAME SECOND EVALUATOR FORMTEXT ?????CERT # FORMTEXT ?????SKILL TEST DATE FORMTEXT ?? / FORMTEXT ?? / FORMTEXT ????SIGNATURE SECOND EVALUATORXOverall Skill Sheet Score FORMCHECKBOX Pass FORMCHECKBOX FailPRINT NAME THIRD EVALUATOR FORMTEXT ?????CERT # FORMTEXT ?????SKILL TEST DATE FORMTEXT ?? / FORMTEXT ?? / FORMTEXT ????SIGNATURE THIRD EVALUATORXOverall Skill Sheet Score FORMCHECKBOX Pass FORMCHECKBOX FailOHIO DEPARTMENT OF PUBLIC SAFETYONE FIREFIGHTER EXTENSION LADDERCARRY AND RAISECANDIDATE NAME (Please Print) FORMTEXT ?????DATE FORMTEXT ?????CHARTER FORMTEXT ?????CHARTER # FORMTEXT ?????VOLUNTEER FIREFIGHTERPRACTICAL SKILL EVALUATIONPrimary TaskOne Firefighter Extension Ladder Carry and RaiseJPR(s)5.3.6Reference SourceNFPA 1001 Standard, 2013 EditionSkill No.7-3Candidate InstructionThe candidate, wearing personal protective clothing, shall remove the 24’ extension ladder from the fire department pumper and carry it to a point of service (as indicated by the evaluator). The candidate shall properly raise (for the purpose of rescue) the 24’ extension ladder to the second floor window. The candidate shall properly spot and secure the 24’ extension ladder for climbing. Note: The student is not permitted to run at any time. State Maximum Allotted10 minutesPERFORMANCE STEPSTEST 1RETEST 2RETEST 3Safely performs the following steps:PFPFPFWearing complete personal protective clothing. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Avoids any unsafe act or operation while carrying, raising, or operating on the ladder.— CRITICAL POINT FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Proper ladder carry (low or high shoulder, butt-end forward). FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Checks and verbalizes for overhead and ground obstruction before raising. — CRITICAL POINT FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Proper spotting of ladder (1/4 of used length from building). FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Proper raise using beam or flat raise (uses building to butt, fly section in, flush to building). FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Proper placement (just below sill, rolls ladder to fly out, 75 degree climbing angle), halyard is secured with a clove hitch, and overhand safety and locks are visually checked, verbalized, and corrected if needed. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Skill shall be completed within 10 minutes. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Firefighter must have at least 70% pass mark for each skill and perform all critical points (6 / 8 required).Score: FORMTEXT ?? / 8NUMBER OF ATTEMPTSTEST 1RETEST 2RETEST 3SCORE FORMTEXT ?? / 8 FORMTEXT ?? / 8 FORMTEXT ?? / 8TIME FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????EVALUATOR COMMENTS FORMTEXT ????? FORMTEXT ?????PRINT NAME FIRST EVALUATOR FORMTEXT ?????CERT # FORMTEXT ?????SKILL TEST DATE FORMTEXT ?? / FORMTEXT ?? / FORMTEXT ????SIGNATURE FIRST EVALUATORXOverall Skill Sheet Score FORMCHECKBOX Pass FORMCHECKBOX FailPRINT NAME SECOND EVALUATOR FORMTEXT ?????CERT # FORMTEXT ?????SKILL TEST DATE FORMTEXT ?? / FORMTEXT ?? / FORMTEXT ????SIGNATURE SECOND EVALUATORXOverall Skill Sheet Score FORMCHECKBOX Pass FORMCHECKBOX FailPRINT NAME THIRD EVALUATOR FORMTEXT ?????CERT # FORMTEXT ?????SKILL TEST DATE FORMTEXT ?? / FORMTEXT ?? / FORMTEXT ????SIGNATURE THIRD EVALUATORXOverall Skill Sheet Score FORMCHECKBOX Pass FORMCHECKBOX FailOHIO DEPARTMENT OF PUBLIC SAFETYLADDERS – USING A LEG LOCKCANDIDATE NAME (Please Print) FORMTEXT ?????DATE FORMTEXT ?????CHARTER FORMTEXT ?????CHARTER # FORMTEXT ?????VOLUNTEER FIREFIGHTERPRACTICAL SKILL EVALUATIONPrimary TaskLadders – Using A Leg LockJPR(s)5.3.6, 5.3.10Reference SourceNFPA 1001 Standard, 2013 EditionSkill No.7-6Candidate InstructionThe candidate, wearing personal protective equipment and provided with a forcible entry tool and an assistant to secure the ladder, shall climb to a height of at least 15’ with the tool (safety belt / harness is permitted). The candidate shall then secure himself / herself using the leg lock technique to the ladder and demonstrate using the tool to break the window.State Maximum Allotted10 minutesPERFORMANCE STEPSTEST 1RETEST 2RETEST 3LADDERS – USING A LEG LOCKPFPFPFClimbs ladder with tool in one hand & slides the other hand underneath the beam (maintains three points of contact). — CRITICAL POINT FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Climbs smoothly & rhythmically. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Raises leg up & over two consecutive rungs. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Places foot through the rung underneath knee. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Hooks tip of boot over beam or rung. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Places opposite leg / foot against beam. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Appears stable to perform work with the tool. — CRITICAL POINT FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Firefighter must have at least 70% pass mark for each skill and perform all critical points(5 / 7 required). The charter training program may demonstrate and / or simulate this skill.Score: FORMTEXT ?? / 7NUMBER OF ATTEMPTSTEST1RETEST 2RETEST 3SCORE FORMTEXT ?? / 7 FORMTEXT ?? / 7 FORMTEXT ?? / 7TIME FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????EVALUATOR COMMENTS FORMTEXT ????? FORMTEXT ?????PRINT NAME FIRST EVALUATOR FORMTEXT ?????CERT # FORMTEXT ?????SKILL TEST DATE FORMTEXT ?? / FORMTEXT ?? / FORMTEXT ????SIGNATURE FIRST EVALUATORXOverall Skill Sheet Score FORMCHECKBOX Pass FORMCHECKBOX FailPRINT NAME SECOND EVALUATOR FORMTEXT ?????CERT # FORMTEXT ?????SKILL TEST DATE FORMTEXT ?? / FORMTEXT ?? / FORMTEXT ????SIGNATURE SECOND EVALUATORXOverall Skill Sheet Score FORMCHECKBOX Pass FORMCHECKBOX FailPRINT NAME THIRD EVALUATOR FORMTEXT ?????CERT # FORMTEXT ?????SKILL TEST DATE FORMTEXT ?? / FORMTEXT ?? / FORMTEXT ????SIGNATURE THIRD EVALUATORXOverall Skill Sheet Score FORMCHECKBOX Pass FORMCHECKBOX FailOHIO DEPARTMENT OF PUBLIC SAFETYRESCUE – VICTIM CARRIESCANDIDATE NAME (Please Print) FORMTEXT ?????DATE FORMTEXT ?????CHARTER FORMTEXT ?????CHARTER # FORMTEXT ?????VOLUNTEER FIREFIGHTERPRACTICAL SKILL EVALUATIONPrimary TaskRescue – Victim CarriesJPR(s)5.3.9Reference SourceNFPA 1001 Standard, 2013 EditionSkill No.10-2Candidate InstructionThe candidate, wearing PPE shall demonstrate proper victim removal techniques using ONE of the following techniques: extremity carry, seat carry, or blanket drag method. Other assistants will be made available if applicable. The candidate shall give orders and directions when moving the victim.State Maximum Allotted10 minutesPERFORMANCE STEPSTEST 1RETEST 2RETEST 3Safely performs the following steps:EXTREMITY CARRYPFPFPFKneels at the victim’s head & directs other rescuer to victim’s feet. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Directs other rescuer to grasp victim’s wrists & pull victim into a sitting position while candidate supports victim’s head & neck. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Slips his/her arms under the victim’s arms & around the chest, grasping the wrists when other rescuer releases them. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Directs other rescuer to face away from the victim & grasp under the victim’s knees FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Stands with other rescuer using proper lifting techniques & carries victim to safety. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Firefighter must have at least 70% pass mark for each skill and perform all critical points(4 / 5 required). The charter training program may demonstrate and / or simulate this skill.Score: FORMTEXT ?? / 5PERFORMANCE STEPSTEST 1RETEST 2RETEST 3Safely performs the following steps:SEAT CARRYPFPFPFRescuers face each other and grasp own right forearm just above wrist. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Rescuers then grasp each other’s left forearm and kneel onto ground with one knee. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Instructs victim to sit on rescuers joined arms and rescuers communicate to lift victim. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Stands with other rescuer using proper lifting techniques & carries victim to safety. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Firefighter must have at least 70% pass mark for each skill and perform all critical points(3 / 4 required). The charter training program may demonstrate and / or simulate this skill.Score: FORMTEXT ?? / 4PERFORMANCE STEPSTEST 1RETEST 2RETEST 3Safely performs the following steps:BLANKET DRAG METHODPFPFPFPositions blanket next to victim ensuring it extends above victim’s head. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Kneels on victim’s side opposite the blanket & rolls victim against knees. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Pulls blanket against victim & allows victim to roll back onto blanket. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Wraps blanket around victim. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Drags victim to safety by pulling the end of the blanket at the victim’s head.— CRITICAL POINT FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Firefighter must have at least 70% pass mark for each skill and perform all critical points(4 / 5 required). The charter training program may demonstrate and / or simulate this skill.Score: FORMTEXT ?? / 5EXTREMITY CARRYNUMBER OF ATTEMPTSTEST1RETEST 2RETEST 3SCORE FORMTEXT ?? / 5 FORMTEXT ?? / 5 FORMTEXT ?? / 5TIME FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????EVALUATOR COMMENTS FORMTEXT ????? FORMTEXT ?????SEAT CARRYNUMBER OF ATTEMPTSTEST1RETEST 2RETEST 3SCORE FORMTEXT ?? / 4 FORMTEXT ?? / 4 FORMTEXT ?? / 4TIME FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????EVALUATOR COMMENTS FORMTEXT ????? FORMTEXT ?????BLANKET DRAGNUMBER OF ATTEMPTSTEST1RETEST 2RETEST 3SCORE FORMTEXT ?? / 5 FORMTEXT ?? / 5 FORMTEXT ?? / 5TIME FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????EVALUATOR COMMENTS FORMTEXT ????? FORMTEXT ?????PRINT NAME FIRST EVALUATOR FORMTEXT ?????CERT # FORMTEXT ?????SKILL TEST DATE FORMTEXT ?? / FORMTEXT ?? / FORMTEXT ????SIGNATURE FIRST EVALUATORXOverall Skill Sheet Score FORMCHECKBOX Pass FORMCHECKBOX FailPRINT NAME SECOND EVALUATOR FORMTEXT ?????CERT # FORMTEXT ?????SKILL TEST DATE FORMTEXT ?? / FORMTEXT ?? / FORMTEXT ????SIGNATURE SECOND EVALUATORXOverall Skill Sheet Score FORMCHECKBOX Pass FORMCHECKBOX FailPRINT NAME THIRD EVALUATOR FORMTEXT ?????CERT # FORMTEXT ?????SKILL TEST DATE FORMTEXT ?? / FORMTEXT ?? / FORMTEXT ????SIGNATURE THIRD EVALUATORXOverall Skill Sheet Score FORMCHECKBOX Pass FORMCHECKBOX FailOHIO DEPARTMENT OF PUBLIC SAFETYRESCUE – VICTIM DRAGSCANDIDATE NAME (Please Print) FORMTEXT ?????DATE FORMTEXT ?????CHARTER FORMTEXT ?????CHARTER # FORMTEXT ?????VOLUNTEER FIREFIGHTERPRACTICAL SKILL EVALUATIONPrimary TaskRescue – Victim DragsJPR(s)5.3.9Reference SourceNFPA 1001 Standard, 2013 EditionSkill No.10-3Candidate InstructionThe candidate, wearing PPE, shall demonstrate proper victim removal techniques using the lift and drag, OR the push and pull drag methods. Assistants will be made available if applicable. The candidate shall give orders and directions when moving the victim.State Maximum Allotted10 minutesPERFORMANCE STEPSTEST 1RETEST 2RETEST 3LIFT AND DRAG METHODPFPFPFLocates and assesses victim’s condition. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Takes position at the head of victim. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Rescuer wraps both arms around victim’s torso and locks hands together (or uses webbing or other method to drag victim if unable to stand based on conditions). FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Using proper lifting techniques, lifts victim (if conditions allow) and drag to safety. — CRITICAL POINT FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Firefighter must have at least 70% pass mark for each skill and perform all critical points(3 / 4 required). The charter training program may demonstrate and / or simulate this skill.Score: FORMTEXT ?? / 4PERFORMANCE STEPSTEST 1RETEST 2RETEST 3PUSH AND PULL METHODPFPFPFLocates and assesses victim’s condition and places on back. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Unfasten waist strap of victim SCBA and passes through crotch area and refastens. — CRITICAL POINT FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Rescuer locates himself / herself at victim’s head and takes hold of SCBA shoulder strap.Assistant: locates himself / herself inside the legs of the downed firefighter, lifting victim’s one leg over shoulder; head should be high in victim’s groin area and shoulder being used to push buttocks of downed fire fighter. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX On command, rescuer pulls firefighter, while assistant uses legs to push at the same time. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Firefighter must have at least 70% pass mark for each skill and perform all critical points(3 / 4 required). The charter training program may demonstrate and / or simulate this skill.Score: FORMTEXT ?? / 4LIFT AND DRAG METHODNUMBER OF ATTEMPTSTEST1RETEST 2RETEST 3SCORE FORMTEXT ?? / 4 FORMTEXT ?? / 4 FORMTEXT ?? / 4TIME FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????EVALUATOR COMMENTS FORMTEXT ????? FORMTEXT ?????PUSH AND PULL METHODNUMBER OF ATTEMPTSTEST1RETEST 2RETEST 3SCORE FORMTEXT ?? / 4 FORMTEXT ?? / 4 FORMTEXT ?? / 4TIME FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????EVALUATOR COMMENTS FORMTEXT ????? FORMTEXT ?????PRINT NAME FIRST EVALUATOR FORMTEXT ?????CERT # FORMTEXT ?????SKILL TEST DATE FORMTEXT ?? / FORMTEXT ?? / FORMTEXT ????SIGNATURE FIRST EVALUATORXOverall Skill Sheet Score FORMCHECKBOX Pass FORMCHECKBOX FailPRINT NAME SECOND EVALUATOR FORMTEXT ?????CERT # FORMTEXT ?????SKILL TEST DATE FORMTEXT ?? / FORMTEXT ?? / FORMTEXT ????SIGNATURE SECOND EVALUATORXOverall Skill Sheet Score FORMCHECKBOX Pass FORMCHECKBOX FailPRINT NAME THIRD EVALUATOR FORMTEXT ?????CERT # FORMTEXT ?????SKILL TEST DATE FORMTEXT ?? / FORMTEXT ?? / FORMTEXT ????SIGNATURE THIRD EVALUATORXOverall Skill Sheet Score FORMCHECKBOX Pass FORMCHECKBOX FailOHIO DEPARTMENT OF PUBLIC SAFETYADVANCING A CHARGED LINE OUTDOORSCANDIDATE NAME (PLEASE PRINT) FORMTEXT ?????DATE FORMTEXT ?????CHARTER FORMTEXT ?????CHARTER # FORMTEXT ?????VOLUNTEER FIREFIGHTERPRACTICAL SKILL EVALUATIONPrimary Task Advancing Fire HoseJPR(s)5.3.10Reference SourceNFPA 1001 Standard, 2013 EditionSkill No.12-1Candidate InstructionThe candidate, wearing protective clothing, and given the necessary equipment and assistance, shall advance a 1-?” or 1-?” or larger hoseline. State Maximum Allotted10 minutesPERFORMANCE STEPSTEST 1RETEST 2RETEST 2ADVANCING A CHARGED LINE OUTDOORSPFPFPFWearing complete personal protective clothing. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Advances hoseline with partner; both firefighters are on the same side of hose. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Sets nozzle pattern. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Bleeds air out of hoseline before spraying outdoor property. — CRITICAL POINT FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Firefighter must have at least 70% pass mark for each skill and perform all critical points(3 / 4 required).Score: FORMTEXT ? / 4NUMBER OF ATTEMPTSTEST 1RETEST 2RETEST 3SCORE FORMTEXT ?? / 4 FORMTEXT ?? / 4 FORMTEXT ?? / 4TIME FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????EVALUATOR COMMENTS FORMTEXT ????? FORMTEXT ?????PRINT NAME FIRST EVALUATOR FORMTEXT ?????CERT # FORMTEXT ?????SKILL TEST DATE FORMTEXT ?? / FORMTEXT ?? / FORMTEXT ????SIGNATURE FIRST EVALUATORXOverall Skill Sheet Score FORMCHECKBOX Pass FORMCHECKBOX FailPRINT NAME SECOND EVALUATOR FORMTEXT ?????CERT # FORMTEXT ?????SKILL TEST DATE FORMTEXT ?? / FORMTEXT ?? / FORMTEXT ????SIGNATURE SECOND EVALUATORXOverall Skill Sheet Score FORMCHECKBOX Pass FORMCHECKBOX FailPRINT NAME THIRD EVALUATOR FORMTEXT ?????CERT # FORMTEXT ?????SKILL TEST DATE FORMTEXT ?? / FORMTEXT ?? / FORMTEXT ????SIGNATURE THIRD EVALUATORXOverall Skill Sheet Score FORMCHECKBOX Pass FORMCHECKBOX FailOHIO DEPARTMENT OF PUBLIC SAFETYHORIZONTAL VENTILATIONCANDIDATE NAME (PLEASE PRINT) FORMTEXT ?????DATE FORMTEXT ?????CHARTER FORMTEXT ?????CHARTER # FORMTEXT ?????VOLUNTEER FIREFIGHTERPRACTICAL SKILL EVALUATIONPrimary TaskHorizontal VentilationJPR(s)5.3.11Reference SourceNFPA 1001 Standard, 2013 EditionSkill No.14-1Candidate InstructionThe candidate, wearing protective clothing, and given an assistant and the necessary tools and equipment, shall demonstrate ventilating a structure using the following methods. State Maximum Allotted 15 minutesPERFORMANCE STEPSTEST 1RETEST 2RETEST 3MECHANICAL VENTILATION PFPFPFWearing complete personal protective clothing. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Organizes and collects necessary equipment. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Uses or simulates safe procedures for clearing window / door glass and removing obstructions with respect to wind conditions. — CRITICAL POINT FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Ensures exit opening is proportioned to entry opening and establishes a draft path. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Positions and starts fan. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Ensures smoke is cleared before shutting down fan. — CRITICAL POINT FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Firefighter must have at least 70% pass mark for each skill and perform all critical points(5 / 6 required).Score: FORMTEXT ? / 6MECHANICAL VENTILATIONNUMBER OF ATTEMPTSTEST 1RETEST 2RETEST 3SCORE FORMTEXT ? / 6 FORMTEXT ? / 6 FORMTEXT ? / 6TIME FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????EVALUATOR COMMENTS FORMTEXT ????? FORMTEXT ?????PRINT NAME FIRST EVALUATOR FORMTEXT ?????CERT # FORMTEXT ?????SKILL TEST DATE FORMTEXT ?? / FORMTEXT ?? / FORMTEXT ????SIGNATURE FIRST EVALUATORXOverall Skill Sheet Score FORMCHECKBOX Pass FORMCHECKBOX FailPRINT NAME SECOND EVALUATOR FORMTEXT ?????CERT # FORMTEXT ?????SKILL TEST DATE FORMTEXT ?? / FORMTEXT ?? / FORMTEXT ????SIGNATURE SECOND EVALUATORXOverall Skill Sheet Score FORMCHECKBOX Pass FORMCHECKBOX FailPRINT NAME THIRD EVALUATOR FORMTEXT ?????CERT # FORMTEXT ?????SKILL TEST DATE FORMTEXT ?? / FORMTEXT ?? / FORMTEXT ????SIGNATURE THIRD EVALUATORXOverall Skill Sheet Score FORMCHECKBOX Pass FORMCHECKBOX FailOHIO DEPARTMENT OF PUBLIC SAFETYWATER SUPPLY - SUPPLY LAY CONNECTIONSCANDIDATE NAME (Please Print) FORMTEXT ?????DATE FORMTEXT ?????CHARTER FORMTEXT ?????CHARTER # FORMTEXT ?????VOLUNTEER FIREFIGHTERPRACTICAL SKILL EVALUATIONPrimary TaskWater Supply-Hydrant-Supply Lay ConnectionsJPR(s)5.3.15Reference SourceNFPA 1001 Standard, 2013 EditionSkill No.17-1Candidate InstructionThe candidate, wearing personal protective clothing, and given supply or intake hose, hose tools, and a fire hydrant, shall connect a fire department pumper to a water supply with a forward lay and ensure connections are tight and water flow is not obstructed.State Maximum Allotted10 minutesPERFORMANCE STEPSTEST 1RETEST 2RETEST 3HYDRANT (FORWARD LAY CONNECTION)PFPFPFWearing complete personal protective clothing. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Grasps needed equipment and sufficient hose (spanner and hydrant wrench, necessary appliance and adapter). FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Secures hydrant, ensuring they are not between hose and hydrant, and signals pump operator to start lay. — CRITICAL POINT FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Removes cap from appropriate outlet(s) and ensures other outlet caps are tightened (uses appropriate outlet nearest fire). FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Places hydrant wrench on the valve stem operating nut and removes hose loop from hydrant and connects hose to hydrant outlet closest to fire. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Installs hydrant gate(s) on extra outlet(s) as required by department guidelines. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Ensures supply line is attached to pumper OR hose clamp is used and placed properly by verbal or visual command. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Opens hydrant slowly and ensures water flow is not restricted. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Firefighter must have at least 70% pass mark for each skill and perform all critical points(6 / 8 required). Score: FORMTEXT ??/ 8NUMBER OF ATTEMPTSTEST 1RETEST 2RETEST 3SCORE FORMTEXT ?? / 8 FORMTEXT ?? / 8 FORMTEXT ?? / 8TIME FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????EVALUATOR COMMENTS FORMTEXT ????? FORMTEXT ?????PRINT NAME FIRST EVALUATOR FORMTEXT ?????CERT # FORMTEXT ?????SKILL TEST DATE FORMTEXT ?? / FORMTEXT ?? / FORMTEXT ????SIGNATURE FIRST EVALUATORXOverall Skill Sheet Score FORMCHECKBOX Pass FORMCHECKBOX FailPRINT NAME SECOND EVALUATOR FORMTEXT ?????CERT # FORMTEXT ?????SKILL TEST DATE FORMTEXT ?? / FORMTEXT ?? / FORMTEXT ????SIGNATURE SECOND EVALUATORXOverall Skill Sheet Score FORMCHECKBOX Pass FORMCHECKBOX FailPRINT NAME THIRD EVALUATOR FORMTEXT ?????CERT # FORMTEXT ?????SKILL TEST DATE FORMTEXT ?? / FORMTEXT ?? / FORMTEXT ????SIGNATURE THIRD EVALUATORXOverall Skill Sheet Score FORMCHECKBOX Pass FORMCHECKBOX FailOHIO DEPARTMENT OF PUBLIC SAFETYWATER SUPPLYHYDRANT SUPPLY LAY CONNECTIONSCANDIDATE NAME (Please Print) FORMTEXT ?????DATE FORMTEXT ?????CHARTER FORMTEXT ?????CHARTER # FORMTEXT ?????VOLUNTEER FIREFIGHTERPRACTICAL SKILL EVALUATIONPrimary TaskWater Supply-Hydrant-Supply Lay ConnectionsJPR(s)5.3.15Reference SourceNFPA 1001 Standard, 2013 EditionSkill No.17-2Candidate InstructionThe candidate, wearing personal protective clothing, and given supply or intake hose, hose tools, and a fire hydrant, shall connect a fire department pumper to a water supply with a reverse lay and ensure connections are tight and water flow is not obstructed.State Maximum Allotted10 minutesPERFORMANCE STEPSTEST 1RETEST 2RETEST 3REVERSE LAY CONNECTIONPFPFPFWearing complete personal protective clothing. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Grasps needed equipment and sufficient hose (spanner and hydrant wrench, necessary appliance and adapter) to reach attack pumper intake. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Anchors hose to stationary object and signals driver to start reverse lay. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Supply line is attached to attack pumper OR hose clamp is used and placed properly. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Intake hose is connected from supply pumper or hydrant and opens hydrant properly and ensures water flow is not restricted. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Prepares supply hose for connection and connects to discharge outlet of supply pumper and charges line once attack pumper is ready (releases hose clamp if used). FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Ensures all connections are tight. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Firefighter must have at least 70% pass mark for each skill and perform all critical points(5 / 7 required). Score: FORMTEXT ?? / 7NUMBER OF ATTEMPTSTEST 1RETEST 2RETEST 3SCORE FORMTEXT ?? / 7 FORMTEXT ?? / 7 FORMTEXT ?? / 7TIME FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????EVALUATOR COMMENTS FORMTEXT ????? FORMTEXT ?????PRINT NAME FIRST EVALUATOR FORMTEXT ?????CERT # FORMTEXT ?????SKILL TEST DATE FORMTEXT ?? / FORMTEXT ?? / FORMTEXT ????SIGNATURE FIRST EVALUATORXOverall Skill Sheet Score FORMCHECKBOX Pass FORMCHECKBOX FailPRINT NAME SECOND EVALUATOR FORMTEXT ?????CERT # FORMTEXT ?????SKILL TEST DATE FORMTEXT ?? / FORMTEXT ?? / FORMTEXT ????SIGNATURE SECOND EVALUATORXOverall Skill Sheet Score FORMCHECKBOX Pass FORMCHECKBOX FailPRINT NAME THIRD EVALUATOR FORMTEXT ?????CERT # FORMTEXT ?????SKILL TEST DATE FORMTEXT ?? / FORMTEXT ?? / FORMTEXT ????SIGNATURE THIRD EVALUATORXOverall Skill Sheet Score FORMCHECKBOX Pass FORMCHECKBOX FailOHIO DEPARTMENT OF PUBLIC SAFETYOPERATING PORTABLE FIRE EXTINGUISHERSCANDIDATE NAME (Please Print) FORMTEXT ?????DATE FORMTEXT ?????CHARTER FORMTEXT ?????CHARTER # FORMTEXT ?????VOLUNTEER FIREFIGHTERPRACTICAL SKILL EVALUATIONPrimary TaskSelect and Use a Fire Extinguisher Operating Portable Fire ExtinguishersJPR(s)5.3.16Reference SourceNFPA 1001 Standard, 2013 EditionSkill No.18-1Candidate InstructionThe candidate, wearing personal protective clothing, and given a selection of portable fire extinguishers, shall extinguish an incipient Class A, B, or C fire so that the correct extinguisher is chosen, the fire is completely extinguished, and proper extinguisher handling techniques are followed.State Maximum Allotted3 minutesPERFORMANCE STEPSTEST 1RETEST 2RETEST 3OPERATING PORTABLE FIRE EXTINGUISHERSPFPFPFWearing complete personal protective clothing. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Identifies class of fire (A, B, C). FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Correct fire extinguisher / agent is selected. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Verbalizes disrupting electrical current prior to extinguishing (class C only). FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Assures operation prior to using (fully charged and test fire extinguisher). FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Uses Pull, Aim, Squeeze, and Sweep method of application. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Extinguishes fire completely and backs away when retreating. — CRITICAL POINT FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Firefighter must have at least 70% pass mark for each skill and perform all critical points(5 / 7 required).Score: FORMTEXT ??/ 7NUMBER OF ATTEMPTSTEST 1RETEST 2RETEST 3SCORE FORMTEXT ?? / 7 FORMTEXT ?? / 7 FORMTEXT ?? / 7TIME FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????EVALUATOR COMMENTS FORMTEXT ????? FORMTEXT ?????PRINT NAME FIRST EVALUATOR FORMTEXT ?????CERT # FORMTEXT ?????SKILL TEST DATE FORMTEXT ?? / FORMTEXT ?? / FORMTEXT ????SIGNATURE FIRST EVALUATORXOverall Skill Sheet Score FORMCHECKBOX Pass FORMCHECKBOX FailPRINT NAME SECOND EVALUATOR FORMTEXT ?????CERT # FORMTEXT ?????SKILL TEST DATE FORMTEXT ?? / FORMTEXT ?? / FORMTEXT ????SIGNATURE SECOND EVALUATORXOverall Skill Sheet Score FORMCHECKBOX Pass FORMCHECKBOX FailPRINT NAME THIRD EVALUATOR FORMTEXT ?????CERT # FORMTEXT ?????SKILL TEST DATE FORMTEXT ?? / FORMTEXT ?? / FORMTEXT ????SIGNATURE THIRD EVALUATORXOverall Skill Sheet Score FORMCHECKBOX Pass FORMCHECKBOX Fail ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download