Division of Emergency Medical Services



Division of Emergency Medical ServicesVolunteer Firefighter Practical SkillsExamination PacketEFFECTIVE APRIL 1, 2019INDEX OF PRACTICAL SKILL SHEETS – VOLUNTEER FIREFIGHTER SKILL #OBJECTIVESKILLTESTMETHODSTATE MAXIMUM ALLOTTED1-24.1.2Personal Protective Equipment - Donning PPEM1 Minute1-34.3.1Personal Protective Equipment - Donning SCBAM1 Minute1-44.3.14.2.4Personal Protective Equipment - SCBA Emergency ProceduresM5 Minutes7-34.3.6One Firefighter Extension Ladder Carry and RaiseM10 Minutes12-14.3.10Advancing a Charged Line OutdoorsM10 Minutes2-14.3.20Knots and HoistingR10 Minutes3-14.2.3Communications – Radio TransmissionR1 Minute4-14.3.2Responding on ApparatusR5 Minutes6-14.3.4Forcible EntryR5 Minutes7-14.3.6Two Firefighter Ladder Carry and RaiseR10 Minutes7-74.3.10Operating A Hose Line from a LadderR2 Minutes10-74.2.4Declaring a MaydayR3 Minutes14-14.3.11Horizontal VentilationR15 Minutes16-14.3.14Two Firefighter Salvage Cover Fold and DeploymentR10 Minutes16-24.3.14One Firefighter Salvage Cover Roll and SpreadR10 Minutes17-14.3.15Water Supply – Hydrant – Forward Lay ConnectionsR10 Minutes17-24.3.15Water Supply – Hydrant – Reverse Lay ConnectionsR10 Minutes18-14.3.16Operating Portable Fire ExtinguishersR3 Minutes19-14.3.18Securing Building UtilitiesR3 MinutesOHIO DEPARTMENT OF PUBLIC SAFETYPERSONAL PROTECTIVE EQUIPMENT (PPE) DONNING PPECANDIDATE NAME (Please Print) FORMTEXT ?????DATE FORMTEXT ?????CHARTER FORMTEXT ?????CHARTER # FORMTEXT ?????VOLUNTEER FIREFIGHTERPRACTICAL SKILL EVALUATIONPrimary TaskPersonal Protective Equipment - Donning PPESkill No.1-2Reference SourceNFPA 1001 Standard, 2019 EditionJPR4.1.2Candidate InstructionThe candidate, given a complete ensemble of personal protective clothing, shall don 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 EQUIPMENT (PPE) DONNING SCBACANDIDATE NAME (Please Print) FORMTEXT ?????DATE FORMTEXT ?????CHARTER FORMTEXT ?????CHARTER # FORMTEXT ?????VOLUNTEER FIREFIGHTERPRACTICAL SKILL EVALUATIONPrimary TaskPersonal Protective Equipment - Donning SCBASkill No.1-3Reference SourceNFPA 1001 Standard, 2019 EditionJPR4.3.1Candidate InstructionThe candidate, wearing complete ensemble of 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 ensemble of personal protective clothing. — 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 Open cylinder valve completely. — 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 EQUIPMENT (PPE)SCBA EMERGENCY PROCEDURESCANDIDATE NAME (Please Print) FORMTEXT ?????DATE FORMTEXT ?????CHARTER FORMTEXT ?????CHARTER # FORMTEXT ?????VOLUNTEER FIREFIGHTERPRACTICAL SKILL EVALUATIONPrimary TaskPersonal Protective Equipment - SCBA Emergency ProceduresSkill No.1-4Reference SourceNFPA 1001 Standard, 2019 EditionJPR(s)4.3.1, 4.2.4Candidate InstructionsThe candidate, wearing complete ensemble of personal protective equipment (PPE), 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 ensemble of PPE. 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 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 RaiseSkill No.7-3Reference SourceNFPA 1001 Standard, 2019 EditionJPR4.3.6Candidate InstructionThe candidate, wearing complete ensemble of personal protective equipment (PPE), 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 ensemble of PPE. 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 EVALUATORX Overall 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 HoseSkill No. 12-1Reference SourceNFPA 1001 Standard, 2019 EditionJPR4.3.10Candidate InstructionThe candidate, wearing complete ensemble of personal protective equipment (PPE), and given the necessary equipment and assistance, shall advance a 1-?” or 1-?” or larger hoseline. State Maximum Allotted10 minutesPERFORMANCE STEPSTEST 1RETEST 2RETEST 3ADVANCING A CHARGED LINE OUTDOORSPFPFPFWearing complete ensemble of personal protective equipment. 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 SAFETYKNOTS AND HOISTINGCANDIDATE NAME (Please Print) FORMTEXT ?????DATE FORMTEXT ?????CHARTER FORMTEXT ?????CHARTER # FORMTEXT ?????VOLUNTEER FIREFIGHTERPRACTICAL SKILL EVALUATIONPrimary TaskKnots and Hoisting Skill No.2-1Reference SourceNFPA 1001 Standard, 2019 EditionJPR4.3.20Candidate InstructionThe candidate, wearing personal 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 with appropriate overhand safety.State Maximum Allotted10 MinutesPERFORMANCE STEPSTEST 1RETEST 2RETEST 3Safely performs the following steps:PFPFPFWearing personal protective clothing. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Correctly ties the following knots: bowline, clove hitch. Both 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: FORMTEXT ?? / 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 SAFETYCOMMUNICATIONS - RADIO TRANSMISSIONCANDIDATE NAME (Please Print) FORMTEXT ?????DATE FORMTEXT ?????CHARTER FORMTEXT ?????CHARTER # FORMTEXT ?????VOLUNTEERFIREFIGHTERPRACTICAL SKILL EVALUATIONPrimary TaskCommunications - Radio TransmissionSkill No.3-1Reference SourceNFPA 1001 Standard, 2019 EditionJPR4.2.3Candidate InstructionThe candidate shall demonstrate transmitting and receiving radio messages using a two-way portable radio.State Maximum Allotted1 minutePERFORMANCE STEPSTEST 1RETEST 2RETEST 3USING A TWO-WAY RADIOPFPFPFChecks equipment and ensures that radio is on correct frequency, battery is fully charged, and radio is ready to be used. — CRITICAL POINT FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Waits for open channel prior to transmitting ensuring that they are not interrupting other transmissions. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Begins with call sign of station being called. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Uses radio phonetics correctly. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Transmits message clearly, concisely, and using clear speech (no codes). — 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).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 EVALUATORX Overall Skill Sheet Score FORMCHECKBOX Pass FORMCHECKBOX FailOHIO DEPARTMENT OF PUBLIC SAFETYRESPONDING ON APPARATUSCANDIDATE NAME (Please Print) FORMTEXT ?????DATE FORMTEXT ?????CHARTER FORMTEXT ?????CHARTER # FORMTEXT ????? VOLUNTEERFIREFIGHTERPRACTICAL SKILL EVALUATIONPrimary TaskIncident Response - Responding on ApparatusSkill No. 4-1Reference SourceNFPA 1001 Standard, 2019 Edition JPR4.3.2Candidate InstructionThe candidate, wearing personal protective clothing, shall properly use all safety devices and equipment while responding on an apparatus to an emergency. The candidate shall properly mount and dismount apparatus, recognizing potential hazards.State Maximum Allotted5 minutesPERFORMANCE STEPSTEST 1RETEST 1RETEST 3Safely performs the following steps:PFPFPFStarting properly dressed in all personal protective clothing & equipment. — CRITICAL POINT FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Mounts apparatus using proper foot and hand holds. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Sits in a proper location and fastens seatbelt and other safety devices. — CRITICAL POINT FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Indicates to driver that they are seated and secured. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Completes in cab functions which do not require removal of safety devices. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Remains seated until driver indicates that dismount is safe. — CRITICAL POINT FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Dismount using appropriate hand rails and steps while observing the surroundings. 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 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 EntrySkill No.6-1Reference SourceNFPA 1001 Standard, 2019 EditionJPR4.3.4Candidate InstructionThe candidate, wearing complete ensemble of personal 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 ensemble of 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 RaiseSkill No.7-1Reference SourceNFPA 1001 Standard, 2019 EditionJPR4.3.6Candidate InstructionThe candidate, wearing complete ensemble of personal protective equipment (PPE), 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 ensemble of PPE. 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 SAFETYOPERATING A HOSE LINE FROM A LADDERCANDIDATE NAME (Please Print) FORMTEXT ?????DATE FORMTEXT ?????CHARTER FORMTEXT ?????CHARTER # FORMTEXT ?????VOLUNTEERFIREFIGHTER IPRACTICAL SKILL EVALUATIONPrimary TaskLadders – Operating A Hose LineSkill No.7-7Reference SourceNFPA 1001 Standard, 2019 EditionJPR4.3.10Candidate InstructionThe candidate, wearing complete ensemble of personal protective equipment with SCBA, will operate a charged hose line (1?” diameter or larger) while secured to a ground ladder.State Maximum Allotted2 minutesPERFORMANCE STEPSTEST 1RETEST 2RETEST 3LADDERS – OPERATING A HOSE LINEPFPFPFVerifies that ladder is securely tied off and properly heeled. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Climbs ladder, maintaining 3 points of attachment, carrying a hose rope tool or webbing to secure hose to the ladder. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Climbs to proper position and performs a leg lock or secures to ladder with ladder belt. — CRITICAL POINT FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Brings up charged hose line using the hand - over - hand method. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Places nozzle over the rung approx. 12” and secures hose to the ladder using hose rope tool or webbing. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Directs hose line to be secured to the ladder every 20’. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Operates then closes nozzle slowly to prevent water hammer. 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 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 SAFETYDECLARING A MAYDAYCANDIDATE NAME (Please Print) FORMTEXT ?????DATE FORMTEXT ?????CHARTER FORMTEXT ?????CHARTER # FORMTEXT ????? VOLUNTEERFIREFIGHTERPRACTICAL SKILL EVALUATIONPrimary TaskDeclaring A MaydaySkill No. 10-7Reference SourceNFPA 1001 Standard, 2019 EditionJPR4.2.4Candidate InstructionThe candidate, wearing personal protective equipment including SCBA, shall demonstrate procedures for declaring a mayday.State Maximum Allotted3 minutesPERFORMANCE STEPSTEST 1RETEST 2RETEST 3DECLARING A MAYDAYPFPFPFWearing complete personal protective clothing including SCBA. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Transmits on radio that MAYDAY is declared (repeat three times) and reports his / her assignment. — CRITICAL POINT FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Listen for acknowledgement of MAYDAY, if no response, repeat. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Reports nature of MAYDAY and current location (last known location). FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Manually activates PASS device. — 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 ?? / 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 EVALUATORX Overall 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 VentilationSkill No.14-1Reference SourceNFPA 1001 Standard, 2019 EditionJPR4.3.11Candidate InstructionThe candidate, wearing complete ensemble of personal protective equipment (PPE), 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 ensemble of PPE. 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 SAFETYTWO FIREFIGHTER SALVAGE FOLD AND DEPLOYMENTCANDIDATE NAME (PLEASE PRINT) FORMTEXT ?????DATE FORMTEXT ?????CHARTER FORMTEXT ?????CHARTER # FORMTEXT ?????VOLUNTEERFIREFIGHTERPRACTICAL SKILL EVALUATIONPrimary TaskSalvage - Two Firefighter Salvage Fold and DeploymentSkill No.16-1Reference SourceNFPA 1001 Standard, 2019 EditionJPR4.3.14Candidate InstructionThe candidate, wearing personal protective clothing, and given a salvage cover and an assistant, shall demonstrate the following salvage cover fold. The candidate shall also demonstrate deploying the folded salvage cover after arranging furnishings.State Maximum Allotted10 minutesPERFORMANCE STEPSTEST 1RETEST 2RETEST 3SALVAGE COVER FOLDPFPFPFWearing personal protective clothing. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Folds cover in half lengthwise. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Takes open corners and folds cover lengthwise again. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Takes open corners from one end to the other end placing them on top (all 4 corners should be together at this point). FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Folds cover end over end until desired size. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Properly arranges furnishings. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Opens and correctly deploys folded salvage cover (edges tucked under furniture). 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 EVALUATORX Overall Skill Sheet Score FORMCHECKBOX Pass FORMCHECKBOX FailOHIO DEPARTMENT OF PUBLIC SAFETYONE FIREFIGHTER SALVAGE – COVER ROLL AND SPREADCANDIDATE NAME (Please Print) FORMTEXT ?????DATE FORMTEXT ?????CHARTER FORMTEXT ?????CHARTER # FORMTEXT ?????VOLUNTEERFIREFIGHTERPRACTICAL SKILL EVALUATIONPrimary TaskOne Firefighter Salvage Cover Roll and SpreadSkill No. 16-2Reference SourceNFPA 1001 Standard, 2019 EditionJPR4.3.14Candidate InstructionThe candidate, wearing protective clothing, and with the assistance of the evaluator or an assistant, shall roll a salvage cover for the one - firefighter spread. The candidate shall arrange and cover the assortment of furniture using the one - firefighter spread with a rolled cover. The candidate must use the cover that he/she prepared. State Maximum Allotted10 minutesPERFORMANCE STEPSTEST 1RETEST 2RETEST 3SALVAGE COVER ROLL AND SPREADPFPFPFWearing complete personal protective clothing. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Cover prepared correctly (creates inside/outside folds, folds ends approximately 12” in, rolls to one end). FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Properly arranges furnishings. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Cover deployed correctly (unrolled from one end, edges tucked under furniture). 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(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 EVALUATORX Overall Skill Sheet Score FORMCHECKBOX Pass FORMCHECKBOX FailOHIO DEPARTMENT OF PUBLIC SAFETYWATER SUPPLY - HYDRANT - FORWARD LAY CONNECTIONSCANDIDATE NAME (Please Print) FORMTEXT ?????DATE FORMTEXT ?????CHARTER FORMTEXT ?????CHARTER # FORMTEXT ?????VOLUNTEER FIREFIGHTERPRACTICAL SKILL EVALUATIONPrimary TaskWater Supply - Hydrant - Forward Lay ConnectionsSkill No.17-1Reference SourceNFPA 1001 Standard, 2019 EditionJPR4.3.15Candidate InstructionThe candidate, wearing complete ensemble of personal protective equipment (PPE), 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 ensemble of PPE. 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 operates hydrant to flush debris from hydrant. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Closes hydrant, 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(7/9 required). Score: FORMTEXT ?? / 9NUMBER OF ATTEMPTSTEST 1RETEST 2RETEST 3SCORE FORMTEXT ?? / 9 FORMTEXT ?? / 9 FORMTEXT ?? / 9TIME 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 - HYDRANT - REVERSE LAY CONNECTIONSCANDIDATE NAME (Please Print) FORMTEXT ?????DATE FORMTEXT ?????CHARTER FORMTEXT ?????CHARTER # FORMTEXT ?????VOLUNTEER FIREFIGHTERPRACTICAL SKILL EVALUATIONPrimary TaskWater Supply – Hydrant - Reverse Lay ConnectionsSkill No.17-2Reference SourceNFPA 1001 Standard, 2019 EditionJPR4.3.15Candidate InstructionThe candidate, wearing complete ensemble of 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 ensemble of 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 TaskOperating Portable Fire ExtinguishersSkill No.18-1Reference SourceNFPA 1001 Standard, 2019 EditionJPR 4.3.16Candidate InstructionThe candidate, wearing complete ensemble of 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 ensemble of 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 FailOHIO DEPARTMENT OF PUBLIC SAFETYSECURING BUILDING UTILITIESCANDIDATE NAME (Please Print) FORMTEXT ?????DATE FORMTEXT ?????CHARTER FORMTEXT ?????CHARTER # FORMTEXT ?????VOLUNTEERFIREFIGHTERPRACTICAL SKILL EVALUATIONPrimary TaskSecuring Building UtilitiesSkill No.19-1Reference SourceNFPA 1001 Standard, 2019 EditionJPR4.3.18Candidate InstructionThe candidate, wearing complete PPE, employing all safety precautions, and given tools, shall demonstrate the ability to secure building utilities.State Maximum Allotted3 minutesPERFORMANCE STEPSTEST 1RETEST 2RETEST 3SECURING BUILDING UTILITIESPFPFPFWearing complete PPE. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Identifies utility control device and selects proper tool to shut off supply. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Identifies any hazards present and controls or avoids identified hazards. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Uses proper methods to safely secure utilities. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Ensures utility company has been called. 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 ?? / 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 EVALUATORX Overall Skill Sheet Score FORMCHECKBOX Pass FORMCHECKBOX Fail ................
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