Checklist

Scope

This category audits the Medical, Fitness and Wellness Program and the Hearing Conservation Program: the fire department physician, essential job tasks, candidate and member medical evaluation, respirator clearance, fitness for duty and accommodation, the health-related fitness program, fatigue and hours of work, return to work, immunization, vision, hearing conservation, health information custody, training, indicators and the accountability loop. It is Master Index category 10 items 10.1, 10.2, 10.4, 10.5, 10.6 and 10.8 (02 Audit Checklist Master Index). Rehabilitation at incidents (10.7) is scored in Checklist - Rehabilitation; cancer screening (10.3) in Checklist - Cancer Prevention, Exposure and Screening; psychological health in Checklist - Psychological Health and Peer Support.

Criteria

The criteria come from the occupational health and wellness standard’s medical program, fitness and infection control content (NFPA 1580, 2025) and the medical and physical requirements of the responder health and safety standard (NFPA 1550, 2024, ch. 13); the respirator standard’s medical clearance requirement (CSA Z94.4-18); the work disability management standard (CSA Z1011:20); the impairment management standard (CSA Z1008:21); the extreme conditions standard (CSA Z1010:18); the joint labour-management wellness-fitness model (IAFF & IAFC, 2018); the occupational exposure limits for physical agents, which the applicable regulation often adopts by reference to the threshold limit values (ACGIH, n.d.) (J22 Exposure Limits, Heat and Cold Stress); the three-step test for a bona fide occupational requirement (British Columbia (Public Service Employee Relations Commission) v. BCGSEU, 1999); the applicable provincial or territorial occupational health and safety, workers’ compensation, human rights and privacy legislation (see Jurisdiction requirements and 00 Jurisdiction Index); and the accreditation criteria on medical and fitness evaluations, fitness facilities, wellness training, cardiac assessment and the annual appraisal (CPSE, 2019, criteria 11B.1, 11B.2, 11B.3, 11B.5, 11B.6).

Scoring

0 not in place. 1 documented, not implemented. 2 implemented, not verified effective. 3 implemented and effective with evidence. The category score is the mean of the item scores; report it by category. Score the tracker, the files and the interviews, not the policy.

How to run this category

Pull 10 members at random from the roster, including three volunteers and two SCBA-qualified volunteers: check each on Form - Annual Medical and Fitness Completion Tracker.
Open two human resources files (with the HR custodian present) and look for anything beyond a determination.
Read the physician agreement, the essential job task list and the last five accommodation case files.
Read the last three months of fatigue monitoring and the fatigue declaration count.
Get in a front-line cab (headsets), stand at a pump panel (muffs), and read the noise survey.
Interview a volunteer firefighter, a company officer, a peer fitness trainer and the return-to-work coordinator.
Read the last two quarterly updates and the open items in the Corrective Action Register.

#	Item	Stage	Evidence expected
1	A written program exists, approved, reviewed within 24 months, citing the current editions of the occupational health and wellness and responder health and safety standards	S1	Program note; approval and review dates (NFPA 1580, 2025; NFPA 1550, 2024)
2	A fire department physician (or clinic lead) is designated under a written agreement that sets scope, confidentiality, turnaround and cost	S1	Signed agreement; named by role
3	The physician has been oriented to the essential job tasks, SCBA and PPE loads, the exposure profile, rehab and the volunteer tiers, with an annual update	S1	Orientation record; physician interview (NFPA 1580, 2025)
4	An essential job task list is approved by the fire chief, included in job descriptions and postings, and reconciled with the collective agreement and the volunteer by-law	S1	Approved list with date; job postings; no conflicting clause found. Score 0 if no list
5	Every candidate in the last three years completed a medical evaluation to the candidate criteria and a validated physical ability test before appointment, including volunteers	S1	Candidate files, five sampled (NFPA 1550, 2024, cl. 13.1.1); (IAFF & IAFC, 2018)
6	Career members and all interior or SCBA-qualified members have an annual medical evaluation; completion 95 per cent or better	S2	Tracker; 10 sampled. Score 2 at 85 to 94; 1 below 85 (NFPA 1550, 2024, cl. 13.1.2)
7	Volunteer tiers are published; every active volunteer has had a Tier 1 entry evaluation; tier currency 90 per cent or better	S1 for Tier 1; S2 for currency	Tiers in the program; tracker by tier; three volunteers interviewed know their tier
8	Every SCBA-qualified member, career and volunteer, holds a current respirator medical clearance; members without clearance are restricted from SCBA assignment in the roster	S1	Tracker; roster flags; cross-check with Checklist - Respiratory Protection. Score 0 if any SCBA-qualified member is uncleared and unrestricted (CSA Z94.4-18)
9	The annual evaluation content includes history and exposure summary review, examination, vitals, body composition, vision, audiometry, spirometry, bloodwork, urinalysis, ECG, stress test by risk profile, cancer screening by age and sex, immunization status, a mental-health screen and a sleep-disorder screen	S2	Physician agreement content schedule; physician attestation (NFPA 1580, 2025)
10	Exercise stress testing is completed for the indicated cohort (age 40 and over or risk-flagged); 90 per cent or better	S2	Clinic aggregate; tracker cohort flags (NFPA 1580, 2025)
11	The physician receives the member’s exposure summary before each evaluation and attests to reviewing it	S2	Summaries sent against medicals done; attestation dates
12	Fitness determinations are reported in categories (fit, fit with restrictions by task number, temporarily unfit, unfit) and only the determination reaches the department	S1	Determination forms; tracker columns
13	Human resources and operational files hold no results, diagnoses, laboratory values or fitness scores	S1	Two HR files opened with the custodian; station file sample. Score 0 if any raw result found
14	A written information-sharing protocol is signed with each custodian naming what crosses to the department (determination, imminent risk, member consent)	S1	Signed protocols; HSO interview (see J10 Privacy and Health Information for the privacy legislation)
15	Members can obtain their own department records within 10 working days	S1	Access log; one request traced
16	A written accommodation process applies the three-step bona fide occupational requirement test; the last five cases show the task at issue, the options considered and rejected with reasons, the member’s input and representation offered	S1	Case files (British Columbia (Public Service Employee Relations Commission) v. BCGSEU, 1999). Score 0 if a member was removed from a role with no documented test
17	The percentile-based aerobic classification is reconciled with absolute task demands before any adverse use	S2	Program text; physician and program manager interviews (NFPA 1580, 2025)
18	Volunteers not cleared for a role are assigned to roles they are cleared for and the assignment is recorded as an accommodation, not a penalty	S1	Roster flags; volunteer officer interview
19	A health-related fitness program runs on duty for career members and credited time for volunteers, with a written rule that no assessment result is a basis for discipline or removal from duty	S2	Program text; schedule; trainer and member interviews (IAFF & IAFC, 2018)
20	Peer fitness trainers are certified, with at least one per platoon per district and one per volunteer district	S2	Certificates; coverage table
21	Annual fitness assessment completion is 90 per cent or better for career members; volunteers have an assessment within 24 months; results are held by the trainer and the member only	S2	Trainer aggregate counts; no scores found in department systems
22	Station fitness equipment is inspected monthly and serviced annually; an AED is on every apparatus and in every station and checked	S1	Station logs; apparatus check sheets; one AED checked
23	A fatigue policy sets a maximum continuous duty period, minimum rest, a night-tour rest policy, post-incident rest, driver fatigue rules and the self-declaration rule	S1	Policy - Fatigue and Hours of Work; limits filled in, not placeholders
24	Overtime hours, duty periods over the limit, consecutive-tour events and incidents by hour of day are monitored monthly and reviewed by the platoon chiefs	S2	Last three monthly reports; platoon chief interview
25	Fatigue self-declarations are honoured without penalty and counted without names; the count appears in the quarterly update	S1	Officer logs (counts); quarterly update; member interviews
26	Sleep-disorder screening is in the medical with a diagnostic and treatment pathway; a treated member stays on duty	S2	Content schedule; physician interview
27	Volunteers have a pager-silence window the dispatch system honours and a self-declaration before driving to a call	S1	Dispatch configuration; volunteer interviews
28	A return-to-work coordinator is named, a modified-duties list exists, first contact is made within three working days of a lost-time injury, and plans are written and graduated	S1 for coordinator and list; S2 for the full system	Last three plans; contact log; aligned to the work disability management standard (CSA Z1011:20)
29	Psychological injury follows the same return-to-work system with the clinical pathway	S2	One case traced in aggregate; Checklist - Psychological Health and Peer Support
30	Immunizations in the schedule are offered at department cost; status flags are complete for 95 per cent or more of members with patient contact; the post-exposure protocol is at every station and sharps containers are on apparatus	S1	Tracker flags; station and apparatus check (NFPA 1580, 2025, infection control content)
31	Vision is assessed in every medical and apparatus operators hold the licence class medical	S1	Tracker; operator licence records
32	A noise survey has been done within five years and after any apparatus or facility change, with a control assigned to every source over the exposure limit	S1	Survey report; controls list (ACGIH, n.d.)
33	Intercom headsets work at every riding position on front-line apparatus; hearing protection is at every pump panel, fan and tool station and worn when observed	S1	Cab check on two apparatus; pump panel check; ISO observation log
34	Every member in scope has a baseline audiogram; annual audiometry currency is 95 per cent or better; flagged shifts are retested within 30 days and followed up	S1 for baseline; S2 for annual	Tracker; follow-up records; provider calibration certificate (NFPA 1580, 2025); (CCOHS, n.d.-a)
35	A wellness calendar delivers cardiac risk literacy, tobacco cessation, nutrition, heat-strain and sleep education	S2	Calendar; attendance aggregates (IAFF & IAFC, 2018)
36	Training is current: officers on cardiac warning signs, impairment, fatigue rules and the accommodation process; members on cardiac risk, heat strain, sleep hygiene and hearing protection; trainers certified; the return-to-work coordinator oriented	S1	Training records; supervisor competency records; two officers interviewed
37	Indicators 1 to 13 of the program are reported quarterly against baseline and target, with volunteers by tier	S2	Last two quarterly indicator worksheets
38	A learning-team session with members, including volunteers, was held before the medical, fitness, fatigue or return-to-work procedures were written or last changed	S2	Session write-up without names; revision history (Hollnagel, 2014); (Conklin, 2012)
39	The just-culture line is written and known: learning teams, fatigue declarations and after-action reviews are never used for discipline; conduct concerns (impairment, falsification) go to a separate process under the impairment standard	S1	Policy text; interviews (Dekker, 2016); (CSA Z1008:21)
40	Accountability and closed feedback loop. The program’s table names one owner (deputy chief through the program manager), doers, verifiers with frequency (HSO quarterly sample, JOHSC twice a year, audit annually), feedback paths with cycle times, and the closure rule with escalation on the register’s priority scale; deficiencies in the register and closed with evidence	S1	Table filled with roles; register entries for the quarter; escalation applied to overdue items; one closed item traced to evidence
41	Member’s concern route. A concern about the medical, fitness or fatigue program is logged the same day and answered to the member within 10 working days; anonymous concerns answered in the quarterly notice	S1	Concern log; answer dates; interview the last two members who raised one
42	Psychological safety. Members report they can tell their officer they are not fit for a task or too tired to drive without it counting against them; declarations made are honoured at 100 per cent; the culture survey item is tracked	S2	Survey item; declaration counts and honoured rate; interviews (Edmondson, 1999)DOI
43	Leaders model the program: the fire chief and officers attend their own medicals on time, declare fatigue, go through rehab at working fires, and report back what the aggregate numbers say	S2	Tracker (chief officers current); interviews; quarterly notices
44	The program feeds the learning system: any cardiac event, collapse, heat illness or fatigue-related collision triggers a post-incident analysis; the after-action review asks who was running on empty	S2	Triage log; AAR records; Incident Investigation and Learning Program
45	The Stage 1 minimum is funded: physician agreement, SCBA clearances, candidate testing, Tier 1 medicals, fatigue limits, modified-duties list, protocol, tracker	S1	Budget worksheet; program appraisal
46	The collective agreement and the volunteer by-law contain no clause that conflicts with the medical program	S1	Counsel or HR review note; agreement clauses checked
47	An annual program appraisal with aggregate metrics has gone to the fire chief’s management review and the JOHSC	S2	Appraisal; JOHSC minutes
48	Accreditation crosswalk (where applicable): initial, regular and rehabilitative medical and fitness evaluations; fitness facilities and equipment; wellness and fitness training; cardiac assessment; annual appraisal	S2	Evidence above mapped to (CPSE, 2019, criteria 11B.1, 11B.2, 11B.3, 11B.5, 11B.6)

Effectiveness questions (observation or interview only)

Ask a volunteer firefighter when their last medical was, what it covered, whether they are cleared for SCBA, and who saw the results. Compare the answer with the tracker.
Ask a company officer what they would do if a member said at 0300 that they were too tired to drive the apparatus home from a fire, and what happened the last time it occurred.
Ask the human resources custodian to open a personnel file at random while you watch, and look for anything beyond a determination.

Category result

Items scored	Mean score	Items at 0 or 1	Open corrective actions	Auditor (role)	Date

Jurisdiction requirements

This chapter relies on the following legal requirements, which differ by province and territory. Check your jurisdiction’s section on each topic page before adopting it.

Topic	What to check in your jurisdiction	Page
Privacy and Health Information	Which health information statute makes the physician, clinic or other provider a custodian, and which access-to-information and privacy statute governs the department’s own records (items 13 to 15)	J10 Privacy and Health Information
Volunteer Firefighters	Whether volunteers are covered for workers’ compensation, and any condition, such as a participation threshold, a volunteer must meet to benefit from the firefighter presumptions (items 28, 44)	J11 Volunteer Firefighters
Respiratory Protection, Fit Testing and Breathing Air	Which respiratory protection program standard the regulation adopts, and whether a medical evaluation is required before a member wears a respirator (item 8)	J14 Respiratory Protection, Fit Testing and Breathing Air
Exposure Limits, Heat and Cold Stress	The basis of the exposure limits for chemical substances and physical agents, including noise, heat and cold (items 32 to 34)	J22 Exposure Limits, Heat and Cold Stress
Noise and Hearing Conservation	The noise exposure limit and exchange rate, and whether audiometric testing is required by law and how often; the program’s own audiometry schedule applies either way (items 32 to 34)	J23 Noise and Hearing Conservation
Workers’ Compensation and Firefighter Presumptions	Which heart, cancer and PTSD presumptions cover firefighters, their qualifying conditions, and whether compensation coverage of career members is mandatory (items 28, 44)	J32 Workers' Compensation and Firefighter Presumptions
Return to Work, Accommodation and Hours of Work	The duty to accommodate to undue hardship and the bona fide occupational requirement defence, any statutory return-to-work duties, and any hours-of-work rule that reaches firefighters (items 16 to 18, 23, 28)	J33 Return to Work, Accommodation and Hours of Work

References

British Columbia (Public Service Employee Relations Commission) v. BCGSEU, [1999] 3 S.C.R. 3 (Supreme Court of Canada).

American Conference of Governmental Industrial Hygienists [ACGIH]. (n.d.). Threshold limit values for chemical substances and physical agents and biological exposure indices (current edition).

Canadian Centre for Occupational Health and Safety [CCOHS]. (n.d.-a). Audiometric testing by jurisdiction (OSH Answers). https://ccohs.gc.ca/oshanswers/phys_agents/audiometric_testing.html

Center for Public Safety Excellence [CPSE]. (2019). Fire and emergency service self-assessment manual (10th ed.). Commission on Fire Accreditation International. https://cpse.org/wp-content/uploads/2019/08/10th-Edition-FESSAM-Strikethrough-Underline-v.4.pdf

Conklin, T. (2012). Pre-accident investigations: An introduction to organizational safety. Ashgate.

CSA Group. (2018). CAN/CSA-Z94.4-18 (R2023), Selection, use, and care of respirators (5th ed.). https://www.csagroup.org/store/product/2426374/

CSA Group. (2018). CSA Z1010:18 (R2023), Management of work in extreme conditions. https://webstore.ansi.org/standards/csa/csaz10102018

CSA Group. (2020). CSA Z1011:20 (R2024), Work disability management system. https://www.csagroup.org/store/product/CSA%20Z1011:20/

CSA Group. (2021). CSA Z1008:21, Management of impairment in the workplace. https://www.techstreet.com/standards/csa-z1008-21?product_id=2221471

Dekker, S. (2016). Just culture: Restoring trust and accountability in your organization (3rd ed.). CRC Press.

Edmondson, A. C. (1999). Psychological safety and learning behavior in work teams. Administrative Science Quarterly, 44(2), 350–383. doi:10.2307/2666999

Hollnagel, E. (2014). Safety-I and Safety-II: The past and future of safety management. Ashgate.

International Association of Fire Fighters [IAFF], & International Association of Fire Chiefs [IAFC]. (2018). The fire service joint labor management wellness-fitness initiative (4th ed.). https://www.iaff.org/wfi/

National Fire Protection Association. (2024). NFPA 1550, Standard for emergency responder health and safety (consolidates NFPA 1500, 1521 and 1561). https://www.nfpa.org/codes-and-standards/nfpa-1550-standard-development/1550

National Fire Protection Association. (2025). NFPA 1580, Standard for emergency responder occupational health and wellness (consolidates NFPA 1581, 1582, 1583 and 1584). https://www.nfpa.org/codes-and-standards/nfpa-1580-standard-development/1580