Checklist

Scope

This category audits the Firefighter Rehabilitation Program: triggers, sector setup, medical monitoring and release thresholds, rest and rehydration, active and passive cooling, cold-weather rehab, return to duty, documentation, training-ground rehab, partner agreements, equipment, training, indicators and the accountability loop. It is Master Index category 10 item 10.7 (02 Audit Checklist Master Index). Heat and cold work-rest tables and the WBGT thresholds are scored in Checklist - Wildland, Heat and Weather; the medical program in Checklist - Medical, Fitness and Wellness.

Criteria

The criteria come from the rehabilitation content of the occupational health and wellness standard: rehab as a required function, the work-cycle triggers, the nine components, medical monitoring, contamination control at rehab and release (NFPA 1580, 2025, legacy NFPA 1584); the emergency operations chapter of the responder health and safety standard (NFPA 1550, 2024, ch. 10); the rehab requirement for live-fire training, formerly in NFPA 1403 and now in the fire service training standard (NFPA 1400, 2026); the extreme conditions standard (CSA Z1010:18); the heat-stress and cold-stress threshold limit values adopted by reference (ACGIH, n.d.); the cardiac fatality evidence (NFPA, 2026; USFA, 2025); the applicable provincial or territorial occupational health and safety and workers’ compensation requirements on injury reporting, heat and cold stress limits, first aid and firefighter presumptions (J08 Incident Reporting and Investigation; J22 Exposure Limits, Heat and Cold Stress; J24 First Aid; J32 Workers' Compensation and Firefighter Presumptions; see Jurisdiction requirements); and the accreditation criteria on rehabilitative evaluation and cardiac assessment (CPSE, 2019, criteria 11B.1, 11B.5).

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 logs, the kits and the interviews, not the SOG.

How to run this category

Pull the last 10 working fires and the last three live-fire or strenuous training evolutions; find the rehab log for each.
Check every sampled log for entry and release vitals, SpCO, dispositions and injury report links.
Open the rehab kit on three front-line apparatus (one volunteer) and find the district cooling and warming kits.
Read the release thresholds and the medical director’s signature; read the EMS agreement.
Interview a rehab sector officer, a monitor, an incident commander, a volunteer firefighter and the training safety officer.
Read the last two quarterly updates and the open items in the Corrective Action Register.

#	Item	Stage	Evidence expected
1	A written program and SWP exist, approved, reviewed within 24 months, citing the current edition of the occupational health and wellness standard’s rehabilitation content	S1	Program and SWP notes; dates (NFPA 1580, 2025)
2	Triggers to establish rehab are explicit: every working fire or SCBA use in the hazard zone, incidents beyond one cylinder or 45 minutes, heat or cold at threshold, live fire and strenuous training, hazmat entries, wildland operations	S1	SWP section 1; incident commander interview
3	Work-cycle triggers for sending crews are explicit (10 minutes after one cylinder or 20 minutes of hard work; 20 minutes after two cylinders, a 60-minute cylinder or 40 minutes of hard work) and the department has considered tighter cycles in heat	S1	SWP step 5; program section 5.1 (NFPA 1580, 2025)
4	The symptom override is written and known: a member with chest pain, shortness of breath, dizziness, nausea, confusion or unusual fatigue goes to rehab immediately regardless of the cycle	S1	SWP step 6; three members interviewed can state it
5	Rehab was established and logged at 100 per cent of the sampled working fires and training evolutions	S1	13 sampled events with logs. Score 2 at 90 to 99; 1 below 90; 0 if rehab is only at “big” fires
6	Median time from first SCBA use to rehab established is reported and falling	S2	CAD and log times; quarterly update
7	The sector is sited upwind and uphill of smoke and exhaust, outside the hot, warm and collapse zones, sheltered, with seating and EMS access	S1	Logs (location field); ISO observation; sector officer interview
8	PPE is doffed and bagged at the rehab entry and hands, face and neck wiped before eating or drinking	S1	Logs; kit contains bags and wipes; observation at a drill (NFPA 1580, 2025)
9	Rehab is inside the accountability system: members tag in and out and are not available for assignment while in rehab	S1	Accountability records show rehab in and out; SWP - Accountability and Personnel Accountability Reports
10	Release thresholds (heart rate, blood pressure, temperature, oxygen saturation, SpCO, symptoms, rest completed) are set and signed by the medical director or fire department physician	S1	Signed threshold page; monitoring card matches. Score 0 if no thresholds (NFPA 1580, 2025)
11	Vital signs are recorded on entry and before release for every member on every sampled log	S1	Logs. Score 0 if any sampled log has entry vitals only
12	Pulse CO-oximetry (SpCO) is available at every working fire and recorded where smoke exposure was possible	S1	Device on first-due apparatus or with monitors; logs show SpCO
13	A member who does not meet the criteria is held, reassessed, treated or transported; dispositions are recorded; nobody self-releases	S1	Logs show dispositions; member and officer interviews confirm no self-release
14	Every transport or refusal has an injury or exposure report number and the incident commander and the HSO were told before the end of the incident	S1	Logs reconciled to injury reports for 12 months. Score 0 if any transport has no injury report
15	Fluids are available at every rehab (water or electrolyte, cool in summer and warm in winter), caffeine and energy drinks are excluded, and food is provided at incidents over three hours	S1	Kit contents; logs at long incidents (NFPA 1580, 2025)
16	Passive cooling is standard at every rehab (coat, hood, helmet off, pants opened, SCBA off, shade and air movement)	S1	SWP; observation at a drill
17	Active cooling (forearm immersion, misting, cold towels) is available within 10 minutes of every first-due area when the heat threshold is reached	S1	District kit inventory; response time check
18	Cold-weather rehab provides a heated shelter, dry gloves, hoods and socks, warm fluids, wind protection and rotation of static crews; shivering, numbness, slurring and confusion are transport triggers	S1	Winter shelter plan per district; cold cache; SWP (ACGIH, n.d.); (CSA Z1010:18)
19	Heat emergency and cold emergency actions are explicit stop-work triggers (temperature at or above 39 °C or altered mentation; uncontrolled shivering or confusion)	S1	SWP warning callout; monitor interview
20	Rehab is established before every live-fire and strenuous training evolution with a fixed rehab area, students cycled on the same triggers, and summer scheduling adjusted to the WBGT forecast	S1	Training records; training safety officer checklist; schedule (NFPA 1400, 2026)
21	Physical ability testing and recruit evolutions have a monitor or EMS present	S1	Testing records
22	Written agreements exist with EMS for on-scene monitoring and with any canteen or mutual aid rehab provider, with the department’s fallback when the partner is delayed	S1	Agreements; reviewed within 12 months
23	Every front-line apparatus carries the Part A rehab kit (fluids, seats, wipes, blood pressure cuff, pulse CO-oximeter or oximeter, thermometer, log and cards, vest, seasonal items) and it is checked weekly	S1	Three apparatus checked against the list; check sheets. Score 0 if any apparatus has no kit
24	Monitoring devices are checked, calibrated per manufacturer and in date; consumables are in date	S1	Device logs; stores log
25	Each platoon and each volunteer district has at least two trained monitors and one trained sector officer; a pocket position checklist is in every kit	S1	Training records; coverage table; card in kit
26	Training is current: all members on heat and cold illness, triggers and no self-release (annual before summer); officers on sending crews; commanders and ISOs on establishing rehab; monitors with an annual skills check; partners oriented	S1	Training records; skills sign-offs; two members interviewed
27	Rehab logs are attached to incident and training records and retained with the exposure records, because the log is the member’s record if a presumptive heart injury claim follows (J32 Workers' Compensation and Firefighter Presumptions); the HSO samples 10 per quarter	S1	Filing; HSO sample record
28	Indicators 1 to 11 of the program are reported quarterly against baseline and target	S2	Last two quarterly indicator worksheets
29	A learning-team session with crews, including a volunteer station, was held before the SWP was written or last changed, and it described where crews actually sit, who takes release vitals when EMS has left, and what the pump operator does in January	S2	Session write-up without names; revision history (Hollnagel, 2014); (Conklin, 2012)
30	The just-culture line is written and known: logs, AARs and learning teams are never used for discipline; a crew that skipped rehab under pressure is reviewed for the pressure, not punished	S1	Policy text; interviews (Dekker, 2016)
31	Accountability and closed feedback loop. The program’s table names one owner (deputy chief through the Health, Wellness and Rehab program manager), doers, verifiers with frequency (ISO at every working fire, HSO quarterly, JOHSC on inspection, audit annually), feedback paths with cycle times including the seasonal notices, and the closure rule with escalation on the register’s priority scale	S1	Table filled with roles; register entries; seasonal notices sent; one closed item traced to evidence
32	Member’s concern route. A rehab concern raised at the scene or afterward is logged the same day and answered within 10 working days; anonymous concerns answered in the seasonal notice	S1	Concern log; answer dates; interview the last two members who raised one
33	Psychological safety. Members report they can say “I need rehab” or hold a crew member back without being judged; the ISO and sector officer have pulled or held chief officers; crews going to rehab on time are named as the example in AARs	S2	Survey item; logs with chief officers; AAR cards; interviews (Edmondson, 1999)DOI
34	Leaders model the program: chief officers go through rehab at working fires and teasing about rehab is treated as a safety hazard in officer training	S2	Logs; officer training content; interviews
35	The program feeds the learning system: any transport from rehab, heat or cold illness, cardiac symptom, or required rehab not established triggers a post-incident analysis; every working fire’s AAR asks when rehab was set up, who missed it and who left early	S2	Triage log; AAR records; Incident Investigation and Learning Program
36	The Stage 1 minimum is funded: SOG and thresholds, apparatus kits, pulse CO-oximeters, district cooling and warming kits, trained monitors and sector officers, EMS agreement or fallback	S1	Budget worksheet; program appraisal
37	Accreditation crosswalk (where applicable): rehabilitative evaluation and cardiac assessment supported by the on-scene monitoring record	S2	Evidence above mapped to (CPSE, 2019, criteria 11B.1, 11B.5)

Effectiveness questions (observation or interview only)

Ask a rehab monitor to run the medical monitoring card on you from memory: entry, thresholds, release, what they do when a number is high. Then ask what they did the last time a number was high.
Ask a volunteer firefighter what happens at 0100 at a barn fire when they have been through two cylinders, their day job starts at 0700, and the captain says “rehab”. What do they actually do, and what does the captain actually do?
Stand at the rehab area at a live-fire evolution or a drill: is it upwind, is anyone sitting in full PPE, is anyone drinking with contaminated gloves, and does anyone leave without being released?

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
Incident Reporting and Investigation	Which serious injuries must be reported to the regulator and how quickly, and the employer’s deadline for reporting a work injury to the compensation board, for members treated or transported from rehab (item 14)	J08 Incident Reporting and Investigation
Exposure Limits, Heat and Cold Stress	The basis of the heat-stress (WBGT) and cold-stress limits the OHS regulation adopts, such as the ACGIH TLVs, and the official weather alert source (items 17 to 19)	J22 Exposure Limits, Heat and Cold Stress
First Aid	The first aid coverage, attendant certification and kit the law requires at incident and training sites (items 21, 22)	J24 First Aid
Workers’ Compensation and Firefighter Presumptions	Whether a heart injury presumption covers firefighters, its qualifying event, time window and any service minimum, which makes the rehab log part of the member’s record (item 27)	J32 Workers' Compensation and Firefighter Presumptions

References

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

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

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.

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

National Fire Protection Association. (2026). NFPA 1400, Standard on fire service training (consolidates NFPA 1402, 1403, 1404, 1407, 1408, 1410 and 1451). https://www.nfpa.org/codes-and-standards/nfpa-1400-standard-development/1400

National Fire Protection Association [NFPA]. (2026). Fatal firefighter injuries in the United States in 2025. https://content.nfpa.org/-/media/Project/Storefront/Catalog/Files/Research/NFPA-Research/Emergency-responders/osFFF.pdf

United States Fire Administration [USFA]. (2025). Firefighter fatalities in the United States in 2024. Federal Emergency Management Agency. https://www.usfa.fema.gov/downloads/pdf/publications/firefighter-fatalities-2024.pdf