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Form

Form - Annual Program Appraisal

Document FSSMS-FRM-01Stage 2Revision 3Version 0.3.3

Topic pages open on your jurisdiction, and requirements tables show its line. You can change this on any page.

How to use

One appraisal per program, completed by the program manager with the team, due March 15 for an April to March fiscal year (two months before the budget submission where the municipality’s cycle is earlier), presented to the senior leadership team and received by the management review (06 Program Improvement Teams section 10; Management Review section 4). It is also the exhibit a CFAI peer team expects for the “formal and documented program appraisal, at least annually” indicators (CPSE, 2019, criterion 11B.6 and the Category V closing indicators such as 5E.3 and 5G.2), so a department pursuing accreditation writes it once for both purposes. Six to 12 pages plus the budget worksheet. Writing conventions: present tense for the description; every continuous quality improvement item tied to the audit category, the CFAI indicator where one applies, and the register ID; status tags in capitals at the start of each bullet (COMPLETED, IN PROGRESS, ONGOING, ON HOLD, FIRST DRAFT COMPLETED, CANCELLED); quarter and year on every plan statement; SWOT cells of three to six words; people by role; stakeholders by organization type.

Part A: Header

Field Entry
Program or project name
Appraisal author (role) and program manager (role)
Date
Type of appraisal Annual / Project
Fiscal year covered
Audit category or categories (02 Audit Checklist Master Index)
CFAI criteria and indicators this program answers (10th edition numbers)
Strategic plan goal and objective this program serves

Part B: Program description and outline

Narrative, present tense: what the program is, who runs it (team composition by role, including standing consultants), what it covers (stations, modules, career and volunteer), what standards and the applicable regulation it is assessed against (see J01 OHS Legislation, Regulator and Enforcement and the program’s other topic pages in 00 Jurisdiction Index), the outcome statement from the charter, and how the program is delivered day to day.

Component Audit category and item CFAI indicator ISO 45001 clause Strategic plan task Status tag
1
2
3

Part C: Continuous quality improvement

C1. Recommendations received and responses

Source (audit finding, peer-team recommendation, JOHSC recommendation, learning review, regulator) Reference Recommendation (paraphrased) Response and status tag Register ID

C2. Indicator plans

One sentence per audit item or CFAI indicator scored below 3 or not met: “The program plans to {{Action}} by {{Quarter}} {{Year}}.”

C3. Strategic goals and objectives

Strategic goal (quoted) SMART objective Measure Target quarter and year Status tag

Part D: Risks and mitigation tactics

Risk (to members, to the program, to the department) Likelihood and severity (from the hazard profile method) Mitigation Status tag Owner (role)

Part E: Inputs and resources

Category Current state Gap Plan
Personnel (roles: program manager, team lead and understudy, members by station type, standing consultants, clinician, training officer)
Financial (budget lines and pressures; estimates where known; link to Part I)
Equipment and supply (standard manifest items, life cycle status, items on trial)
Education, professional development and qualification maintenance (certifications held and due, courses needed, instructor capacity)
Other essential resources (policy changes, administrative support, records system, stakeholders by organization type, standards: NFPA, CSA, ISO, the applicable regulation)

Part F: SWOT analysis

Strengths Weaknesses
Opportunities Threats

Part G: Outcomes and impacts

G1. Activities completed and outcomes achieved (COMPLETED tags)

G2. Expected outputs and milestones still open (ONGOING, IN PROGRESS, ON HOLD tags, with the quarter)

G3. Indicator results against baseline and target (the year on one table)

Indicator Baseline Target Result Trend What changed because of the data
Psychological-safety measure for this program

G4. Corrective action status for this program (opened, closed, overdue, reopened; effectiveness checks)

G5. Learning-team sessions, learning reviews and what they changed

G6. JOHSC consultation record for the year (dates, items, outcomes)

G7. Areas for improvement (the program’s own honest list)

Part H: Next steps and conclusion

Quarter Milestones for next year Owner (role)
Q1
Q2
Q3
Q4

Five-year outlook (three to five lines): where the program should be, what has to be true for that, and what decisions the senior team needs to make this year.

Development and succession status: understudy acted this year (Y/N); members’ development plans reviewed (Y/N); rotation rule met (Y/N); capability gaps.

Part I: Budget worksheet

Attach the completed Form - Program Team Budget Worksheet (the 14 lines of the owner’s model: current fiscal year actual or forecast, next fiscal year request, and years two, three and four, each figure with its basis). Its annual totals are the appraisal’s financial section; the appraisal does not carry a second table, so the two never disagree (06 Program Improvement Teams section 11).

Safety-critical items in this worksheet that, if not funded, leave a legal duty unmet or a critical control absent (listed plainly for the management review’s section D and the council report):

Part J: Sign-off

Role Confirmation Date
Program manager (prepared)
Team lead (contributed)
Standing JOHSC consultant (reviewed)
Deputy chief (reviewed)
Presented to senior leadership team (date)
Received by management review (date)

Fields

Field Type Required Who completes
Header fields Text; dates; pick lists Yes Program manager
Program description; component table Text; table Yes Program manager
C1 recommendations and responses Repeating group Yes (may be “none”) Program manager
C2 indicator plans Text, one sentence each One per item below 3 Program manager
C3 strategic objectives Repeating group Yes Program manager
Risks and mitigations Repeating group At least one Program manager with team
Inputs and resources (five categories) Text Yes Program manager
SWOT Four cells Yes Team
G1 to G7 Text; tables Yes Program manager with team
Next year milestones by quarter; five-year outlook; succession status Table; text; Y/N Yes Program manager
Budget worksheet Attached Form - Program Team Budget Worksheet Yes Program manager with finance liaison
Safety-critical unfunded items Text Yes (may be “none”) Program manager
Sign-off Roles, dates Yes Roles listed

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
OHS Legislation, Regulator and Enforcement Which OHS statute and regulations the program is assessed against, who enforces them, and whether a federal regime applies instead for any part of the department J01 OHS Legislation, Regulator and Enforcement

References

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

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