Form
Form - Rehabilitation Log
Document FSSMS-FRM-26Stage 1Revision 5Version 0.3.3
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Purpose. The record that rehabilitation was established at an incident or training evolution, who went through it, their vital signs on entry and before release, and what happened to anyone who did not meet the release criteria (NFPA 1580, 2025, legacy NFPA 1584). One log per rehab sector per incident or evolution; one row per member per rehab cycle. The log goes with the incident or training record and is retained with the exposure records, because a cardiac event in the 24 hours after the incident will be judged against it. Procedure: SWP - Rehabilitation at Incidents and Training. (S1)
| Field | Entry |
|---|---|
| Incident or training number; date; incident type | |
| Rehab sector officer (role); monitor (role; department or EMS agency) | |
| Time rehab established; location relative to the hazard (upwind / uphill / outside zones / away from exhaust) | |
| Site conditions: air temperature; humidity, humidex or WBGT; wind; precipitation | |
| Shelter in use (shade / tent / heated cab or vehicle / building); cooling in use (passive / forearm immersion / misting / cold towels); warming in use (shelter / dry clothing / blankets / warm fluids) | |
| Partners on scene (EMS unit; canteen or support association; mutual aid rehab unit) | |
| PPE doffing and bagging point set up at the entry (Y/N); wipes available (Y/N) |
| Member ID | Unit | Time in | Cylinders this cycle | Entry HR | Entry BP | Entry RR | Entry temp | Entry SpO2 | Entry SpCO | Entry symptoms | Fluids / food | Cooling or warming applied | Release HR | Release BP | Release RR | Release temp | Release SpO2 | Release SpCO | Release symptoms | Time out | Disposition (R / H / T / X / F) | Monitor initials |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Disposition codes: R released to command; H held for further rest then released (record second release vitals on a new row); T treated by EMS; X transported; F refused assessment or transport.
| Field | Entry |
|---|---|
| Total members through rehab; total cycles | |
| Members held / treated / transported / refused (counts) | |
| Transports and refusals: injury or exposure report numbers; incident commander told (time); {{Health and Safety Officer}} told (time) | |
| Food provided at an incident over three hours (Y/N, time); toilets arranged (Y/N) | |
| Kit restocked (Y/N); rehab equipment decontaminated (Y/N) | |
| Rehab demobilized (time) | |
| Concerns raised by members (what; by role); answered on (date) by (role) | |
| Sector officer sign-off (role, initials, date); attached to incident or training record (date); HSO review (date) |
| Field | Type | Required | Who completes |
|---|---|---|---|
| Sector fields (Part A) | Text, times, numbers, Y/N | Yes, for every rehab established | Rehab sector officer |
| Member rows (Part B) | ID, times, numbers, text, code | One per member per cycle; entry and release vitals both required | Monitor |
| Disposition and injury report links | Code, number | Yes | Monitor; sector officer |
| Closure (Part C) | Counts, Y/N, times, text | Yes | Sector officer |
| Concern and answer | Text, date, role | When raised | Sector officer; program manager |
| Sign-off and review | Role, initials, dates | Yes | Sector officer; HSO |
- Start Part A when rehab is established; record the site conditions from the apparatus thermometer, a WBGT meter or the weather service.
- Take entry vitals within five minutes of arrival and release vitals before anyone leaves. A row without release vitals is incomplete. Apply the release criteria approved by the medical director; the medical monitoring card in the program carries them.
- Nobody self-releases. A member who does not meet the criteria is held, reassessed, treated or transported; record which.
- Any transport or refusal needs an injury or exposure report number before the log is closed, and the incident commander and the HSO are told before the end of the incident.
- Attach the log to the incident or training record; the HSO reviews a sample each quarter and reconciles transports to injury reports. The log is retained with the exposure records. Learning information in this log is never used for discipline.
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