# Checklist - Medical, Fitness and Wellness > Fire Service Safety Management System, version 0.3.3 (2026-10-25). The Human Factor. Document FSSMS-AUD-P04. > > Canonical: https://thehumanfactor.ca/library/fire-service-safety/checklist-medical-fitness-and-wellness > > Licence: CC BY-NC-SA 4.0 with the Adopting Agency Grant (https://creativecommons.org/licenses/by-nc-sa/4.0/) > > General information only, not legal, medical or other professional advice. Verify every requirement against the current official text of the law, standards and manufacturer instructions that apply to you. Obtain your own legal review and consult your joint health and safety committee before adopting anything. You adopt, adapt, implement and rely on this material entirely at your own risk and on your own responsibility. Full terms: Terms of Use, thehumanfactor.ca. ## Scope This category audits the [Medical, Fitness and Wellness Program](https://thehumanfactor.ca/library/fire-service-safety/medical-fitness-and-wellness-program) and the [Hearing Conservation Program](https://thehumanfactor.ca/library/fire-service-safety/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](https://thehumanfactor.ca/library/fire-service-safety/audit-checklist-master-index)). Rehabilitation at incidents (10.7) is scored in [Checklist - Rehabilitation](https://thehumanfactor.ca/library/fire-service-safety/checklist-rehabilitation); cancer screening (10.3) in [Checklist - Cancer Prevention, Exposure and Screening](https://thehumanfactor.ca/library/fire-service-safety/checklist-cancer-prevention-exposure-and-screening); psychological health in [Checklist - Psychological Health and Peer Support](https://thehumanfactor.ca/library/fire-service-safety/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)](https://thehumanfactor.ca/library/fire-service-safety/checklist-medical-fitness-and-wellness#ref-nfpa-1580) and the medical and physical requirements of the responder health and safety standard [(NFPA 1550, 2024, ch. 13)](https://thehumanfactor.ca/library/fire-service-safety/checklist-medical-fitness-and-wellness#ref-nfpa-1550); 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)](https://thehumanfactor.ca/library/fire-service-safety/checklist-medical-fitness-and-wellness#ref-iaff-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](https://thehumanfactor.ca/library/fire-service-safety/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](https://thehumanfactor.ca/library/fire-service-safety/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)](https://thehumanfactor.ca/library/fire-service-safety/checklist-medical-fitness-and-wellness#ref-cpse-2019). ## 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 1. 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](https://thehumanfactor.ca/library/fire-service-safety/form-annual-medical-and-fitness-completion-tracker). 2. Open two human resources files (with the HR custodian present) and look for anything beyond a determination. 3. Read the physician agreement, the essential job task list and the last five accommodation case files. 4. Read the last three months of fatigue monitoring and the fatigue declaration count. 5. Get in a front-line cab (headsets), stand at a pump panel (muffs), and read the noise survey. 6. Interview a volunteer firefighter, a company officer, a peer fitness trainer and the return-to-work coordinator. 7. Read the last two quarterly updates and the open items in the [Corrective Action Register](https://thehumanfactor.ca/library/fire-service-safety/corrective-action-register). ## Checklist | \# | Item | Stage | Evidence expected | Score (0-3) | Finding | Owner | Due | |:---|:---|:---|:---|:---|:---|:---|:---| | 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](https://thehumanfactor.ca/library/fire-service-safety/checklist-medical-fitness-and-wellness#ref-nfpa-1580); [NFPA 1550, 2024](https://thehumanfactor.ca/library/fire-service-safety/checklist-medical-fitness-and-wellness#ref-nfpa-1550)) | | | | | | 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)](https://thehumanfactor.ca/library/fire-service-safety/checklist-medical-fitness-and-wellness#ref-nfpa-1580) | | | | | | 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)](https://thehumanfactor.ca/library/fire-service-safety/checklist-medical-fitness-and-wellness#ref-nfpa-1550); [(IAFF & IAFC, 2018)](https://thehumanfactor.ca/library/fire-service-safety/checklist-medical-fitness-and-wellness#ref-iaff-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)](https://thehumanfactor.ca/library/fire-service-safety/checklist-medical-fitness-and-wellness#ref-nfpa-1550) | | | | | | 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](https://thehumanfactor.ca/library/fire-service-safety/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)](https://thehumanfactor.ca/library/fire-service-safety/checklist-medical-fitness-and-wellness#ref-nfpa-1580) | | | | | | 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)](https://thehumanfactor.ca/library/fire-service-safety/checklist-medical-fitness-and-wellness#ref-nfpa-1580) | | | | | | 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](https://thehumanfactor.ca/library/fire-service-safety/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)](https://thehumanfactor.ca/library/fire-service-safety/checklist-medical-fitness-and-wellness#ref-nfpa-1580) | | | | | | 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)](https://thehumanfactor.ca/library/fire-service-safety/checklist-medical-fitness-and-wellness#ref-iaff-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](https://thehumanfactor.ca/library/fire-service-safety/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](https://thehumanfactor.ca/library/fire-service-safety/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)](https://thehumanfactor.ca/library/fire-service-safety/checklist-medical-fitness-and-wellness#ref-nfpa-1580) | | | | | | 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)](https://thehumanfactor.ca/library/fire-service-safety/checklist-medical-fitness-and-wellness#ref-nfpa-1580); (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)](https://thehumanfactor.ca/library/fire-service-safety/checklist-medical-fitness-and-wellness#ref-iaff-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)](https://thehumanfactor.ca/library/fire-service-safety/checklist-medical-fitness-and-wellness#ref-hollnagel-2014); [(Conklin, 2012)](https://thehumanfactor.ca/library/fire-service-safety/checklist-medical-fitness-and-wellness#ref-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)](https://thehumanfactor.ca/library/fire-service-safety/checklist-medical-fitness-and-wellness#ref-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)](https://thehumanfactor.ca/library/fire-service-safety/checklist-medical-fitness-and-wellness#ref-edmondson-1999) | | | | | | 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](https://thehumanfactor.ca/library/fire-service-safety/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)](https://thehumanfactor.ca/library/fire-service-safety/checklist-medical-fitness-and-wellness#ref-cpse-2019) | | | | | ## Effectiveness questions (observation or interview only) 1. 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. 2. 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. 3. 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 | |:---|:---|:---|:---|:---|:---| | | | | | | | > **Tip: Volunteer and composite departments** > > Score the volunteer stations as their own sample line. An SCBA-qualified volunteer with no clearance is a 0 on item 8 for the whole category, whatever the career completion rate. ## 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](https://thehumanfactor.ca/library/fire-service-safety/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](https://thehumanfactor.ca/library/fire-service-safety/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](https://thehumanfactor.ca/library/fire-service-safety/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](https://thehumanfactor.ca/library/fire-service-safety/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](https://thehumanfactor.ca/library/fire-service-safety/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](https://thehumanfactor.ca/library/fire-service-safety/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](https://thehumanfactor.ca/library/fire-service-safety/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). Center for Public Safety Excellence \[CPSE\]. (2019). *Fire and emergency service self-assessment manual* (10th ed.). Commission on Fire Accreditation International. 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.). CSA Group. (2018). *CSA Z1010:18 (R2023), Management of work in extreme conditions*. CSA Group. (2020). *CSA Z1011:20 (R2024), Work disability management system*. CSA Group. (2021). *CSA Z1008:21, Management of impairment in the workplace*. 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. https://doi.org/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.). National Fire Protection Association. (2024). *NFPA 1550, Standard for emergency responder health and safety* (consolidates NFPA 1500, 1521 and 1561). National Fire Protection Association. (2025). *NFPA 1580, Standard for emergency responder occupational health and wellness* (consolidates NFPA 1581, 1582, 1583 and 1584).