# Form - Exposure Report > Fire Service Safety Management System, version 0.3.3 (2026-10-25). The Human Factor. Document FSSMS-FRM-16. > > Canonical: https://thehumanfactor.ca/library/fire-service-safety/form-exposure-report > > 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. **Purpose.** The per-member, per-incident record of an exposure to products of combustion, a chemical, a biological agent or a physical agent, kept for the member’s lifetime of risk so that medical surveillance and a later compensation claim, including one under a firefighter presumption ([J32 Workers' Compensation and Firefighter Presumptions](https://thehumanfactor.ca/library/fire-service-safety/j32-workers-compensation-and-firefighter-presumptions)), rest on facts, not memory [(NFPA 1585, 2025)](https://thehumanfactor.ca/library/fire-service-safety/form-exposure-report#ref-nfpa-1585); [(IARC, 2023)](https://thehumanfactor.ca/library/fire-service-safety/form-exposure-report#ref-iarc-2023). One report per exposed member per incident; the officer starts it, the member confirms it, the {{Health and Safety Officer}} reviews it. It is not an injury report: symptoms, first aid, medical attention or lost time also require [Form - Injury and Incident Report](https://thehumanfactor.ca/library/fire-service-safety/form-injury-and-incident-report) and start the statutory reporting clocks your jurisdiction sets ([J08 Incident Reporting and Investigation](https://thehumanfactor.ca/library/fire-service-safety/j08-incident-reporting-and-investigation)). Procedure: [SWP - Exposure Reporting](https://thehumanfactor.ca/library/fire-service-safety/swp-exposure-reporting). (S1) ## Part A: Incident (pre-filled from the incident record where the system allows) | Field | Entry | |:---|:---| | Incident or training number; date | | | CAD times: dispatch / arrival / cleared | | | Incident type (structure fire / vehicle fire / wildland or interface / live-fire training / hazmat / medical / other) | | | Occupancy and fuel package (residential / commercial / industrial / vehicle / solar or battery / hazmat / structure age and asbestos likelihood / other) | | | Address type only (the address itself stays in the incident record, not in the member export) | | | Unit and station; company officer (role) | | ## Part B: Member and exposure (one report per member) | Field | Entry | |:---|:---| | Member ID; career or volunteer; station | | | Role and assignment at the incident | | | Zone (hot / warm / cold) | | | Activity (interior attack / overhaul / exterior / pump / investigation / training burn / hazmat entry / wildland line / other) | | | Duration in hot or warm zone (minutes) | | | SCBA on (time) / off (time); worn through overhaul (Y/N) | | | Air monitoring before SCBA removal (Y/N); CO reading; HCN reading; cleared by (role) | | | Suspected agents (smoke and products of combustion / diesel exhaust / CO / HCN / asbestos / silica or dust / chemical, name / blood or body fluid / airborne illness / PFAS foam / wildland smoke / noise / heat / radiation / other) | | | Route (inhalation / skin / eyes / ingestion / needlestick or wound) | | | PPE worn and condition (structural ensemble / hood type / SCBA / gloves / chemical ensemble / wildland ensemble / respirator type) | | ## Part C: Decontamination done | Field | Entry | |:---|:---| | Gross decon (preliminary exposure reduction) at the scene (Y/N, time) | | | Hood exchanged (Y/N) | | | Skin wipes used (Y/N) | | | PPE bagged and sent for advanced cleaning (Y/N, tag) | | | Rode in clean cab or in station wear (Y/N; if N, note) | | | Shower within 60 minutes (Y/N, time) | | | Decontamination log number ([Form - Decontamination Log](https://thehumanfactor.ca/library/fire-service-safety/form-decontamination-log)) | | ## Part D: Health (restricted access: {{Health and Safety Officer}} and the fire department physician only) | Field | Entry | |:---|:---| | Symptoms at the time (none / headache / nausea / dizziness / shortness of breath / chest pain / skin or eye irritation / other) | | | Symptoms later (member may add within 30 days; date) | | | Rehab vitals taken (Y/N; [Form - Rehabilitation Log](https://thehumanfactor.ca/library/fire-service-safety/form-rehabilitation-log) reference) | | | Medical attention sought (Y/N; where; date) | | | Injury report filed (Y/N; number) | | | Post-exposure protocol activated for biological exposure (Y/N; time; [SWP - Infection Control and Post-Exposure](https://thehumanfactor.ca/library/fire-service-safety/swp-infection-control-and-post-exposure)) | | ## Part E: Reporting and sign-off | Field | Entry | |:---|:---| | Witnesses (role only) | | | Reporter (role); date and time started | | | Member acknowledgement (ID; date) | | | {{Health and Safety Officer}} review date; agent and activity codes | | | Regulator notice required (Y/N; time sent); compensation board report required (Y/N; date sent; claim number) | | | Linked records: incident number; rehab log; decon log; injury report; deployment exposure log | | | Concern raised by the member about this report (what); answered on (date) by (role) | | ## Fields | Field | Type | Required | Who completes | |:---|:---|:---|:---| | Incident fields (Part A) | Text, choice, times | Yes | Pre-filled; company officer | | Member identity, zone, activity, duration | ID, choice, number | Yes | Company officer | | SCBA times and monitoring | Times, Y/N, numbers, role | Yes | Company officer | | Agents, route, PPE | Multi-choice, text | Yes | Company officer with the member | | Decontamination (Part C) | Y/N, times, tag | Yes | Company officer | | Health (Part D) | Choice, text, dates | Yes if any; otherwise “none” | Member; HSO; physician | | Acknowledgement | ID, date | Yes, within seven days | Member | | Review, codes, clocks, links | Dates, codes, numbers | Yes | HSO | | Concern and answer | Text, date, role | When raised | HSO | ## Instructions 1. The company officer starts the report before the end of the shift; a volunteer unit before leaving the hall or within 24 hours by phone or app. If in doubt whether something was an exposure, file it. 2. The member checks and adds to their own section and acknowledges within seven days. Acknowledging confirms the record is yours, not that nothing happened. Later symptoms can be added for 30 days. 3. The {{Health and Safety Officer}} reviews within five working days, cross-checks the incident record for anyone missing, codes it, and files it. Part D is visible only to the HSO and the physician. 4. Exposures with symptoms, medical attention or transport also need an injury report and may need a regulator notice and a compensation board report, by the deadlines your jurisdiction sets ([J08 Incident Reporting and Investigation](https://thehumanfactor.ca/library/fire-service-safety/j08-incident-reporting-and-investigation)). 5. The record is exported for the member on request within 10 working days and retained for the duration of service plus 30 years (OSHA, n.d.-a, 29 CFR 1910.1020, as the benchmark). Learning information in this report is never used for discipline. > **Tip: Volunteer and composite departments** > > Keep paper copies on every apparatus for when the system is down; the HSO enters them. The report must take under five minutes on a phone or it will not be done. ## 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 exposures and injuries must be reported to the regulator and how fast (including a fire or explosion where nobody is hurt), and the employer’s deadline to report to the compensation board | [J08 Incident Reporting and Investigation](https://thehumanfactor.ca/library/fire-service-safety/j08-incident-reporting-and-investigation) | | Volunteer Firefighters | What a volunteer must show to benefit from the presumptions (such as a participation threshold and the chief’s confirmation), which this record and the annual participation confirmation support | [J11 Volunteer Firefighters](https://thehumanfactor.ca/library/fire-service-safety/j11-volunteer-firefighters) | | Workers’ Compensation and Firefighter Presumptions | The cancers presumed work-related in firefighters, the minimum years of service for each, and the qualifying exposure condition (such as whether forest fire exposure counts) | [J32 Workers' Compensation and Firefighter Presumptions](https://thehumanfactor.ca/library/fire-service-safety/j32-workers-compensation-and-firefighter-presumptions) | ## References International Agency for Research on Cancer \[IARC\]. (2023). *Occupational exposure as a firefighter* (IARC Monographs on the Identification of Carcinogenic Hazards to Humans, Vol. 132; working group met June 2022). National Fire Protection Association. (2025). *NFPA 1585, Standard for exposure and contamination control* (first edition). Occupational Safety and Health Administration \[OSHA\]. (n.d.-a). *Access to employee exposure and medical records* (29 C.F.R. § 1910.1020). U.S. Department of Labor.