# Form - Volunteer Participation Annual Confirmation

> Fire Service Safety Management System, version 0.3.3 (2026-10-25). The Human Factor. Document FSSMS-FRM-11.
>
> Canonical: https://thehumanfactor.ca/library/fire-service-safety/form-volunteer-participation-annual-confirmation
>
> 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.

## What this form is for

One confirmation per volunteer or paid-on-call member per calendar year, prepared from the department’s attendance system and signed by the fire chief or deputy chief. It records how much of the department’s activity (emergency responses and training) the member took part in.

**Why it matters to the member.** In some provinces and territories, a volunteer firefighter qualifies for presumptive workers’ compensation coverage for occupational cancers and heart injury only if they can show a minimum level of participation in the department’s activities in each year of the qualifying period, confirmed in writing by the chief ([J11 Volunteer Firefighters](https://thehumanfactor.ca/library/fire-service-safety/j11-volunteer-firefighters); [J32 Workers' Compensation and Firefighter Presumptions](https://thehumanfactor.ca/library/fire-service-safety/j32-workers-compensation-and-firefighter-presumptions)). The threshold, the activities that count, the way participation is calculated and who must sign all differ by jurisdiction. Years later, when a member is ill, this record may be the only evidence of their service, and a department that does not keep it can cost a member their claim. Even where no participation threshold applies, the confirmation is the department’s evidence of each member’s exposure history, which the [Occupational Cancer Prevention, Exposure Tracking and Screening Program](https://thehumanfactor.ca/library/fire-service-safety/occupational-cancer-prevention-exposure-tracking-and-screening-program) relies on.

**Who completes it.** The station or district officer prepares it from the attendance records by January 31 for the previous year; the member reviews it and may add a comment; the fire chief or deputy chief signs it; the records administrator files the original in the member’s service file (not the medical file) and gives the member a copy. Where the jurisdiction’s compensation board prescribes its own form for this confirmation, complete that form as well and attach it.

## The form

| Field | Entry |
|:---|:---|
| Calendar year covered |  |
| Member name and member identifier |  |
| Station or company |  |
| Member category (volunteer / paid-on-call / composite career member also serving as volunteer) |  |
| Status during the year (active all year / joined on (date) / left on (date) / leave of absence from (date) to (date)) |  |
| Total emergency responses dispatched to the member’s station or company during the year |  |
| Emergency responses the member attended |  |
| Response participation (percent) |  |
| Total scheduled training sessions offered to the member |  |
| Training sessions the member attended |  |
| Training participation (percent) |  |
| Combined participation in department activities (percent), calculated as your jurisdiction’s rule defines it ([J11 Volunteer Firefighters](https://thehumanfactor.ca/library/fire-service-safety/j11-volunteer-firefighters)) |  |
| Fires attended where the member was exposed to smoke or products of combustion (count) |  |
| Exposure reports filed by or for the member during the year (count; cross-reference [Form - Exposure Report](https://thehumanfactor.ca/library/fire-service-safety/form-exposure-report)) |  |
| Meets the jurisdiction’s participation threshold for the year (yes / no / no threshold applies) |  |
| Source of the counts (attendance system name and report date) |  |
| Prepared by (officer role) and date |  |
| Member review: I have seen this record (signature and date) |  |
| Member comment (optional) |  |
| Confirmed by the fire chief or deputy chief (signature, printed name and date) |  |
| Copy given to member (date) |  |
| Board-prescribed form completed and attached (yes / no / not required) |  |

## Fields

| Field | Type | Required | Who completes |
|:---|:---|:---|:---|
| Calendar year covered | Year | Yes | Preparing officer |
| Member name and identifier | Text | Yes | Preparing officer |
| Station or company | Text | Yes | Preparing officer |
| Member category | Choice | Yes | Preparing officer |
| Status during the year | Choice plus dates | Yes | Preparing officer |
| Total responses dispatched | Integer | Yes | Preparing officer, from the attendance system |
| Responses attended | Integer | Yes | Preparing officer, from the attendance system |
| Response participation | Percent, one decimal | Yes | Calculated |
| Training sessions offered | Integer | Yes | Preparing officer |
| Training sessions attended | Integer | Yes | Preparing officer |
| Training participation | Percent, one decimal | Yes | Calculated |
| Combined participation | Percent, one decimal | Yes | Calculated by the jurisdiction’s method |
| Fires with smoke exposure | Integer | Yes | Preparing officer, from incident and exposure records |
| Exposure reports | Integer | Yes | Preparing officer |
| Meets threshold | Choice | Yes | Preparing officer |
| Source of counts | Text | Yes | Preparing officer |
| Prepared by and date | Text, date | Yes | Preparing officer |
| Member review | Signature, date | Yes | Member |
| Member comment | Text | No | Member |
| Confirmation | Signature, name, date | Yes | Fire chief or deputy chief |
| Copy given to member | Date | Yes | Records administrator |
| Board form attached | Choice | Where the board prescribes a form | Records administrator |

## Instructions

1.  **Count from records, not memory.** Use the attendance system’s report for the calendar year. If attendance was not recorded for part of the year, say so in the source field and record what evidence was used (sign-in sheets, incident reports, training rosters).
2.  **Treat leave fairly.** Where a member was on approved leave (medical, parental, deployment), record the leave dates; calculate participation over the period the member was available, unless your jurisdiction’s rule says otherwise, and note the method.
3.  **Never leave a year blank.** If a member was inactive, complete the form anyway and record why; a gap with no record is worse for the member than a record of low participation.
4.  **Keep it out of the medical file.** This is a service record. It contains no health information.
5.  **Retain it for the long term.** Keep participation confirmations for the member’s service plus at least 30 years, alongside exposure records ([Policy - Records, Privacy and Health Information](https://thehumanfactor.ca/library/fire-service-safety/policy-records-privacy-and-health-information)), or longer where your jurisdiction’s retention rule requires it ([J09 Records Retention](https://thehumanfactor.ca/library/fire-service-safety/j09-records-retention)).
6.  **Correct errors openly.** If a member disputes a count, the officer reviews the source records with the member; corrections are made by a dated amendment signed by the chief, never by replacing the original.

> **Tip: Volunteer and composite departments**
>
> Build the attendance system before anything else in the volunteer program. It feeds this form, fit-test and training currency, and the medical and fitness completion tracker ([Form - Annual Medical and Fitness Completion Tracker](https://thehumanfactor.ca/library/fire-service-safety/form-annual-medical-and-fitness-completion-tracker)).

## Definitions

- **Activities of the department.** The emergency responses and scheduled training sessions that count toward participation, as the jurisdiction’s rule defines them.
- **Participation threshold.** The minimum share of activities a volunteer must attend each year to qualify for a presumption, where a jurisdiction sets one.
- **Presumptive coverage.** A rule in workers’ compensation law that presumes certain diseases in firefighters are work-related once service and other conditions are met.
- **Qualifying period.** The minimum years of service a presumption requires for a given disease.

## 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 |
|:---|:---|:---|
| Records Retention | Any retention period the law sets for participation, exposure and service records that support a presumptive claim | [J09 Records Retention](https://thehumanfactor.ca/library/fire-service-safety/j09-records-retention) |
| Volunteer Firefighters | Whether volunteers are covered by the presumptions; the participation threshold and the activities that count; how combined participation is calculated; who must confirm it in writing; and any form the compensation board prescribes | [J11 Volunteer Firefighters](https://thehumanfactor.ca/library/fire-service-safety/j11-volunteer-firefighters) |
| Workers’ Compensation and Firefighter Presumptions | The presumptive cancers and heart injury, the minimum years of service for each, and the qualifying exposure conditions that the confirmed years of service support | [J32 Workers' Compensation and Firefighter Presumptions](https://thehumanfactor.ca/library/fire-service-safety/j32-workers-compensation-and-firefighter-presumptions) |

## References