ZONE UPDATE Responder Form

Responder UPDATE Form

MO-IA FIRE ZONE REPONDER UPDATE FORM
Select Agency
Select Unit
Your Name*

First NameLast Name
EMP ID (Found on Red Card)*
If unknown input "Unknown"
Your E-mail*
example@example.com
Supervisor*
First and Last Name
Supervisor E-mail*
example@example.com
Your Phone Number*
Address where you want your Red Card and Certificates sent*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Have you taken a refresher?
Refresher Date:

MonthDayYear
Date
Have you taken a Work Capacity Test/Pack Test Needed?
WCT/Pack Test Date

MonthDayYear
Date
- Pack Test (Arduous Duty): Complete a 3-mile walk over level terrain in 45 minutes or less while carrying a 45-pound pack. Wildland firefighting (which includes positions such as firefighter, faller, or crew boss)
- Field Test (Moderate Duty): Complete a 2-mile walk over level terrain in 30 minutes or less while carrying a 25-pound pack. Moderate duty positions (such as operations section chief or safety officer)
- Walk Test (Light Duty): Complete a 1-mile walk over level terrain in 16 minutes or less (no pack carrying requirement). Light duty positions (such as incident communications technician or camp manager)
Have you taken a Base Line Medical Exam or Periodic exam in the last 3 years and cleared for duty? * If LEO SELECT LEO MEDICAL*
Those who receive a rating of qualified or qualified with a risk mitigation waiver must complete a self-certification each year that an exam is not required. They must receive a qualification certification prior to attempting the arduous work capacity test. The medical qualification exam self-certification process is available through the Acuity MLINK Portal.
All those who participate in arduous wildland fire activities must complete a comprehensive baseline medical qualification exam, with subsequent periodic exams every three years.

The medical qualification exam self-certification process is available through the Acuity MLINK Portal.
- FOR DOI EMPLOYEES:
  
  Arduous Duty Testing
  Arduous duty firefighting positions require a medical exam and a physical fitness test. You must complete your medical exam and receive a qualification certificate before you can participate in the pack test.
  
  Once you complete this form we will reach out to you and your supervisor.
  
  Learn about this process on our medical exam webpage.
  
  Moderate and Light Duty Testing
  To participate in the field test for moderate duty positions or the walk test for light duty positions, you must first complete a health screening questionnaire. Complete the questionnaire by following these steps:
  
  Step 1: Contact your local Fire Management Officer. They will collect your information and enter it into the medical exam tracking system, Acuity-CHS. Once you complete this form we will reach out to you and your supervisor.
  
  Step 2: Your local Fire Management Officer will then order your health screening questionnaire.
  Step 3: You’ll receive a registration email and directions to complete the health screening questionnaire.
  Step 4: If cleared, you’ll receive a printable certificate that you can take to your work capacity test. The certificate of qualification can be printed through the Acuity-CHS system, or your local Fire Management Officer or human resources staff can print it for you.
- Should be Empty:

Responder UPDATE Form