Pre-Service Firefighter Education and Training

Transcription

1 Pre-Service Firefighter Education and Training Important: Please read your program specific requirements and/or forms that need to be completed BEFORE the start of the semester. Equipment List You will need to purchase or provide: Black safety shoes or boots NFPA fire gloves or mitts NFPA balaclava NFPA helmet (orange) Approved NFPA or CAN/CSA Structural Firefighter Boots Uniforms can be purchased during the first week from suppliers. The cost of the above items is approximately $ A list of vendors will be provided to you on Orientation Day. This curriculum is based on the National Fire Protection Association (NFPA) 1001 (2013) Edition which meets the body of knowledge and practical skills required to meet the job-related performance objectives. Graduates of the Pre-Service Firefighter Education and Training Program are eligible to write the OFM Provincial Firefighter Test. For additional program information contact: Timmins Campus Craig Hartley Coordinator (705) ext hartleyc@northern.on.ca

2 Pre-Service Firefighter Important Program Information Welcome to the Northern College PRE-SERVICE FIREFIGHTER program. You have chosen to pursue an exciting and challenging career. You should be aware that there are strict requirements used by various fire agencies for their firefighter selection testing instruments. Northern College does not use these strict requirements as entrance requirements; however we do use them for career counseling purposes. We want you to be successful in the Pre-Service Firefighter program. In order to do this, Northern College will familiarize you with the criteria that will be used as part of the pre-interview assessment phase of the recruitment of firefighters. This will assist us in helping you succeed in your quest to becoming the best you can be. The following outlines what you will require during and for the first week at the Timmins Campus and what is involved with the firefighter selection process: 1. Health Physical Assessment form MUST BE COMPLETED AND SUBMITTED before the college will allow you to participate in fitness testing. You must bring in a completed physical assessment form from your physician or medical practitioner indicating that you can participate in rigorous fitness testing. This testing process is a COMPULSORY part of the program and will not be repeated. It is very important to remember to bring attire that is suitable for strenuous physical activity. 2. Vision and Hearing Evaluation. The appropriate forms are attached. Please have them completed by an audiologist and an optometrist prior to beginning the program. 3. Students must complete a Criminal Record Check and Vulnerable Person Sector Check, at their local police department by completing the applicable CIPC form. Students must provide a copy of the original document to the designated person in their department and must be done on the first day of class and be current within 3 months of the start of the 1 st semester. Any costs incurred when obtaining the Criminal Record Check and Vulnerable Person Sector Check is the student s responsibility. More information on the process of obtaining the Criminal Record Check and Vulnerable Person Sector Check can be found at 4. Prior to admission, you must provide evidence that you are a Canadian citizen or that you have permanent residency in Canada. We recommend that you hold a valid Driver s License (Class G). Note: Prior to hire in a Fire Service a DZ license may be required. If you have any questions regarding the above, please contact the Coordinator, Craig Hartley at (705) ext or by at hartleyc@northern.on.ca.

3 First Year Student Placement Requirements Dear Student: The following requirements must be met in order to attend placements for fall 2014 and winter Please note that an expectation of the (T085) Pre-Service Firefighter program is that every student must obtain and provide this required documentation. These documents include the following: 1. A completed Health Assessment Form 2. Standard First Aid/CPR certification (Health Care Provider Level) 3. Criminal record check CPIC including Vulnerable Sector Screen 4. TB test - 2 step (once 2 step has completed, following years require a 1 step test) 5. Hepatitis B Vaccination 6. WHMIS certification (to be offered by the college, dates to be confirmed) 7. Mask Fit testing (to be offered by the college, dates to be confirmed) 1. A Health Assessment Form is available online at This assessment must be completed by you and your physician. It will be used to ensure students meet minimum health requirements for admission. 2. Standard First Aid/CPR certification (Health Care Provider Level) is required for all incoming students. Courses are available on the following dates: Standard First Aid/CPR/Level HCP Saturday and Sunday 9:00 am - 5:00 pm Cost: $ (max 18 participants) **To book please call (705) HE June 14 & 15, 2014 HE July 5 & 6, 2014 HE July 19 & 20, 2014 HE August 9 & 10, 2014 HE August 23 & 24, A police criminal record check, (including a vulnerable sector screen), must be obtained from your local police services. Please allow four to six weeks for the police department to process the request. Original copies only will be accepted, addressed with your name and year of program. Photocopies of originals are not acceptable. Pre-Service Firefighter - 1 original required 4. TB test: please follow up with your primary care provider or your local health unit.

4 5. Hepatitis B Vaccination: please follow up with your primary care provider or your local health unit. Note: Requirements from 1-5 MUST be provided by the first day of classes in September. Therefore, knowing what the expectations are, please plan accordingly and come prepared for the first day of classes. BE SURE TO KEEP YOUR ORIGINAL DOCUMENTATION. 6. WHMIS: This will be offered by the college; dates to be confirmed. 7. Mask Fit testing: This will be offered by the college; dates to be confirmed. FAILURE TO MEET THESE REQUIREMENTS WILL RESULT IN DENIAL OF ACCESS TO PLACEMENTS WHICH WILL RESULT IN FAILURE FOR THE COURSE PLACEMENT. Thank you for your cooperation. Have a good and safe summer. Craig Hartley Coordinator

5 HEALTH RECORD This form is to be completed by the student and his/her physician. Mail to: Northern College P.O. Box 3211 Timmins, ON P4N 8R6 The applicant is responsible for any related costs/fees in having this form completed by his/her physician. This health record form must be completed and returned PRIOR to the start of the school year. Your program includes clinical and/or practical placement components for which there are specific health requirements. Hospitals and agencies expect that these health requirements will be fulfilled. Failure to supply this information will jeopardize your placement and graduation eligibility. PART A: TO BE COMPLETED BY THE APPLICANT Name Date of Birth Program Surname Month/Day/Year Circle one Given Names Paramedic Paramedic Bridging Pre-Service Firefighter Permanent Address Number Street, Road, Etc. Apt # City, Town Prov. Telephone Number Emergency Contact Name (Last, First) Relationship Telephone Address Family Clinician Telephone THE STATEMENTS GIVEN ARE TRUE TO THE BEST OF MY KNOWLEDGE AND BELIEF. I UNDERSTAND THAT FALSIFYING INFORMATION MAY RESULT IN MY REMOVAL FROM PLACEMENT AND/OR PRACTICUM. Applicant s Signature Date

6 Please complete the information on both sides of this record. Photocopy for your own records. PART B: PAST AND PRESENT MEDICAL HISTORY- Must be completed by a physician. DOES THE APPLICANT CURRENTY HAVE OR HAVE THEY EVER HAD? YES NO Notes Allergies Diabetes Epilepsy Heart Disease Hepatitis B/Hepatitis C/HIV Back Problems Is he/she currently taking medication? If YES, please list. Are there other medical problems we should be aware of? (I.E. special needs, hearing, emotional problems or other health concerns? Has he/she travelled or lived outside of Canada in the past 6 months? NOTE: It is the applicant s responsibility to inform program personnel of health information that may need to be considered in order to protect the student and/or clients.

7 In addition to the regularly scheduled adult immunizations, students arrequired to have serology for Varicella, Measles, Mumps, Rubella and Hepatitis B, to ensur immunity. Pre-Service Firefighter students are exempted from this requirement. A. Chicken Pox (Varicella) - Serology must be completed regardless of medical history. Serology Enclosed? Yes No If Immune Status is negative or indeterminate, please include dates of vaccination: 1 st Vaccination 2 nd Vaccination Medical Exemption? (please explain) B. Measles, Mumps, Rubella - Serology must be completed regardless of medical history. Serology Enclosed? Yes No If Immune Status is negative or indeterminate, please include date of MMR booster and enclose proof of vaccination: Booster Date: Proof Attached? Medical Exemption? (please explain) C. Tetanus, Diptheria, Polio Tetanus/Diptheria/Polio Tetanus/Diptheria/Polio (Adacel) Tetanus/Diptheria Vaccination must have been administered within 10 years of expected graduation date Date of most recent booster: Proof Enclosed? Medical Exemption? (please explain) D. Two-Step Mantoux (TB) - 2 Step Mantoux Testing is required for students entering all Heath Sciences, Community and Emergency Services Programs Date of second reading: Proof enclosed? Prior History of BCG Vaccination? No Yes if yes, Year Province/Country Prior History of TB Infection? No Yes if yes, Year Province/Country Treatment Regime:

8 In cases of Positive Test Results, a clear chest radiograph is required as proof of no infection. Chest X-ray Date: Results: Medical Exemption? (please explain) E. Hepatitis B - Serology must be completed regardless of medical history. Process of 3 injections must have begun prior to applicant s admission date into the Program. Serology Enclosed? Yes No Date of 1 st Vaccination 2 nd 3 rd Proof Enclosed? Medical Exemption? (please explain) F. Communicable Disease Declaration (Pre-Service Firefighter applicants are exempted from this requirement.) Communicable Disease Declaration Signed/Dated by Clinician and enclosed? Yes No G. Seasonal Influenza Vaccination It is strongly recommended all applicants protect themselves with an annual influenza vaccination. Some placement services/agencies mandate the flu shot while others highly recommend it but do not make it mandatory. In the latter case, if an outbreak occurs, the applicant will likely be unable to attend their placement thus jeopardizing successful completion of their clinical course. SIGNATURES (MANDATORY) Physician s Name (Printed) Date Address: Physician s Signature: FREEDOM OF INFORMATION AND PROTECTION OF PERSONAL PRIVACY Personal information on this form is collected under the authority of the Ministry of Colleges and Universities Act, R.S.O. 1980, c 272, s.5; and the regulated Health Professionals Act, Sec , and will be used to ensure students meet minimum health requirement for admission to their clinical facility. Consent for Release of Information I agree to the release of information about my immunization record to placement agencies or appropriate faculty members, as required. Signature: Date: Name (Please Print):

9 Specific Detail About Immunization Tuberculosis (TB) Testing A 2-step TB test is required by many placement agencies. If the first test is negative, a second one is performed after 1-3 weeks in the opposite forearm, using 0.1 ml of 5 TU strength vaccines for both. Results must be reported in mm of induration. Some agencies will not accept the results if this guideline is not strictly followed and retesting will have to be done. If you ve had a previously documented 2-step test with a negative result, a single test will be sufficient. Please provide the documentation for both the single and the 2-step. Students who have a positive result on their TB skin test must have appropriate follow-up by a physician. If the positive result was in the past, you must provide documentation that you have had medical follow-up. Persons who have received BCG vaccination (against TB) more than 9 years ago, require a 2-step test unless the results of a previous Mantoux test are available (in mm of induration). Measles/Mumps/Rubella It is important to have immunity against Measles and Rubella particularly when working with or around children, or women of childbearing age. If you are not immune, either through immunization or through having had the disease, you may be removed from Placement in case of an outbreak, or if you have been exposed. It is necessary for you to provide one of the following: the date of having had measles and/or rubella; the date when you were immunized against measles and/or rubella; or the results of a blood test which measures the amount of antibody in your system. If you were born in 1957 or later, have never had measles or rubella immunization and have never had either disease, you require a single dose of vaccine. Immunization to Measles, Mumps and Rubella is usually given in the form of a triple vaccine called MMR (Measles, Mumps, and Rubella). Tetanus/Diphtheria/Polio (TdP) After the initial series as a child, no further polio vaccination is required under usual circumstances. A Tetanus diphtheria (Td) booster is required every 10 years. Chicken Pox (Varicella) Chicken Pox is highly communicable especially during the stage before lesions appear. For this reason, it is important for you to provide information regarding whether or not you are immune. By documenting when you ve had a full-blown case of chicken pox, or by having a blood test you can measure the amount of antibody in your system. If you are not immune to chicken pox, it is possible that your placement might have to be altered if you are working in a high risk area. Hepatitis B This immunization maybe mandatory in some agencies at the present time, and is highly recommended for those in higher risk occupations. In fact, it is a good protective measure for all individuals, and is currently being given routinely to certain groups of school age children. THIS IMMUNIZATION CAN BE OBTAINED BY VISITING THE PORCUPINE HEALTH UNIT, TIMISKAMING HEALTH UNIT, OR YOUR FAMILY PHYSICIAN. THE TOTAL COST IS APPROXIMATELY $90.00 FOR THE 3 INJECTIONS. IT IS THE RESPONSIBILITY OF THE STUDENT TO ASSUME THE COST OF THE HEPATITIS B IMMUNIZATIONS. Students, who are enrolled in an extended health plan that covers this immunization, are advised to obtain it through their family physician. NOTE: Many Health Care and Emergency Services agencies have a mandatory requirement for Hepatitis B immunization/flu vaccination prior to employment. Since clinical placements necessitate that students have the same immunization and occupational abilities as agency employees, failure to comply with immunization standards may preclude students from participating in clinical placements and will jeopardize success in the program.

10 Pre-Service Firefighter Audiology Evaluation Report NAME ADDRESS DOB D M Y SEX DATE D M Y TEL. RIGHT EAR Hearing Aid Serial No. Mold/Rec. Tone MPO AGC Volume RE SYMBOLS AD masked BC masked LE LEFT EAR Hearing Aid Serial No. Mold/Rec. Tone MPO AGC Volume RELIABILITY Poor Fair Good Tympanogram ME Pressure ME Volume Comments Tympanogram ME Pressure ME Volume K 2K 4K 8K K 2K 4K 8K K 2K 4K 8K K 2K 4K 8K S.R.P. S.R.T. NIVEAU CONFORT Comfort Level DISCRIMINATION TOLERANCE PAROLE SPEECH ECOUTEURS EARPHONES CHAMP LIBRE FEE FEILD S.R.P. S.R.T. NIVEAU CONFORT Comfort Level DISCRIMINATION TOLERANCE MASQUE / MASKING REPORT: IMPEDANCE: RECOMMENDATIONS: Date Signature (Audiologist)

11 Pre-Service Firefighter Vision Examination Report **Note: Please ensure all areas are fully completed The personal information gathered below is collected under the authority of the Ministry of Colleges and Universities Act, R.S.O., and will be used only to assess and counsel you in regards to your ability to be successful as a result of having taken this program. APPLICANT PARTICULARS NAME (LAST) ADDRESS NAME (FIRST) TEL. FINDINGS OF EYE EXAMINER: VISUAL ACUITY TEST Right Eye Left Eye Both Eyes Method of Measurement Visual Acuity-Far Uncorrected Snellen Decimal A.M.A. Visual Acuity-Far Uncorrected Snellen Decimal A.M.A. Visual Acuity-Far Uncorrected Snellen Decimal A.M.A. Visual Acuity-Far Uncorrected Snellen Decimal A.M.A. VISUAL CORRECTION FREQUENCY OF USE C. PARTICULARS RE EXAMINER SURNAME INITIALS QUALIFICATIONS ADDRESS TOWN / CITY PROVINCE POSTAL CODE PHONE Nil Eyeglasses Contact Lenses For Permanent Use For Occasional Use DATE OF EXAMINATION CORRECTIVE PROCEDURES Nil Radial Keratotomy Orthokeratotomy Laser Keratectomy X-chrom Lenses Other Details of corrective procedures: (Include date of procedure, prior vision, complications, prognosis. If space is insufficient, attach separate page). VISUAL FIELDS A normal visual field for the purpose of this examination is defined as a vision of 120o in each eye in the horizontal plane and the absence of scotoma. **Note the attached NFPA guideline section 6.4 eyes and vision. Normal Defective (details): DIPLOPIA Absent Present (details): COLOUR VISION Use of Ishihara Pseudo-Isochromatic plates. If deficiency is found administer Farnsworth D-15 as an alternatively acceptable test. In the event of a colour vision deficiency, kindly attach actual Ishihara and Farnsworth D-15 results for subsequent review. Normal Deficiency Other conditions or comments (if space is insufficient, please attach separate page).

12 Criminal Record Check and Vulnerable Person Sector Check The Schools of Health Sciences, Community and Emergency Services require successful completion of placements or visits in a variety of agencies that may include schools, health, community and social agencies. Students will be working with or have unsupervised access to, vulnerable persons* while on placement, and therefore must complete a satisfactory Criminal Record Check and Vulnerable Person Sector Check prior to having direct contact with vulnerable persons. *Vulnerable persons are defined by the Criminal Records Act as: persons who because of their age, disability or other circumstances, whether temporary or permanent, are in a position of dependence on others or who are otherwise at a greater risk than the general population of being harmed by persons in a position of authority or trust relative to them. Without a clear Criminal Record Check and Vulnerable Person Sector Check, a placement agency may deny a student access to their premises. The student must provide an original Criminal Record Check and Vulnerable Person Sector Check, which can be obtained at their local police department. Policies may vary between Police Services regarding the provision of Criminal Record Checks, and may require a letter stating that the student is enrolled in their program, and must be signed by the Director of the Program. This letter will be prepared by the college and mailed to each student. If you do not receive a letter, or have any questions or concerns, please contact the Program Assistant at extension Addiction Counselor Students - as identified in the Reflective Practice course BScN Students - 1 st day of each Fall Semester - 1 original copy Developmental Services Worker Students - as identified in the Reflective Practice course Early Childhood Education Students - as identified in the Reflective Practice course Massage Therapy Students - 1 st day of each Fall Semester - 1 original copy Medical Laboratory Technician Students - 1 st day of the Winter Semester Paramedic Bridging Students - 1 st day of each Fall Semester - 1 original copy Police Foundations Students - 1 st day of each Fall Semester - 1 original copy Practical Nursing Students - **1 st day of each Fall Semester - 1 original copy Pre-Service Firefighter Students - 1 st day of Fall Semester - 1 original copy Social Service Worker Students - as identified in the Reflective Practice course Personal Support Worker - **1 st day of Fall Semester - 1 original copy Any cost incurred when obtaining the Criminal Record Check and Vulnerable Person Sector Check is the student s responsibility. More information on the process of obtaining the Criminal Record Check and Vulnerable Person Sector Check can be found at Important: The Criminal Record Check and Vulnerable Person Sector Check are requirements of the school boards, institutions and agencies where students are assigned to complete their placements and are for that purpose ONLY. As such, individual agencies may require updated information prior to commencement of hire. **Clinical Agencies for Practical Nursing and Personal Support worker programs require that Criminal Reference Checks must be within 6 months of attendance. Please do not apply for your check prior to July 01, 2014.

13 STANDARD FIRST AID/CPR REQUIREMENTS Applicants to Community Services programs require Standard First Aid/CPR Level C. Applicants to Health Sciences and Emergency Services programs require Standard First Aid/CPR Level C-HCP (Health Care Provider Content). Students, who cannot provide proof of official certification in Standard First Aid/CPR prior to the start of the 2014/2015 academic year, must take one of the Standard First Aid/CPR courses listed below. Enrolment will be on a first come, first served basis. Once a course is filled, students will be registered in the next available session. Students are encouraged to verify their registration in the course prior to attending the session. Complete this form and return it to Northern College with your Confirmation of Registration as soon as possible. Payment for these Standard First Aid/CPR courses must be made SEPARATELY from your tuition fees. I wish to confirm my registration for the following session: STANDARD FIRST AID/CPR AED LEVEL HCP * June 14 & 15, 2014 HE ( ) Porcupine (max 18) Fee: $ * July 5 & 6, 2014 HE ( ) Porcupine (max 18) Fee: $ * July 19 & 20, 2014 HE ( ) Porcupine (max 18) Fee: $ * August 9 & 10, 2014 HE ( ) Porcupine (max 18) Fee: $ * August 23 & 24, 2014 HE ( ) Porcupine (max 18) Fee: $ * June 12 & 13, 2014 HE ( ) Kirkland Lake (max 16) Fee: $159.00/ (HCP) * July 28 & 29, 2014 HE ( ) Kirkland Lake (max 16) Fee: $159.00/ (HCP) * August 30 & 31, 2014 HE ( ) Kirkland Lake (max 16) Fee: $159.00/ (HCP) * July 19 & 20, 2014 HE ( ) Haileybury (max 16) Fee: $159.00/ (HCP) * July 23 & 24, 2014 HE ( ) Haileybury (max 16) Fee: $159.00/ (HCP) * August 12 & 13, 2014 HE ( ) Haileybury (max 16) Fee: $159.00/ (HCP) * August 16 & 17, 2014 HE ( ) Haileybury (max 16) Fee: $159.00/ (HCP) CPR LEVEL HCP RE-CERTIFICATION * June 14, 2014 HE ( ) Porcupine (max 18) Fee: $75.00 * July 5, 2014 HE ( ) Porcupine (max 18) Fee: $75.00 * August 9, 2014 HE ( ) Porcupine (max 18) Fee: $75.00 * August 21, 2014 HE ( ) Porcupine (max 18) Fee: $75.00 * August 22, 2014 HE ( ) Porcupine (max 18) Fee: $75.00 * August 22, 2014 HE ( ) Porcupine (max 18) Fee: $75.00 * August 23, 2014 HE ( ) Porcupine (max 18) Fee: $75.00

14 First Name Last Name OCAS Number Student Number (if applicable) Amount of Payment $ Method of Payment: o o o o o Cash Cheque / Money Order (Made payable to Northern College) Telephone Banking or Internet Banking Please use your OCAS Number or Northern College Student Number as your billing or account number) VISA / MasterCard (If I have chosen option B or C, payments will be processed as indicated in the attached payment schedule) I authorize Northern College to process my credit card as indicated on the attached payment schedule. Credit Card Number Expiry Date Cardholder s Name Signature NOTE: *These courses are scheduled from 9:00 a.m. to 5:00 p.m. on Saturday and Sunday. ** DO NOT SEND CASH IN THE MAIL. POST-DATED CHEQUES ARE NOT ACCEPTED. Telephone registrations will only be accepted if pre-paid by credit card.