Document ID: FEMA-2011-0018-0004
Agency: fema
Document Type: Supporting & Related Material
Title: 
Posted Date: 2011-10-04T04:00Z

POSITION TASK BOOK FOR THE POSITION OF

ALL-HAZARDS
SAFETY OFFICER

	Version: April 2011
                                       
                                       

                                       
                                       
                                       
                        Position Task Book Assigned To:

Individual's Name:
Duty Station:
Phone Number:

                       Position Task Book Initiated By:

Official's Name:
Title:
Duty Station:
Phone Number:

Location Position Task Book was Initiated: ____________________

Date Position Task Book was Initiated: _____________________

                                   EVALUATOR
                                       
DO NOT COMPLETE THIS UNLESS YOU ARE RECOMMENDING THE TRAINEE FOR CERTIFICATION
                                       
                                       
VERIFICATION/CERTIFICATION OF COMPLETED POSITION TASK BOOK FOR THE POSITION OF:
                                       
                       FINAL EVALUATOR'S VERIFICATION
                                       
I verify all tasks have been performed and are documented with appropriate initials.
I also verify_________________________________________________________
has performed as a trainee and should therefore be considered for certification in this 
position.
                                       
                                       
FINAL EVALUATOR'S SIGNATURE: ____________________________________ 

DATE: ____________________

Evaluator's Printed Name:
Title:
Duty Station:
Phone Number:

                                       
                 AGENCY HEAD RECOMMENDATION FOR CERTIFICATION
                                       
I certify ____________________________________________________________
has met all requirements for qualification in this position and I recommend he/she be
certified for the position.
                                       

OFFICIAL'S SIGNATURE: _____________________________________

DATE: ______________________________

Official's Name:
Title:
Duty Station:
Phone Number:
                                       
                                       
                                       

                  NATIONAL INCIDENT MANAGEMENT SYSTEM (NIMS)
                         INCIDENT COMMAND SYSTEM (ICS)
                          POSITION TASK BOOKS (PTBs)
                                       
Position Task Books (PTBs) are designed to be used by any individual (trainee) interested in becoming certified under the National Incident Management System (NIMS). The PTBs are intended to be used to document experiences that indicate successful completion of tasks specific to an Incident Command System (ICS) position. The performance requirements for each position are associated with core ICS competencies, behaviors, and tasks as suggested to the Federal Emergency Management Agency (FEMA) by a multi-disciplined, highly-experienced expert panel. 

Trainees are evaluated during this process by qualified evaluators, and the trainee's performance is documented in the PTB for each task by the evaluator's initials and date of completion. An Evaluation Record will be completed by all evaluators documenting the trainee's progress after each evaluation opportunity. 

Successful performance of all tasks, as observed and recorded by an evaluator, will result in a recommendation to the Authority Having Jurisdiction (AHJ) of the trainee, that the trainee be certified in that position. Evaluation and confirmation of the trainee's performance while completing all tasks will normally require more than one training assignment and several different evaluators. Incidents lasting several days may involve multiple evaluators. Tasks may be evaluated on incidents, in a classroom simulation, in training and exercises, and in other work situations as long as there is a qualified evaluator.  

It is important performances be critically evaluated and accurately recorded by each evaluator.  All tasks should be evaluated.  

The NIMS Qualification Process Guide lists the definitions for trainee, evaluator, training officer, and AHJ. 

Responsibilities:

1. Authority Having Jurisdiction (AHJ):
   * Selecting trainees based on the needs of their organization or to fulfill their obligations to contribute to Incident Management Teams (IMTs) or other Mutual Aid agreements
   * Providing opportunities for evaluation and/or making the trainee available for evaluation

2. Trainee:
   * Reviewing and understanding instructions in the PTB
   * Identifying desired objectives/goals whenever an opportunity for evaluation is recognized
   * Providing background information to an evaluator
   * Assuring the evaluation record is complete
   * Completing all tasks for an assigned position within the timeframe allowed for that position (all tasks with an approval older than the allowed timeframe should be reevaluated)
   * Notifying the local AHJ/training officer when the PTB is completed, and obtaining a signature recommending certification
   * Retaining the original PTB and providing a copy of the PTB to the appropriate individual/department to obtain a qualification from your agency

3. Evaluator(s):
   * Being qualified and proficient in the evaluated position
   * Meeting with the trainee and determining past experience, current qualifications, and desired objectives/goals
   * Reviewing tasks with the trainee
   * Explaining to the trainee the evaluation procedures that will be utilized and which tasks may be performed during the evaluation period
   * Accurately evaluating and recording demonstrated performance of tasks
   * Dating and initialing completion of the task to indicate satisfactory performance
   * Documenting unsatisfactory performance
   * Completing the Evaluation Form found at the end of each PTB
   * Completing an Incident Personnel Performance Rating (ICS 225) form
    
   *    Final Evaluator:
   * Being qualified and proficient in the position being evaluated
   * Reviewing the trainee's record to ensure completeness
   * Signing the verification statement on page 2 of the PTB when all tasks have been initialed
   * Ensuring all tasks have been completed within the three years prior to submission for final approval
   * Reevaluating any task with an approval older than three years and bringing up to date
      
4. Training Officer:
   * Providing the correct version of the PTB to the individual in order to document performance
   * Explaining to the trainee the purpose and processes of the PTB as well as the trainee's responsibilities
   * Tracking progress of the trainee
   * Identifying incidents or situations where the trainee may have evaluation opportunities
   * Identifying and assigning an evaluator who can provide a positive experience for the trainee, when the evaluation opportunity is within the AHJ's jurisdiction
   * Receiving and filing documentation from the assignment

6. AHJ Designee
   * Issuing the PTB to document task performance
   * Explaining to the trainee the purpose and processes of the PTB as well as the trainee's responsibilities
   * Tracking progress of the trainee
   * Identifying incident evaluation opportunities
   * Identifying and assigning an evaluator who can provide a positive experience for the trainee and make an accurate and honest appraisal of the trainee's performance
   * Documenting the assignment
   * Conducting progress reviews
   * Conducting a closeout interview with the trainee and evaluator and assuring documentation is proper and complete

Competencies, Behaviors and Tasks:

Each PTB lists the performance requirements (tasks) for specific positions set by the ICS competencies and behaviors (September 2007) recognized by FEMA's National Integration Center and posted to the NIMS Resource Center Web site, http://www.fema.gov/emergency/nims/.

There are numerous bullet statements listed under each task. The bullet statements are listed as guidelines/examples for the evaluator to follow to ensure the intent of the task has been completed. Not all bullet statements for a task are required to be completed if the overall intent of the task has been satisfied.

Each task has a code associated with the type of training assignment where the task may be completed. These include: O = other, I = incident/event and R = rare event. Definitions for these codes may be found below*. While tasks can be performed in any situation, they should be evaluated on the specific type of incident/event for which they are coded. Tasks coded "I" should be evaluated on an incident/event, and so on. Performance of any task other than the designated assignment is not valid for qualification.

*Code:	
    O 	= Task can be completed in a variety of situations, such as in a classroom, exercise or simulation, incident or event, or daily job.
    I	=	Task should be performed on an incident or event which is managed under the ICS. 
    R	=	Rare events seldom occur and opportunities to evaluate trainee performance in real settings are limited. Examples of rare events include accidents, injuries, vehicle and aircraft crashes. Through interviews, the evaluator may be able to determine if the trainee could perform the task in a real situation.

Competency: Assume position responsibilities
Description: Successfully assume role of Safety Officer and initiate position activities at the appropriate time according to the following behaviors. 

Behavior: Ensure readiness for assignment. 

                                     TASK
                                     CODE
                              EVALUATION RECORD #
                                   EVALUATOR
   1. Obtain and assemble information and materials needed for kit. Kit assembled and prepared prior to receiving an assignment. Kit contains critical items needed for the assignment. Kit is easily transportable. The basic information and materials needed may include, but are not limited to, any of the following: 

Reference Material
      * Reference materials appropriate to the incident kind (e.g. Hazmat, law enforcement, fire, Public Works, Public Health, etc.)
      * Emergency Response Field Operations Guide (ERFOG)
      * Agency health and safety code handbook

Forms
      * ICS 208, Safety Message/Plan
      * ICS 213, General Message 
      * ICS 214, Activity Log 
      * ICS 215A, IAP Safety Analysis 
      * ICS 221, Demobilization Checkout
      * Injury and accident forms
   
Supplies
      * Safety Officer's identity strip
      * 100-ft tape 
      * Flagging (several colors) 
      * Clipboard 
      * Writing tablet 
      * Graph paper/carbon paper 
      * Flashlight and batteries 
      * Pencils and assortment of markers 
      * Pocket notebook 
      * Digital camera or camera and several rolls of ASA 400-rated film (color print, slide, no Polaroid) 
      * Hand-held tape recorder and extra batteries 
      * Compass 
      * Alarm clock 
      * Thermometer and wind gauge/belt weather kit or access to local weather information
      * Personal protective equipment (PPE) 
      * Whistle 
      * Chalk 
      * Binoculars 
                                       O

   2. Arrive properly equipped at incident assigned location within acceptable time limits. Check in according to agency/organization guidelines.
                                       I

Behavior: Ensure availability, qualifications, and capabilities of resources to complete assignment. 

                                     TASK
                                     CODE
                              EVALUATION RECORD #
                                   EVALUATOR
   3. Ensure sufficient Assistant Safety Officers (ASOs) to complete necessary tasks.
      * Identify need for ASOs
      * Order ASOs
      * Assign ASOs
      * Supervise ASOs
      * Ensure appropriate knowledge and skills for potential risk
                                       I

Behavior: Gather, update, and apply situational information relevant to the assignment.

                                     TASK
                                     CODE
                              EVALUATION RECORD #
                                   EVALUATOR
   4. Gather information necessary to assess incident assignment and determine immediate needs and actions. 
      * Incident Commander's (ICs) name and agency/organization contact information
      * Make contact 
      * Current resource commitments 
      * Current and anticipated situation  
      * Expected duration of assignment 
                                       I

Behavior: Establish effective relationships with relevant personnel. 

                                     TASK
                                     CODE
                              EVALUATION RECORD #
                                   EVALUATOR
   5. Establish and maintain positive interpersonal and interagency working relationships.
                                       I

   6. Create a work environment that provides diversity and equal opportunity for all personnel assigned to the incident.
                                       I

   7. Recognize functional capabilities of cooperating entities.
                                       I

   8. Proactively work with necessary personnel to collect information and further the investigation process.
                                       I

Behavior: Understand and comply with ICS concepts and principles. 

                                     TASK
                                     CODE
                              EVALUATION RECORD #
                                   EVALUATOR
   9. Maintain appropriate span of control. 
                                       I

   10. Demonstrate knowledge of ICS structure, principles, positions, and ICS forms.
                                       I

   11. Act as agent of the IC.
                                       I

Competency: Lead assigned personnel 

Description: Influence, guide, and direct assigned personnel to accomplish objectives and desired outcomes in a rapidly changing, high-risk environment.

Behavior: Model leadership values and principles. 

                                     TASK
                                     CODE
                              EVALUATION RECORD #
                                   EVALUATOR
   12. Exhibit principles of duty.
      * Be proficient in the job, both technically and as a leader.
      * Make sound and timely decisions.
      * Ensure tasks are understood, supervised, and accomplished.
      * Train and mentor assigned subordinates.
                                       I

   13. Exhibit principles of respect.
      * Know subordinates and look out for their well-being.
      * Keep subordinates informed.
      * Build the team.
      * Assign subordinates in accordance with their capabilities.
                                       I

   14. Exhibit principles of integrity.
      * Know yourself and seek improvement.
      * Seek responsibility and accept responsibility for actions.
      * Set the example.
                                       I

Behavior: Ensure the safety, welfare, and accountability of assigned personnel.

                                     TASK
                                     CODE
                              EVALUATION RECORD #
                                   EVALUATOR
   15. Recognize potentially hazardous situations.
                                       I

   16. Inform subordinates of hazards or threats.
                                       I

   17. Ensure special precautions are taken when extraordinary hazards or threats exist.
                                       I

   18. Ensure adequate rest is provided to all unit personnel.
                                       I

Behavior: Establish work assignments and performance expectations, monitor performance, and provide feedback.

                                     TASK
                                     CODE
                              EVALUATION RECORD #
                                   EVALUATOR
   19. Brief and keep subordinates informed and updated.
                                       I
                                       
                                       
   20. Assign Safety assistants to monitor potentially high-hazard areas or operations considered to be high risk.
                                       I
                                       
                                       
   21. Initiate accident investigation team for those accidents occurring within the incident area.
                                       I
                                       
                                       
   22. Provide counseling and discipline as needed.
                                       I
                                       
                                       
   23. Ensure performance ratings are completed as required by the IC/Agency Administrator.
                                       I
                                       
                                       
   24. Ensure Assistant Safety Officers (ASOs) understand their roles and responsibilities for carrying out the health and safety mission during the incident.
                                       I
                                       
                                       
   25. Ensure incident management team members are aware of the health and safety-related aspects of their jobs and undertake their job responsibilities in a safe manner based on expected duration, size, type of incident, priorities, and values to be protected (e.g. life, property, infrastructure environment, etc.), and jurisdictional involvement.
                                       I
                                       
                                       

Behavior: Coordinate interdependent activities.

                                     TASK
                                     CODE
                              EVALUATION RECORD #
                                   EVALUATOR
   26. Interact and coordinate with all command and general staff.
      * Receive and transmit current and accurate information.
      * Work directly with Medical Unit Leader on ICS 206 (Medical Plan).
                                       I

Competency: Communicate effectively
 
Description: Use suitable communication techniques to share relevant information with appropriate personnel on a timely basis to accomplish objectives in a potentially rapidly changing environment.

Behavior: Ensure relevant information is exchanged during briefings and debriefings.

                                     TASK
                                     CODE
                              EVALUATION RECORD #
                                   EVALUATOR
   27. Discuss the ICS 215A (Incident Action Plan [IAP] Safety Analysis) at operational briefings as appropriate. 
                                       I

   28. Prepare and present health and safety briefing. 
      * Present a health and safety briefing at each briefing session. 
      * Briefing should contain information to alert incident personnel of potential risk/hazard or threat considered to be most critical. 
      * Answer any questions that may arise. 
                                       I

   29. Conduct debriefing with off-duty personnel.
                                       I

   30. Debrief with incident Field Observers. 
      * Meet with the incident Field Observer(s) to obtain information on potential high-hazard areas or operations considered to be of high risk. 
      * Use this information in preparation of health and safety messages and for discussions at briefings. 
      * Safety assistants will be assigned to monitor these areas or operations. 
                                       I

   31. Participate in agency/organization debriefing or closeout as appropriate. 
      * As directed by the IC, provide a debriefing to the Agency Administrator regarding incident safety history, including accidents, hazards, threats, corrective actions, and commendations.
                                       I

Behavior: Ensure documentation is complete and disposition is appropriate.

                                     TASK
                                     CODE
                              EVALUATION RECORD #
                                   EVALUATOR
   32. Complete ICS 214 (Activity Log) for each operational period.
      * Document incidents of a serious nature in the ICS 214 (Activity Log).
                                       I

   33. Ensure accident investigation report(s) is/are complete and provided to IC and local agency/organization.
                                       I

   34. If required, ICS 221 (Demobilization Checkout) is completed and turned in to the appropriate person.  
                                       I

   35. Complete ICS 215A (IAP Safety Analysis) for each operational period. 
                                       I

   36. Ensure copies of ICS 215A (IAP Safety Analysis) are included in documentation package.
                                       I

Behavior: Gather, produce, and distribute information as required by established guidelines and ensure understanding by recipient.

                                     TASK
                                     CODE
                              EVALUATION RECORD #
                                   EVALUATOR
   37. Prepare health and safety messages for the incident. 
                                       I

   38. Post health and safety information on incident bulletin board if appropriate. 
                                       I

   39. Prepare narrative or special reports. 
      * When requested by the incident agency and/or IC, prepare narrative report of incident. 
      * Include the following items: number of injuries and accidents, general health and safety situation and problems encountered, description of significant incidents or unsafe situations, and recommendations for corrective action. 
                                       I

   40. Distribute accident investigation reports and initiate follow-up action. 
      * Follow up to ensure all accident investigation reports are completed, and include all required information. 
      * Distribute copies of the report to the IC and finance position assigned as appropriate. 
      * Recommend need for corrective action based on findings of the report to the IC. Initiate immediate corrective action, if necessary. 
      * Distribute information concerning accidents to IC.
                                       I

   41. Communicate to incident personnel any change in weather conditions during the operational period not predictable and could cause high risk conditions.
                                       I

Behavior: Develop and implement plans and gain concurrence of affected agencies and/or the public. 
   
                                     TASK
                                     CODE
                              EVALUATION RECORD #
                                   EVALUATOR
   42. Develop or implement a health and safety action plan. 
      * Ensure hazards, threats, and risks are identified and adequately monitored for the duration of the incident. 
      * Share action plan with the IC and incident staff and revise as necessary. 
      * Ensure any changes in incident hazards, threats, and risks with relevant corrective actions are reflected in the safety action plan, health and safety messages, and/or safety briefings as appropriate. 
      * Coordinate elements of the health and safety action plan to the IAP.
                                       I

Competency: Ensure completion of assigned actions to meet identified objectives

Description: Identify, analyze, and apply relevant situational information and evaluate actions to complete assignments safely and meet identified objectives. Complete actions within established timeframe.

Behavior: Gather, analyze, and validate information pertinent to the incident or event and make recommendations for setting priorities.

                                     TASK
                                     CODE
                              EVALUATION RECORD #
                                   EVALUATOR
   43. Monitor food and sanitation conditions as needed. 
                                       I

   44. Inspect potable water supplies as needed. 
      * Inspect potable water sources, hauling and storage containers. 
      * Document any deficiencies identified and take corrective action.
                                       I

   45. Monitor incident PPE needs.
                                       I

   46. Inspect incident facilities as appropriate. 
      * Conduct a general inspection of the base and camp facilities soon after they become operational and follow up on a periodic basis throughout the incident for compliance to all health and safety standards. 
      * Identify and document all unsafe conditions and provide this information to the IC or the Base/Camp Manager.
                                       I

   47. Review and approve medical plan as appropriate. 
      * Monitor plan to ensure it addresses current status of incident.
                                       I

   48. Ensure roads are inspected within the incident area as needed. 
      * Ensure an inspection has been done on all roads that will be used for the transportation of personnel and equipment. 
      * All roads should be of adequate width, grade, and maintenance condition to allow safe use by the vehicles being utilized on the incident. 
      * Any roads identified as unsafe for vehicle travel will be closed and monitored for unauthorized use.
                                       I

   49. Monitor operational period length.
      * Identify personnel exceeding the work standards established by the agency/organization responsible for the incident. 
      * Recommend corrective action to IC. 
      * Ensure work/rest guidelines are followed.
                                       I

   50. Monitor incident personnel for general welfare. 
      * Monitor personnel to determine if their needs are being met as related to food, water and rest. 
      * Personnel identified as being high risk due to extreme fatigue or poor physical condition will be evaluated and discussed with IC, and agency/organization representative for final resolution to problem.
                                       I

   51. Monitor responders for PPE use. 
      * Visually check responders preparing for duty to see they are wearing or have all required PPE and other personal gear. 
      * Responders who lack the PPE will be supplied such equipment prior to going into service.
                                       I

Behavior: Prepare clear and concise assessments regarding hazards, hazard behavior, weather, and other relevant events. 

                                     TASK
                                     CODE
                              EVALUATION RECORD #
                                   EVALUATOR
   52. Develop ICS 215A (Incident Safety Analysis, planning matrix). 
      * Complete ICS 215A (IAP Safety Analysis) for each operational period. 
      * Discuss ICS 215A (IAP Safety Analysis) at operational briefings as appropriate. 
                                       I

   53. Conduct initial and ongoing assessments to gather information and determine incident health and safety needs.
                                       I

Behavior: Take appropriate action based on assessed risks.

                                     TASK
                                     CODE
                              EVALUATION RECORD #
                                   EVALUATOR
   54. Remove and identify tools and power equipment determined to be unsafe for use. 
                                       I

   55. Relieve immediately vehicles/operators who have exceeded operational period standards. 
                                       I

   56. Close any roads identified as unsafe for vehicle travel and monitor for unauthorized use.
                                       I

   57. Supply PPE to responders who lack PPE prior to them going into service. 
                                       I

   58. Initiate accident investigations within the incident area. 
      * Initiate accident investigation team for those accidents that occur within the incident area. 
      * Assure information, materials, and the scene etc. are preserved to support a complete and thorough investigation of the accident.
      * Ensure accident investigation report is completed and provided to IC and local agency/organization.
      * The investigation should not interfere with the primary duties of the Safety Officer.
                                       I

Behavior: Modify approach based on evaluation of incident situation. 

                                     TASK
                                     CODE
                              EVALUATION RECORD #
                                   EVALUATOR
   59. Recognize limits of knowledge and seek advice or help on health and safety management as appropriate.
                                       I

Behavior: Anticipate, recognize, and mitigate unsafe situations.

                                     TASK
                                     CODE
                              EVALUATION RECORD #
                                   EVALUATOR
   60. Identify potentially unsafe situations. 
      * Monitor all incident activities to identify any potentially unsafe situations. 
      * Take appropriate action by contacting the responsible supervisor for corrective action. 
      * If necessary, take direct action. 
      * Report to IC and General Staff any action affecting the IAP.
                                       I

   61. Identify those risks or hazards/threats with the highest potential for serious accident or injury. 
      * Identify those types of operations on an incident of this type that most frequently lead to serious injuries or fatalities. 
      * Discuss with IC. 
      * Identify actions needed to prevent an accident from taking place.
                                       I

   62. Exercise emergency authority to stop and prevent unsafe acts. 
      * Use direct intervention to correct any extremely dangerous act, which is being performed outside of agency/organization regulations, policies, standards, and guidelines. 
      * Discuss with IC and document action in ICS 214 (Activity Log).
                                       I

Behavior: Utilize information to produce outputs. 

                                     TASK
                                     CODE
                              EVALUATION RECORD #
                                   EVALUATOR
   63. Report unexpected occurrences.
      * Obtain information about special hazards or threats from: 
            o Subordinates
            o Personal observation
            o Other incident personnel
            o Off incident personnel
      * Standard information shall contain nature of event, location, magnitude, personnel involved (do not release names of victims or agency/organization over radio), initial action taken (e.g., helicopter picking up injured), and appropriate subsequent action.
                                       I
                                       
                                       
   64. Perform assigned job duties in accordance with established health and safety procedures.
                                       I
                                       
                                       

Behavior: Ensure compliance with all legal and safety requirements relevant to air operations.

                                     TASK
                                     CODE
                              EVALUATION RECORD #
                                   EVALUATOR
   65. Monitor all air operations activities if needed. 
      * Review compliance with agency/organization flight duty limitations. 
      * Monitor to ensure air safety requirements are being implemented and followed. 
      * Document all identified serious hazards, threats or unsafe conditions. 
      * Corrective action will be implemented through the IC.
                                       I

   66. Review aircraft incidents/accident reports. 
      * Review on a daily basis all aircraft incident/accident reports. 
      * Monitor to ensure recommended corrective action is implemented.
                                       I

Behavior: Ensure functionality of equipment.

                                     TASK
                                     CODE
                              EVALUATION RECORD #
                                   EVALUATOR
   67. Ensure inspection of tools and power equipment for unsafe conditions. 
      * Review on a periodic basis the condition of hand tools being received on the incident and those being reconditioned to determine they are safe for use. 
      * Identify and remove tools and power equipment determined to be unsafe for use. 
                                       I

   68. Ensure inspection of vehicles, mechanical equipment and driver/operator qualifications are completed. 
      * A periodic inspection of vehicles conducted to ensure they meet all mechanical and maintenance standards. 
      * Ensure drivers/operators are properly trained and have a valid license to operate the vehicle/equipment assigned. 
      * Document deficiencies.
                                       I

Behavior: Plan for demobilization and ensure demobilization procedures are followed. 

                                     TASK
                                     CODE
                              EVALUATION RECORD #
                                   EVALUATOR
   69. Receive demobilization instructions from supervisor. 
      * Brief subordinate staff on demobilization procedures and responsibilities as appropriate. 
      * Ensure incident and agency/organization demobilization procedures are followed. 
      * If required, ICS 221 (Demobilization Checkout) is completed and turned in to the appropriate person. 
      * Ensure copies of ICS 215A (IAP Safety Analysis) are included in documentation package. 
                                       I

Behavior: Transfer position duties while ensuring continuity of authority and knowledge and taking into account the increasing or decreasing incident complexity. 

                                     TASK
                                     CODE
                              EVALUATION RECORD #
                                   EVALUATOR
   70. Determine with replacement time of transfer.

                                       I

   71. Communicate transfer of command to operations and command staff. 
                                       I

   72. If necessary, coordinate with agencies about transfer of command back to local jurisdiction. 
                                       I

               INSTRUCTIONS FOR COMPLETING THE EVALUATION RECORD

There are four separate blocks allowing evaluations to be made. These evaluations may be made on incidents, simulations in classroom, or in daily duties, depending on what the PTB indicates.  This should be sufficient for qualification in the position if the individual is adequately prepared. If additional blocks are needed, a page can be copied from a blank task book and attached.

COMPLETE THESE ITEMS AT THE START OF THE EVALUATION PERIOD:
Evaluator's Name, Incident/Office Title and Agency:  List the name of the evaluator, his/her incident position or office title, and agency.
Evaluator's Home Unit Address and Phone:  Self-explanatory
Incident Number:  The number next to the evaluator's name in the upper left corner of the evaluation record identifies a particular incident or group of incidents. This number should be placed in the column labeled "Evaluation Record #" on the PTB for each task performed satisfactorily. This number enables reviewers of the completed PTB to ascertain the qualifications of the different evaluators prior to making the appropriate sign-off on the PTB.
Location of Incident/Simulation:  Identify the location where the tasks were performed by agency and office.
Incident Kind:  Enter kind of incident (e.g. hazmat, law enforcement, wildland fire, structural fire, search and rescue, flood, tornado, etc.).

COMPLETE THESE ITEMS AT THE END OF THE EVALUATION PERIOD:
Number and Type of Resources:  Enter the number and type of resources assigned to the incident pertinent to the trainee's position.
Duration:  Enter inclusive dates during which the trainee was evaluated. This block may indicate a span of time covering several small and similar incidents if the trainee has been evaluated on that basis (e.g., several initial response wildfires in similar fuel types).
Recommendation:  Check as appropriate and/or make comments regarding the future needs for development of this trainee.
Date:  List the date the record is being completed.
Evaluator's Initials:  Initial here to authenticate recommendations and to allow for comparison with initials in the PTB.
Evaluator's Relevant Certification:  List your certification relevant to the trainee position you supervised.
                               Evaluation Record
                                       
--------------------------------------------------------------------------------

                                 TRAINEE NAME
--------------------------------------------------------------------------------

                               TRAINEE POSITION
                                       
#1
Evaluator's name:
Incident/office title & agency:
Evaluator's home unit address & phone:
        Name and Location
of Incident or
Situation
(agency & area)
Incident Kind
(hazmat, law enforcement, tornado, flood, structural fire, wildfire, search & rescue, etc.)
       Number & Type of
Resources
Pertinent to
Trainee's Position
                 Duration
(inclusive dates
in trainee status)

                                       
The tasks initialed and dated by me have been performed under my supervision in a satisfactory manner by the above named trainee. I recommend the following for further development of this trainee.
______	The individual has successfully performed all tasks for the position and should be considered for certification.
______	The individual was not able to complete certain tasks (comments below) or additional guidance is required.
______	Not all tasks were evaluated on this assignment and an additional assignment is needed to complete the evaluation.
______	The individual is severely deficient in the performance of tasks for the position and needs further training in both required knowledge and skills prior to additional assignment(s) as a trainee.

Recommendations: ______________________________________________________________________________________

_______________________________________________________________________________________________________

Date: ____________________________ Evaluator's initials: ________________________

Evaluator's relevant agency certification or rating:___________________________________________________________

#2
Evaluator's name:
Incident/office title & agency:
Evaluator's home unit address & phone:
        Name and Location
of Incident or
Situation
(agency & area)
Incident Kind
(hazmat, law enforcement, tornado, flood, structural fire, wildfire, search & rescue, etc.)
       Number & Type of
Resources
Pertinent to
Trainee's Position
                 Duration
(inclusive dates
in trainee status)

                                       
The tasks initialed and dated by me have been performed under my supervision in a satisfactory manner by the above named trainee. I recommend the following for further development of this trainee.
______	The individual has successfully performed all tasks for the position and should be considered for certification.
______	The individual was not able to complete certain tasks (comments below) or additional guidance is required.
______	Not all tasks were evaluated on this assignment and an additional assignment is needed to complete the evaluation.
______	The individual is severely deficient in the performance of tasks for the position and needs further training in both required knowledge and skills prior to additional assignment(s) as a trainee.

Recommendations: ______________________________________________________________________________________

_______________________________________________________________________________________________________

Date: ____________________________ Evaluator's initials: ________________________

Evaluator's relevant agency certification or rating:_____________________________________________________
                               Evaluation Record
                             (Continuation Sheet)
                                       
--------------------------------------------------------------------------------

                                 TRAINEE NAME
--------------------------------------------------------------------------------

                               TRAINEE POSITION
                                       
#3
Evaluator's name:
Incident/office title & agency:
Evaluator's home unit address & phone:
        Name and Location
of Incident or
Situation
(agency & area)
Incident Kind
(hazmat, law enforcement, tornado, flood, structural fire, wildfire, search & rescue, etc.)
       Number & Type of
Resources
Pertinent to
Trainee's Position
                 Duration
(inclusive dates
in trainee status)

                                       
The tasks initialed and dated by me have been performed under my supervision in a satisfactory manner by the above named trainee. I recommend the following for further development of this trainee.
______	The individual has successfully performed all tasks for the position and should be considered for certification.
______	The individual was not able to complete certain tasks (comments below) or additional guidance is required.
______	Not all tasks were evaluated on this assignment and an additional assignment is needed to complete the evaluation.
______	The individual is severely deficient in the performance of tasks for the position and needs further training in both required knowledge and skills prior to additional assignment(s) as a trainee.

Recommendations: ______________________________________________________________________________________

_______________________________________________________________________________________________________

Date: ____________________________ Evaluator's initials: ________________________

Evaluator's relevant agency certification or rating:_____________________________________________________

#4
Evaluator's name:
Incident/office title & agency:
Evaluator's home unit address & phone:
        Name and Location
of Incident or situation
(agency & area)
Incident Kind
(hazmat, law enforcement, tornado, flood, structural fire, wildfire, search & rescue, etc.)
       Number & Type of
Resources
Pertinent to
Trainee's Position
                 Duration
(inclusive dates
in trainee status)

                                       
The tasks initialed and dated by me have been performed under my supervision in a satisfactory manner by the above named trainee. I recommend the following for further development of this trainee.
______	The individual has successfully performed all tasks for the position and should be considered for certification.
______	The individual was not able to complete certain tasks (comments below) or additional guidance is required.
______	Not all tasks were evaluated on this assignment and an additional assignment is needed to complete the evaluation.
______	The individual is severely deficient in the performance of tasks for the position and needs further training in both required knowledge and skills prior to additional assignment(s) as a trainee.

Recommendations: ______________________________________________________________________________________

_______________________________________________________________________________________________________

Date: ____________________________ Evaluator's initials: ________________________

Evaluator's relevant agency certification or rating:_____________________________________________________