OHIO DEPARTMENT OF PUBLIC SAFETY PERSONAL PROTECTIVE EQUIPMENT DONNING SCBA CANDIDATE NAME (Please Print) DATE CHARTER CHARTER # VOLUNTEER FIREFIGHTER PRACTICAL SKILL EVALUATION Primary Task Personal Protective Equipment-Donning SCBA (s) 5.3.1 Reference Source NFPA 1001 Standard, 2013 Edition Skill No. 1-3 Candidate Instruction The candidate, wearing personal protective clothing, shall properly don a selfcontained breathing apparatus according to manufacturer’s recommendations within 1 minute. The candidate shall have the hood on and pulled back. The helmet and gloves are not worn to start the practical skill but must be worn to complete the skill. The candidate may use any of the following: Over-the-head method, Coat method, Seat mount method, or Compartment method. Candidate shall clap hands or verbalize at completion of skill; this will allow the evaluator to stop time when clap of hands or verbal indication is heard. Timing starts when the candidate first touches any part of the SCBA after telling the evaluator he or she is ready to start. Timing will end when all protective clothing and SCBA are donned, the PASS device is armed, and the candidate has clapped hands or verbalized completion of the skill. State Maximum Allotted 1 minute PERFORMANCE STEPS TEST 1 RETEST 2 RETEST 3 Safely performs the following steps: P F P F P F Wearing complete personal protective clothing. — CRITICAL POINT Open cylinder valve completely. — CRITICAL POINT Dons SCBA using one of the listed methods and ensures unit is secured and adjusted properly. — CRITICAL POINT Dons face piece, attaches regulator (if using waist mount regulator, attaches breathing tube to regulator), inhales activating regulator, listens for proper seal ensuring there are no leaks. — CRITICAL POINT Ensures exhalation valve is working properly and PASS device is armed. — CRITICAL POINT Dons hood, helmet, and gloves and ensures there is no exposed skin. — CRITICAL POINT Skill shall be completed within 1 minute. — CRITICAL POINT Firefighter must have at least 70% pass mark for each skill and perform all critical points (7 / 7 required). Score: / 7
PRINT NAME FIRST EVALUATOR CERT # SKILL TEST DATE / / SIGNATURE FIRST EVALUATOR X Overall Skill Sheet Score Pass Fail PRINT NAME SECOND EVALUATOR CERT # TEST DATE / / SIGNATURE SECOND EVALUATOR X Overall Skill Sheet Score Pass Fail NAME THIRD EVALUATOR CERT # SKILL TEST DATE / / SIGNATURE EVALUATOR X Overall Skill Sheet Score Pass Fail
PRINT NAME FIRST EVALUATOR CERT # SKILL TEST DATE / / SIGNATURE FIRST EVALUATOR X Overall Skill Sheet Score Pass Fail NAME SECOND EVALUATOR CERT # TEST DATE / / SIGNATURE SECOND EVALUATOR X Overall Skill Sheet Score Pass Fail PRINT NAME THIRD EVALUATOR CERT # SKILL TEST DATE / / SIGNATURE THIRD EVALUATOR X Overall Skill Sheet Score Pass Fail
NAME FIRST EVALUATOR CERT # SKILL TEST DATE / / SIGNATURE FIRST EVALUATOR X Overall Skill Sheet Score Pass Fail PRINT NAME SECOND EVALUATOR CERT # SKILL TEST DATE / / SIGNATURE SECOND EVALUATOR X Overall Skill Sheet Score Pass Fail PRINT NAME THIRD EVALUATOR CERT # SKILL TEST DATE / / SIGNATURE THIRD EVALUATOR X Overall Skill Sheet Score Pass Fail
OHIO DEPARTMENT OF PUBLIC SAFETY WATER SUPPLY HYDRANT SUPPLY LAY CONNECTIONS CANDIDATE NAME (Please Print) DATE CHARTER CHARTER # VOLUNTEER FIREFIGHTER PRACTICAL SKILL EVALUATION Primary Task Water Supply-Hydrant-Supply Lay Connections (s) 5.3.15 Reference Source NFPA 1001 Standard, 2013 Edition Skill No. 17-2 Candidate Instruction The candidate, wearing personal protective clothing, and supply or intake hose, hose tools, and a fire hydrant, shall connect a fire department pumper to a water supply with a reverse lay and ensure connections are tight and water flow is not obstructed. State Maximum Allotted 10 minutes PERFORMANCE STEPS TEST 1 RETEST 2 RETEST 3 REVERSE LAY CONNECTION P F P F P F Wearing complete personal protective clothing. Grasps needed equipment and sufficient hose (spanner and hydrant wrench, necessary appliance and adapter) to attack pumper intake. Anchors hose to stationary object and signals driver to start reverse lay. Supply line is attached to attack pumper OR hose clamp is used and placed properly. Intake hose is connected from supply pumper or hydrant and hydrant properly and ensures water flow is not restricted. Prepares supply hose for connection and connects to discharge outlet of supply pumper and charges line once attack pumper is ready (releases hose clamp if used). Ensures all connections are tight. Firefighter must have at least 70% pass mark for each skill and perform all critical points (5 / 7 required). Score: / 7 NUMBER OF ATTEMPTS TEST 1 RETEST 2 RETEST 3 / 7 / 7 / 7 TIME EVALUATOR COMMENTS
PRINT NAME FIRST EVALUATOR CERT # TEST DATE / / SIGNATURE FIRST EVALUATOR X Overall Skill Sheet Score Pass Fail PRINT NAME SECOND EVALUATOR CERT # SKILL TEST DATE / / SIGNATURE SECOND EVALUATOR X Overall Sheet Score Pass Fail PRINT NAME THIRD EVALUATOR CERT # TEST DATE / / SIGNATURE THIRD EVALUATOR X Overall Skill Sheet Score Pass Fail