Division of Emergency Medical Services - OhioSteps to be Completed Answers PASS FAIL Identify the construction type (Type I – Type V) (4.3.4) ... The candidate will complete a written

Division of Emergency Medical Services

Hazard Recognition Officer Practical Skills Sheets

EFFECTIVE July 10, 2018

Division of Emergency Medical Services Hazard Recognition Officer Practical Skills

INDEX OF PRACTICAL SKILL SHEETS – HAZARD RECOGNITION OFFICER *

SKILL # OBJECTIVE SKILL TEST

METHOD

STATE MAXIMUM ALLOTED

1 4.2.1, 4.3.1, 4.3.2, 4.3.4

Occupancy Classification, Occupancy Calculations, Construction Type

M 30 Minute

2 4.2.5, 4.3.3 Means of Egress – Single Use Occupancy M 30 Minute

3 4.2.2, 4.2.3 Permits O 30 Minute

4 4.2.2, 4.2.3 Plan Review O 30 Minute

5 4.2.4, 4.2.5 4.3.7, 4.3.15

Complaint Investigation O 30 Minute

6 4.2.1, 4.3.9 Operational Readiness – Sprinkler Plan Review O 45 Minutes

7 4.2.1, 4.3.7 Operational Readiness – Portable Fire Extinguishers

M 45 Minutes

8 4.2.1, 4.3.5 Operational Readiness – Fire Suppression System M 45 Minutes

9 4.2.1, 4.3.6 Operational Readiness – Fire Detection System O 45 Minutes

10 4.2.1, 4.3.8

4.3.12, 4.3.13 4.3.14

Recognition and Compliance M 45 Minutes

11 4.3.16 Calculate Hydrant Water Flow O 60 Minutes

12 4.3.11 Emergency Access O 30 Minutes

13 4.3.10 Emergency Planning and Preparedness O 30 Minutes

* Minimum of 5 Mandatory Skills and 2 Optional Skills shall be tested.


HAZARD RECOGNITION OFFICER – SKILL TEST #1

STATUS: Mandatory Candidate Name

Candidate Signature _____________________________________

Occupancy Classification, Occupancy Calculations, and Construction Type

Reference NFPA 1031-2014 Edition, Chapter 4 Skill(s) Tested: 4.2.1, 4.3.1, 4.3.2, & 4.3.4

Test Date Test Site

Task: Given an observation from a field inspection or using the pre-defined facility (Figure 1.1), define and or calculate

occupancy classification, occupancy load, means of egress exit discharge capacity, and construction type in accordance

with the Ohio Fire Code.

Directions: The candidate must provide the required information and calculations, placing the answers in the

appropriate answer column.

Performance Outcome: Successful completion of 100% of the steps listed below. Maximum allowed time to complete is

thirty (30) minutes.

PRACTICAL SKILL START TIME: _______________________ PRACTICAL SKILL END TIME: _______________________

Steps to be Completed Answers PASS FAIL Identify the construction type (Type I – Type V) (4.3.4)

Identify the occupancy classification (4.3.1)

Calculate square footage of the occupancy (4.3.2)

Calculate allowable occupant load for single-use occupancy (4.3.2)

Dining Room: Kitchen: Meeting Room: Lobby:

Total: Calculate allowable exit discharge capacity (4.3.3)

Did the candidate utilize applicable codes and standards in report? (4.2.1)

Task completed “yes” or “no”. All “yes” required to pass.

PASS FAIL

Comments:____________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

Evaluator (Print) _____________________ Evaluator (Signature) ______________________ Evaluator Cert #__________


Cortana’s Place 324 High Street Illuminated Exit Sign

Central City, Ohio 12345 Owner: Dianna Prince Building construction is brick and steel

Din

ing

Ro

om

(Ta

ble

s an

d C

hai

rs)

Mee

tin

g R

oo

m (

no

n-f

ixed

ch

airs

on

ly)

36”

Do

or

Op

enin

g

36”

Do

or

Op

enin

g

36”

Do

or

Op

enin

g

36”

Do

or

Op

enin

g

72”

Do

ub

le

Do

or

Op

enin

g

72”

Do

ub

le

Do

or

Op

enin

g

Lob

by

(no

sea

tin

g)

30 x

20

Figure 1.1 (Not to Scale)


HAZARD RECOGNITION OFFICER – SKILL TEST #2

STATUS: Mandatory

Candidate Name


Means of Egress – Single-use Occupancy

Reference NFPA 1031-2014 Edition, Chapter 4 Skill(s) Tested: 4.2.5, 4.3.3

Test Date Test Site

Task: Given an observation from a field inspection (single-use occupancy) or using the pre-defined facility (Figure 2.1),

describe the code violations and cite the applicable code references using the Ohio Fire Code.

Directions: The candidate must provide the required information placing the answers in the appropriate answer

column.

Performance Outcome: Successfully document the means of egress elements and 100% of the means of egress

deficiencies observed during the field inspection. Maximum allowed time to complete is thirty (30) minutes.

Inspect means of egress elements to ensure compliance with Ohio Fire Code; identify and

document deficiencies (4.3.3)


Violation Description Code Reference PASS FAIL

1.

2.

3.

4.

5.

PASS FAIL

Comments:____________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

Evaluator (Print)_____________________ Evaluator (Signature)______________________ Evaluator Cert #__________


John 117’s 29 High Street Illuminated Exit Sign

Central City, Ohio 12345 Owner: Bruce Wayne Battery Powered Emergency Light

Din

ing

Ro

om

(Ta

ble

s an

d C

hai

rs)

Mee

tin

g R

oo

m (

no

n-f

ixed

ch

airs

on

ly)

36”

Do

or

Op

enin

g

36”

Do

or

Op

enin

g

28” Door Opening Secured with deadbolt

36”

Do

or

Op

enin

g

72”

Do

ub

le

Do

or

Op

enin

g

72”

Do

ub

le

Do

or

Op

enin

g

Lob

by

(no

sea

tin

g)

30 x

20


Pro

ject

ion

Scr

een

Re

stro

om

30 x

20

Re

stro

om

30 x

20



HAZARD RECOGNITION OFFICER – SKILL TEST 3

STATUS: Optional Candidate Name


Permits


Test Date Test Site

Task: Given a situation where a permit is required (Scenario 3.1), the candidate shall recognize the need for a permit. Requirements shall be communicated in accordance with the Ohio Fire Code. Directions: The candidate will complete a written letter identifying the need for both a permit. The candidate shall

identify all applicable Ohio Fire Code references.




Steps to be Completed PASS FAIL

Did the candidate recognize the need for a permit? (4.2.2)

Did the candidate explain the type of permit required? (4.2.2)

Did the candidate direct written communication to the proper responsible party advising how to proceed? (4.2.2, 4.2.3)

Did the candidate identify the applicable codes and standards in the report? (4.2.2, 4.2.3)

Task completed “yes” or “no”. All “yes” required to pass. PASS FAIL

Comments:____________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________



Mr. Smith of ABC Auto Repairs has made a request to your office for information on what would be required to begin storing paint, thinner, and other hazardous materials used in the antique car restoration process. The materials would all be liquids and stored in 5, 10, and 55 gallon containers. The storage area will be protected by an automatic sprinkler system. As a fire inspector you need to respond to Mr. Jenkins request in the form of a letter to Mr. Jenkins. You need to include the following in your letter.

a. Why it is important to obtain a permit and what type of permit is required. b. What is the process and procedures in acquiring a permit? c. The candidate will cite the applicable code references using the Ohio Fire Code.

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

Scenario 3.1





Plan Review


Test Date Test Site

Task: Given a situation where a plan review is required (Scenario 4.1), the candidate shall recognize the need for a plan review. Requirements shall be communicated in accordance with applicable codes and the current NFPA 1031 standard.

Directions: The candidate will complete a written letter identifying the need for plan review. The candidate shall identify

all applicable Ohio Fire Code references.





Did the candidate recognize the need for a plan review? (4.2.3)

Did the candidate explain the need for plan review? (4.2.3)

Did the candidate direct written communication to the proper responsible party advising how to proceed? (4.2.2, 4.2.3)

Did the candidate identify the applicable codes and standards in the report? (4.2.2, 4.2.3)


Comments:____________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

Evaluator (Print)_____________________ Evaluator (Signature)______________________ Evaluator Cert #__________


With the expansion of the municipal water system Mr. Jenkins has contacted your agency about having a new sprinkler system installed in his business. He states that the reduced insurance premiums will make the addition of the sprinkler system very cost effective. As a fire inspector you need to respond to Mr. Jenkins request in the form of a letter to Mr. Jenkins. You need to include the following in your letter.

a. Why is it necessary to do a plan review? Include the appropriate code section(s). b. What kind of plans are needed for review? c. The candidate will cite the applicable code references using the Ohio Fire Code.

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

Scenario 4.1





Complaint Investigation

Reference NFPA 1031-2014 Edition, Chapter 4 Skill(s) Tested: 4.2.4, 4.2.5, 4.3.7, 4.3.15

Test Date Test Site

Task: Investigate a common complaint given a reported situation (Scenario 5.1), so that complaint information is recorded, the appropriate process is initiated, and the complaint is resolved in accordance with the Ohio Fire Code.

Directions: The candidate will complete the Division of EMS Inspection Report Worksheet (Form 5.1) based on the complaint received and follow up field inspection, recording the location of the complaint, complainant information and any code violations found. The candidate will identify all applicable Ohio Fire Code references.





Did the candidate record complainant information? (4.2.4)

Did the candidate record complaint information? (4.2.4)

Did the candidate identify applicable code violations? (4.2.5, 4.3.3, 4.3.15)

Did the candidate accurately describe violations? (4.2.5, 4.3.15)

Did the candidate identify corrective actions? (4.2.5, 4.3.7, 4.3.15)


Comments:_________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________



Scenario: 5.1

Your office receives a complaint, (on this date) from a Julie Miller who states that she is the secretary at Joe’s

Woodworking Shop located at 451 Chestnut St, Sligo Ohio 15432. Mrs. Miller is calling because the owner, Mr. Joe Davis,

has decided that he no longer feels it necessary to have portable fire extinguishers in his shop as a cost saving measure.

In addition she advises that exits are locked and/or blocked by storage. She feels this is creating a very dangerous

situation due to the wood working processes used by Joe’s Woodworking Shop.

Field Inspection: You conduct the field inspection on the same date as the complaint was received. Upon arrival at Joe’s

Woodworking Shop you are greeted by Mr. Joe Davis and he agrees to show you around the facility. During the

inspection you find that there are no portable fire extinguishers located throughout the building and exit doors at the

rear of the building are locked from the inside using slide bolts. In addition, one exit is obstructed by lumber storage and

one is padlocked from the inside. Mr. Davis states that he had all of the portable fire extinguishers removed after they

all failed their last inspection. He further states he did not see the need for replacement as they were never used and

the local fire department is only a few blocks away. With respect to the exits, Mr. Davis states he has limited storage

space and to stay in business he must store lumber in the exit. In addition, the rear exit is padlocked to keep employees

from leaving to take smoke breaks.

Ohio Division of EMS Inspection Report Worksheet

Inspection Date Inspector

Business Name Business Owner

Address Telephone Number

Occupancy Classification

Complainant Name

Date of Complaint

Location of Complaint

Address of Complaint

Nature of Complaint

Fire Code Reference

Violation Description Corrective Action Required

Scenario 5.1





Operational Readiness – Sprinkler Plan Review


Test Date Test Site

Task: Given observations from a field inspection of a fixed suppression system or using the pre-defined facility drawings compare the approved sprinkler system plans (Figure 6.1) with the as-built sprinkler system (Figure 6.2). Directions: The candidate will complete the Division of EMS Inspection Report Worksheet based on the field inspection report of a fixed suppression system. The candidate will compare the approved plans with the as-built fire suppression system plans. The candidate will identify all applicable Ohio Fire Code references.


forty-five (45) minutes.


Steps to be Completed PASS FAIL Did the candidate fully complete the Division of EMS Inspection Report Worksheet? (4.2.1)

Approved Plan Comparison (4.3.9)

Did the candidate compare and determine accuracy of approved plans to an installed fire suppression system?


Comments:_________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________




Inspection Date Inspector



System is installed as approved and operational Yes [ ] No [ ] List all reasons or violations resulting in a “No” answer


Spartan Productions Owner: John Spartan

3124 Harvest Rd, Cortana OH 45632 (123)987-6543

Pendant Automatic Wet type sprinkler head Upright Automatic Wet Type Sprinkler head

City Water

Main

As-Built Fire Suppression System

Figure 6.1

Fire Suppression Plan

Control

Valve

Inspector’s

Test

Connection

Off

ice

Spri

nkle

r R

oom


Spartan Productions Owner: John Spartan

3124 Harvest Rd, Cortana OH 45632 (123)987-6543

Pendant Automatic Wet type sprinkler head Upright Automatic Wet Type Sprinkler head

City Water

Main

Figure 6.2

Control

Valve

Inspector’s

Test

Connection

Spri

nkle

r R

oom

As Built Fire Suppression System

Off

ice

As B

uilt

Fir

e S

up

pre

ssio

n S

ys

tem



STATUS: Mandatory

Candidate Name


Operational Readiness – Portable Fire Extinguishers


Test Date Test Site

Task: Conduct a field inspection of portable fire extinguishers, determine and document operational readiness of the extinguishers in accordance with the Ohio Fire Code. Directions: The candidate will complete the Division of EMS Inspection Report Worksheet (Figure 7.1) based on the field inspection. The candidate will cite the applicable code references using the Ohio Fire Code, referencing the appropriate NFPA code when applicable.





Portable Fire Extinguishers (4.3.7)

Did the candidate determine operational readiness of the portable fire extinguishers?


Comments:_________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

Evaluator (Print) _____________________ Evaluator (Signature) _____________________ Evaluator Cert #__________


Ohio Division of EMS Portable Fire Extinguisher Inspection Report

Facility Name: __________________________ Address: ______________________________________

Owner: ___________________________ Contact Phone Number: ______________________________

Inspection Date: ____________________ Inspector: ___________________________________

Type of Hazard (Light, ordinary, extra)

Extinguisher Rating

Extinguisher Agent

Date Punched on Tag

Cabinet or Bracket Mounted

Condition of Extinguisher

Deficiencies / Code References (wrong type, obstructed, excessive travel distance, improper mounting, storage, etc.)

Comments

Number of extinguishers inspected

Number of extinguishers failed inspection

Number of extinguishers discharged

Number of missing extinguishers

Number of damaged extinguishers

Number of extinguishers replaced

Figure 7.1



STATUS: Mandatory

Candidate Name


Operational Readiness – Fire suppression System


Test Date Test Site

Task: Conduct a field inspection or be given observations from a field inspection of a fixed suppression system, determine and document operational readiness of the systems in accordance with the Ohio Fire Code. Directions: The candidate will complete the Division of EMS Inspection Report Worksheet (Figure 8.1) based on the field inspection of a fixed suppression system. The candidate will cite all the applicable code references using the Ohio Fire Code, referencing the appropriate NFPA code when applicable.





Fixed Suppression System (4.3.5)

Did the candidate determine operational readiness of fixed suppression system?


Comments:_________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

Evaluator (Print) _____________________ Evaluator (Signature)______________________ Evaluator Cert #__________


Ohio Division of EMS Automatic Sprinkler Inspection Report

Facility Name: _______________________________Building Name: __________________________________

Address: __________________________________________________________________________________

Phone Number: ______________________________Owner: ________________________________________

Type of Occupancy: _________________________________________________________________________

Fire Inspector: _______________________________Date of Inspection: _______________________________

Type of system being tested (check all that apply):

[ ] Wet sprinkler system [ ] Dry sprinkler system [ ] Preaction [ ] Deluge

[ ] Wet-Partial coverage [ ] Dry-Partial coverage [ ] Combination (Sprinkler and Standpipe common riser)

Inspection Checklist

Yes No N/A Comments

Sprinkler System: Standpipes/Hose in good condition

Is hydraulic nameplate securely attached to each riser?

Is there a minimum of 18” clearance between the top of storage and sprinkler deflectors?

Controls are readily accessible?

Valves locked open?

Are the heads in good condition?

Wrench/Spare sprinkler heads present?

Is the system supplemented by a fire pump? Is the system composed of more than one riser?

Does this system protect more than one building or occupancy?

Fire Department Connection:

Are the connections the proper size? Are the connections accessible?

Are all FDC caps in place? Is proper signage in place for the FDC?

Inspection Reports:

Annual inspection and testing report of the sprinkler system?

Annual Inspection and testing of fire pumps? Operational Status?

Figure 8.1


Inspector Comments/Remarks

1. Identify and explain any violations:

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

2. Identify all required corrective actions including the time to complete each correction:

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

Inspector Name (Printed) ___________________ (Signature) ______________________





Operational Readiness – Fire Detection System


Test Date Test Site

Task: Conduct a field inspection of a fixed fire detection system, determine and document operational readiness of the systems in accordance with the Ohio Fire Code. Directions: The candidate will complete the Division of EMS Inspection Report Worksheet (Figure 9.1) based on the field inspection report of a fixed fire detection system. The candidate will cite the applicable code references using the Ohio Fire Code, referencing the correct NFPA code when applicable.




Steps to be Completed PASS FAIL Did the candidate fully complete the Division of EMS Inspection Report Worksheet (4.2.1)

Fixed Fire Detection System (4.3.6)

Did the candidate determine operational readiness of the detection and alarm system

Task completed “yes” “no”. All “yes” required to pass. PASS FAIL

Comments:_________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________



Ohio Division of EMS

Fixed Fire Detection and Alarm System Inspection Report

Facility Name: _______________________________ Building Name: __________________________________

Address: __________________________________________________________________________________

Phone Number: ______________________________ Owner: ________________________________________

Type of Occupancy: _________________________________________________________________________

Fire Inspector: _______________________________ Date of Inspection: ______________________________

Inspection Checklist

Yes No NA Comments

Detection System: Control panel/annunciator panel in normal condition (No trouble or alarm conditions)

Detectors properly installed Pull Stations are readily accessible

Inspection Report: Annual inspection and testing report

Detectors:

Detector Type # Installed # Tested Operational If Detectors are OOS provide reason Smoke:

Heat: Combination:

Other (Describe):

Inspector Comments/Remarks

1. Identify and explain any violations:

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

2. Identify all required corrective actions and time to complete each:

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

Inspector Name (Printed) ___________________ (signature) ______________________

Figure 9.1



STATUS: Mandatory

Candidate Name


Recognition and Compliance

Reference NFPA 1031-2014 Edition, Chapter 4 Skill(s) Tested: 4.2.1, 4.3.8, 4.3.12, 4.3.13, 4.3.14

Test Date Test Site

Task: Conduct a field inspection completing the Division of EMS Inspection Report Worksheet in accordance with applicable codes and the current NFPA 1031 standard. Directions: The candidate will complete the Division of EMS Inspection Report Worksheet (Figure 10.1) based on the field inspection and report any violations on the Division of EMS Violation Worksheet (Figure 10.2). The candidate will identify all applicable Ohio Fire Codes and NFPA 1031 standards.

Performance Outcome: Successful completion of 100% of the steps listed below. This skill may be done as a Flip-The-

Switch.



Did the candidate fully complete the Division of EMS Inspection Report Worksheet (4.2.1)

Did the candidate complete and accurately document violations including correct code reference number

Hazardous Condition Recognition (4.3.8)

Did the candidate recognize hazardous conditions involving equipment, processes, and Operations

Code Compliance of Hazardous Materials (4.3.12 & 4.3.13)

Did the candidate verify code compliance for storage, handling, and use of flammable and combustible liquids and gases

Fire Growth Potential (4.3.14)

Did the candidate use field observations to establish potential for hazardous fire growth

Did the candidate identify, document and report conditions contributing to this potential situation

Task completed “yes” “no”. All “yes” required to pass. PASS FAIL

Comments: ________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________



Ohio Division of EMS

Inspection Report Worksheet Inspection Date

Inspector


Address

Telephone Number

Building Area (Sq ft) Occupancy Type / Construction Occupancy Load Means of Egress

Fire Suppression System

Type of System

Operational Status of System Last Inspection Date

Installed System

Yes No

Detection/Alarm Systems

Type of System

Operational Status of System Last Inspection Date

Installed System Yes No

Portable Fire Extinguishers

Type(s) of Extinguishers

Number of Extinguishers Inspected

Last Inspection

Date

Properly mounted/secured

Hazardous Materials Storage

Types of Hazardous Materials Stored: Location of Hazardous Material Storage:

Yes No

Fire Growth Potential

Low Medium High

Description:

ALL VIOLATIONS AND CORRECTIONS MUST BE LISTED ON THE DIVISION OF EMS INSPECTION REPORT

Figure 10.1



Inspection Date

Inspector

Business Name

Business Owner


Fire Code Reference


Figure 10.2





Calculate Hydrant Water Flow

Reference NFPA 1031-2014 Edition, Chapter 4 Skill(s) Tested: 4.3.16

Test Date Test Site

Task: Given an observation from a field inspection or using the information provided in Scenario 11.1, calculate the

hydrant flow for a fire hydrant.

Directions: Given a Pitot Tube and Gauge along with a Hydrant Pressure gauge flow test a hydrant or series of hydrants to determine the fire flow. You will be evaluated on your ability to calculate and graph fire flow and to answer the

questions related to the test.

Performance Outcome: Will be determined on the ability to correctly measure the appropriate hydrant pressures, graph

the findings and determine the correct fire flow within 20 GPM +/-. Maximum allowed time to complete is (1) hour.


Steps to be Completed Answers PASS FAIL Did the candidate properly fill out the Water Flow Test Summary Sheet (4.2.1)

Did the candidate properly plot the data obtained from readings (4.3.16)

Calculate the Static Pressure (4.3.16)

Calculate the Residual Pressure (4.3.16)

Calculate the Fire Flow GPM (4.3.16) Pitot Flow: @ 20 psi

Identify the NFPA Hydrant Color (4.3.15)

Task completed “yes” “no”. All “yes” required to pass.

PASS FAIL

Comments:

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

Evaluator (Print) _____________________ Evaluator (Signature) _____________________ Evaluator Cert # __________


Test hydrant, located at First and Walnut Streets, flow information using a 2 ½” discharge with a Pitot Tube reading of 30

psi, Static Pressure of 70 psi, and a Residual Pressure of 40 psi.

Scenario 11.1


Scenario 11.1





Emergency Access

Reference NFPA 1031 - 2014 Edition, Chapter 4 Skill(s) Tested: 4.3.11

Test Date Test Site

Task: Given observations from a field inspection inside and outside a building (Scenario 12.1), prepare an inspection report

documenting emergency access deficiencies and identifying corrective actions needed in accordance with the Ohio Fire

Code.

Directions: The candidate must evaluate the provided information, determine compliance with emergency access

requirements, and provide the required information, placing the answers in the appropriate answer column of the

Division of EMS Inspection Report Worksheet (Figure 12.1).




Steps to be Completed Answers PASS FAIL Did the candidate inspect emergency access for the site? (4.3.11)

Did the candidate identify deficiencies according to codes, standards, and policies? (4.3.11)

Did candidate document emergency access deficiencies? 4.3.11)


PASS FAIL

Comments:

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

Evaluator (Print) _____________________ Evaluator (Signature) _____________________ Evaluator Cert # _________



Inspection Date

Inspector

Business Name

Business Owner


Fire Code Reference


Figure 12.1


Scenario 12.1

Barry’s Oil Change Owner: Barry Allen

42 Gotham Plaza Place, Central City, Ohio 13579 (321)654-9876

Rear Elevation View

Scenario 12.1





Emergency Planning and Preparedness

Reference NFPA 1031-2014 Edition, Chapter 4 Skill(s) Tested: 4.3.10

Test Date Test Site

Task: Given field observations and copies of a facility’s emergency plans and records of exercises, determine if emergency plans are properly prepared and exercises have been performed in accordance with the Ohio Fire Code.

Directions: The candidate must evaluate the provided information, determine compliance with emergency planning and preparedness requirements, and provide the required information, placing the answers in the appropriate answer column

of the Division of EMS Inspection Report Worksheet (Figure 13.1).




Steps to be Completed Answers PASS FAIL Did the candidate verify emergency/preparedness plans are in place? (4.3.10)

Did the candidate review the written plan as it applies to codes and standards? (4.3.10)

Did the candidate review emergency plan exercise documentation? (4.3.10)

Did candidate identify and document deficiencies in the emergency plan? 4.3.10)

Did the candidate report deficiencies to the jurisdiction? (4.3.10)


PASS FAIL

Comments:

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

Evaluator (Print) _____________________ Evaluator (Signature) _____________________ Evaluator Cert # __________



Inspection Date

Inspector


Address Phone Number

Does the facility have a complete Emergency Plan & Procedures in place? YES NO

Explanation if No:

Confirmation of completed exercise(s) and evaluations of emergency plans and preparedness procedures?

YES NO

Explanation if No:

You have been assigned to evaluate the Emergency Planning and Preparedness for the Dr. Mary Miller & Associates

Medical Offices. When you arrive at the medical office you are cordially greeted by Dr. Miller who provides you the

following documents Evacuation / Fire Safety Plan, Evacuation Drill Log, and a copy of the Emergency Exit Routes. She

informs you that the building has a complete fire alarm system consisting of manual pull stations located throughout the

building and a smoke alarm system. She reports that the entire fire and security alarm system is monitored by the

corporate office through the Emergency Management Watch Office in Pittsburgh PA. Dr. Miller reports that they are

required by corporate to conduct semi-annual fire drills, however due to the recent weather and business of the office

they have been pushing them off. Dr. Miller then gives you a tour of the medical offices and you locate the Emergency

Evacuation Route signs located in the middle of each hallway as well as behind the receptionist desk in the lobby.

Figure 13.1

Scenario 13.1


Evacuation / Fire Safety Plan

Dr. Mary Miller & Associates Medical Offices

69 South Main St

Gotham, OH 45632

Emergency Contact (Local) Dr. Mary Miller 777-777-6666 or Corporate Office 800-111-2121

Fire Alarm System Description:

This medical office building is equipped with a fire alarm system consisting of manual pull stations and

integrated smoke detectors. Whenever the alarm system is activated by either means an audible pulsating

sound will sound as well as flashing strobe lights. The fire alarm system is monitored by the Corporate Office,

Emergency Management Watch Division, in Pittsburgh PA. The watch officer who receives the alarm

notification will contact the office for verification of the alarm and then if required notify the fire department.

If you discover a fire:

• Shout fire and location of the fire

• Activate the nearest pull station

• Proceed to the nearest exit

o While traveling to the nearest exit open all closed doors to ensure no one is in the rooms and all are

aware of the fire emergency

o Leave all doors open so everyone exiting knows the rooms have been cleared

• Confirm with the Watch Officer from Corporate that there is a fire emergency

o If unable to stay and answer phone call from the Watch Officer they can be called directly via cell phone

Evacuation Procedures:

• Move as quickly as possible to the nearest exit

• When exiting any room be sure to check for heat, smoke, and barriers blocking evacuation route

• Leave all room doors open so others passing by are sure rooms are clear of occupants

• Assist patients, family, and civilians towards the exits

• Physician or Nurse Manager should press the emergency shutoff button for the medical gases while evacuating

• Evacuees should stay in the parking lot that they exited too (front or back parking lots)

• Physician or Nurse Manager should confirm that the Watch Office was notified of the fire emergency

Scenario 13.1


Evacuation Drill Log

Date: ________________ Time: _________________ Notification Method: __________________________

Was Corporate Made Aware of Drill: Yes / No Did Corporate Watch Office Initiate the Drill: Yes / No

Supervising Employee: _______________________________

Participating Staff Members:

1. _______________________________

2. _______________________________

3. _______________________________

4. _______________________________

5. _______________________________

6. _______________________________

7. _______________________________

8. _______________________________

9. _______________________________

10. _______________________________

Was the drill conducted during normal office hours: Yes / No

Where patients and family evacuated during the drill: Yes / No If so how many non-employees involved: _______

Any Special Conditions Simulated: Yes / No If so what: _____________________________________________

Any complications, problems, or concerns noted during the drill:

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

Weather Conditions: _______________

Time from alarm initiation or drill start until verification from watch officer: _____________

Time to Complete Evacuation: ___________________

Scenario 13.1


Scenario 13.1

Evacuation Routes

Dr. Mary Miller & Associates Medical Offices

Scenario 13.1

Division of Emergency Medical Services - OhioSteps to be Completed Answers PASS FAIL Identify the construction type (Type I – Type V) (4.3.4) ... The candidate will complete a written

Documents