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OHIO DEPARTMENT OF PUBLIC SAFETY DIVISION OF EMERGENCY MEDICAL SERVICES FIRE SAFETY INSPECTOR COURSE OBJECTIVES CHECK-OFF PACKET STUDENT NAME (PLEASE PRINT) COURSE TITLE COURSE DATES COURSE ID # CHARTER NAME CHARTER #

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Page 1: FIRE SAFETY INSPECTOR COURSE OBJECTIVES CHECK-OFF …ems.ohio.gov/links/EMS0227.pdfEvaluate a building’s area, height, occupancy classification, and construction type, given an approved

OHIO DEPARTMENT OF PUBLIC SAFETY DIVISION OF EMERGENCY MEDICAL SERVICES

FIRE SAFETY INSPECTOR COURSE OBJECTIVES CHECK-OFF PACKET

STUDENT NAME (PLEASE PRINT)

COURSE TITLE

COURSE DATES

COURSE ID #

CHARTER NAME

CHARTER #

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EMS 0227 10/19 [760-1092] Page 2 of 13

OVERVIEW The Fire Safety Inspector course training and education requirements identify and recognize fire service personnel whose accomplishments in training and education meet or exceed nationally recognized standards. NFPA 1031, Standard for Professional Qualifications for Fire Inspector and Plan Examiner sets forth the minimum job performance requirements for Fire Safety Inspector professional qualifications. An individual certified at one of the Fire Service Professional levels will have demonstrated competency in the knowledge and practical skills required to perform at a particular level. The service that can be offered to the citizens, visitors, and communities of the state of Ohio will be enhanced by the professional competency attained through this certification process.

INITIAL FIRE SAFETY INSPECTOR COURSES In accordance with Ohio Revised Code (R.C.) Chapter (4765). The Executive Director for the State Board of Emergency Medical, Fire, and Transportation Services, with advice and counsel of the Fire Safety Inspector and Fire Safety Inspector Training Committee, is responsible for the implementation of fire training and certifications developed in accordance with and consistent to established standards. The Ohio Department of Public Safety, Division of Emergency Medical Services is the certifying agency within the state of Ohio, with administration and delivery of fire training programs provided through chartered fire training programs across the state of Ohio.

It is not the purpose of the NFPA standard, nor the requirements of the Ohio Administrative Code (O.A.C.), to restrict fire training programs from exceeding the minimum requirements, however, Ohio Fire Charters shall ensure:

Hazard Recognition Officer Courses meet the Hazard Recognition Officer requirements of the “Hazard

Recognition Officer Course Objectives."

o A student who has successfully completed a Hazard Recognition Officer course and passed the practical and

written certification examinations will be eligible for certification as a Hazard Recognition Officer in accordance with R.C. section 4765.55.

Fire Safety Inspector Courses meet the Fire Safety Inspector requirements of the “Fire Safety Inspector Course Objectives."

o A student who has successfully completed a Fire Safety Inspector course and passed the practical and written

certification examinations will be eligible for certification as a Fire Safety Inspector in accordance with R.C. section 4765.55.

The training requirements listed above shall commence and end within a consecutive twelve-month period.

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EMS 0227 10/19 [760-1092] Page 3 of 13

FIRE SAFETY INSPECTOR COURSE OBJECTIVES CHECK-OFF PACKET NFPA 1031 (2014 edition)

INSTRUCTIONS The information on this page is required and must be documented in the student files as having been completed prior to admission into the course. CATEGORY: FIRE SAFETY INSPECTOR COURSE ADMISSION REQUIREMENTS O.A.C.: 4765-20-03,

4765-24-14

A chartered fire training program shall admit only those individuals who meet the following requirements into a fire safety inspector or hazard recognition officer course:

O.A.C. REFERENCE

Individuals shall be at least eighteen years of age. 4765-20-03 4765-24-14

Individuals shall hold a current and valid firefighter certificate. 4765-20-03 4765-24-14

Individuals shall meet all admission requirements established by the chartered fire training program. 4765-20-03 4765-24-14

In addition to the requirements for admission as set forth in paragraph (C) of rule 4765-24-14 of the O.A.C., the chartered fire training program shall require each student to be employed by one of the following in order to be eligible for admission into a fire safety inspector course.

O.A.C. REFERENCE

The office of the state fire marshal. 4765-24-14

A firefighting agency as defined in division (A)(3) of section 9.60 of the R.C. 4765-24-14

A private fire company as defined in division (A)(5) of section 9.60 of the R.C. that is providing fire protection in accordance with division (B), (C), or (D) of section 9.60 of the R.C.

4765-24-14

An applicant for fire safety inspector shall not have been convicted of any of the following: O.A.C. REFERENCE

Any felony. 4765-20-03

A misdemeanor committed in the course of practice. 4765-20-03

A misdemeanor involving moral turpitude. 4765-20-03

An applicant for fire safety inspector shall not have committed fraud, misrepresentation, or material deception in applying for, or obtaining, a certificate issued under section 4765.55 of the R.C. and this chapter.

O.A.C. REFERENCE: 4765-20-03

CATEGORY: QUALIFICATIONS FOR FIRE SAFETY INSPECTOR CERTIFICATION O.A.C.: 4765-20-03,

4765-24-14

An applicant for a fire safety inspector certificate shall satisfy the following requirements: O.A.C. REFERENCE

Shall successfully complete a fire safety inspector training course through a chartered fire training program and receive a certificate of course completion.

4765-20-03

Shall pass the knowledge and practical skills examinations. 4765-20-03

Shall submit a completed "Firefighter, Fire Safety Inspector, or Hazard Recognition Officer Initial Application.”

4765-20-03

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EMS 0227 10/19 [760-1092] Page 4 of 13

Individuals shall meet the performance objectives set forth in "NFPA 1031" for Fire Inspector I and II.

O.A.C. REFERENCE: 4765-24-14

Shall pass the knowledge and practical skills examinations as set forth in rule 4765-20-03 of the O.A.C. within 180 days.

O.A.C. REFERENCE: 4765-20-03

Shall submit a completed application within ninety (90) days of passing the knowledge examination.

O.A.C. REFERENCE: 4765-20-03

The information in this section is required and must be documented in the student files as having been completed prior to certification.

The fire training entrance requirements listed above shall have been completed by the student prior to admission into the course and verified by the fire charter program director. We attest that the fire training entrance requirements listed above have been met and that all information provided is true and accurate to the best of our knowledge.

STUDENT NAME

DATE

STUDENT SIGNATURE

X

PROGRAM DIRECTOR NAME

CERTIFICATION # (IF APPLICABLE)

DATE

PROGRAM DIRECTOR SIGNATURE

X

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FIRE SAFETY INSPECTOR COURSE OBJECTIVES CHECK-OFF PACKET

FIRE SAFETY INSPECTOR OBJECTIVES

INSTRUCTIONS

The following pages shall be completed by certified fire safety inspector instructors functioning under the auspices of the charter for each objective they observe. Instructors shall place their initials and date for each objective completed under their observation. The documentation of these check-offs is required to be completed at time of evaluation.

CATEGORY: FIRE SAFETY INSPECTOR NFPA STANDARD: 5.2.1

Process a permit application, given a specific request, so that the application is evaluated and a permit is issued or denied in accordance with the applicable codes, standards, policies, and procedures of the jurisdiction.

COGNITIVE SKILLS NFPA REFERENCE

Identify permit application process. 5.2.1

Identify applicable codes, standards, policies, and procedures of the jurisdiction. 5.2.1

OBJECTIVES PRACTICAL SKILLS INSTRUCTOR

INITIALS DATE

5.2.1 Ability to identify the application of the requisite knowledge.

CATEGORY: FIRE SAFETY INSPECTOR NFPA STANDARD: 5.2.2

Process a plan review application, given a specific request, so that the application is evaluated and processed in accordance with the applicable codes and standards and the policies of the jurisdiction.

COGNITIVE SKILLS NFPA REFERENCE

Identify a plan review application process. 5.2.2

Identify the code requirements of the jurisdiction and policies and procedures of the jurisdiction. 5.2.2

OBJECTIVES PRACTICAL SKILLS INSTRUCTOR

INITIALS DATE

5.2.2 Ability to communicate orally and in writing on matters related to code requirements, policies, and procedures of the jurisdiction.

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CATEGORY: FIRE SAFETY INSPECTOR NFPA STANDARD: 5.2.3

Investigate complex complaints, given a reported situation or condition, so that complaint information is recorded, the investigation process is initiated, and the complaint is resolved in accordance with the applicable codes and standards and the policies of the jurisdiction.

COGNITIVE SKILLS NFPA REFERENCE

Identify applicable codes and standards adopted by the jurisdiction. 5.2.3

Identify policies of the jurisdiction. 5.2.3

OBJECTIVES PRACTICAL SKILLS INSTRUCTOR

INITIALS DATE

5.2.3 Ability to interpret codes and standards.

5.2.3 Ability to recognize problems.

5.2.3 Ability to refer complaints to other agencies when required.

CATEGORY: FIRE SAFETY INSPECTOR NFPA STANDARD: 5.2.4

Recommend modifications to the adopted codes and standards of the jurisdiction, given a fire safety issue, so that the proposed modifications address the problem, need, or deficiency.

COGNITIVE SKILLS NFPA REFERENCE

Identify state statutes or local ordinances establishing or empowering the agency to adopt, enforce, and revise codes and standards.

5.2.4

Identify the legal instruments establishing or adopting codes and standards. 5.2.4

Identify the development and adoption process for fire and life safety legislation or regulations. 5.2.4

OBJECTIVES PRACTICAL SKILLS INSTRUCTOR

INITIALS DATE

5.2.4 Ability to recognize problems.

5.2.4 Ability to collect and develop potential solutions.

5.2.4 Ability to identify cost/risk benefits.

CATEGORY: FIRE SAFETY INSPECTOR NFPA STANDARD: 5.2.5

Recommend policies and procedures for the delivery of inspection services, given management objectives, so that inspections are conducted in accordance with the policies of the jurisdiction and due process of the law is followed.

COGNITIVE SKILLS NFPA REFERENCE

Identify policies and procedures of the jurisdiction related to code enforcement as well as sources of detailed, technical information relating to fire protection and life safety.

5.2.5

OBJECTIVES PRACTICAL SKILLS INSTRUCTOR

INITIALS DATE

5.2.5 Ability to identify approved construction methods and materials related to fire safety.

5.2.5 Ability to read and interpret construction plans and specifications.

5.2.5 Ability to educate, conduct research, make decisions, recognize problems, and resolve conflicts.

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CATEGORY: FIRE SAFETY INSPECTOR NFPA STANDARD: 5.3.1

Compute the maximum allowable occupant load of a multi-use building, given field observations or a description of its uses, so that the maximum allowable occupant load calculation is in accordance with applicable codes and standards.

COGNITIVE SKILLS NFPA REFERENCE

Identify how to calculate occupant loads for an occupancy and for building use. 5.3.1

Identify code requirements, regulations, operational features, and fire hazards presented by various occupancies.

5.3.1

OBJECTIVES PRACTICAL SKILLS INSTRUCTOR

INITIALS DATE

5.3.1 Ability to calculate occupant loads.

5.3.1 Ability to identify occupancy factors related to various occupancy classifications, use measuring tools, read plans, and use a calculator.

CATEGORY: FIRE SAFETY INSPECTOR NFPA STANDARD: 5.3.2

Identify the occupancy classifications of a mixed-use building, given a description of the uses, so that each area is classified in accordance with applicable codes and standards.

COGNITIVE SKILLS NFPA REFERENCE

Identify occupancy classification. 5.3.2

Identify applicable codes and standards. 5.3.2

Identify operational features. 5.3.2

Identify fire hazards presented by various occupancies. 5.3.2

OBJECTIVES PRACTICAL SKILLS INSTRUCTOR

INITIALS DATE

5.3.2 Ability to interpret code requirements and recognize building uses that fall into each occupancy classification.

CATEGORY: FIRE SAFETY INSPECTOR NFPA STANDARD: 5.3.3

Evaluate a building’s area, height, occupancy classification, and construction type, given an approved set of plans and construction features, so that it is verified that the building is in accordance with applicable codes and standards.

COGNITIVE SKILLS NFPA REFERENCE

Identify building construction with emphasis on fire-rated construction. 5.3.3

Identify evaluation of methods of construction and assemblies for fire rating. 5.3.3

Identify analysis of test results and manufacturer’s specifications. 5.3.3

OBJECTIVES PRACTICAL SKILLS INSTRUCTOR

INITIALS DATE

5.3.3 Ability to identify characteristics of each type of building construction and occupancy classification.

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CATEGORY: FIRE SAFETY INSPECTOR NFPA STANDARD: 5.3.4

Evaluate fire protection systems and equipment provided for life safety and property protection, given field observations of the facility and documentation, the hazards protected, and the system specifications, so that the fire protection systems provided are approved for the occupancy or hazard being protected.

COGNITIVE SKILLS NFPA REFERENCE

Identify applicable codes and standards for fire protection systems. 5.3.4

Identify basic physical science as it relates to fire behavior and fire suppression, implications and hazards associated with system operation.

5.3.4

Identify installation techniques and acceptance inspection. 5.3.4

Identify testing and reports of maintenance of completed installations. 5.3.4

Identify use and function of various systems. 5.3.4

OBJECTIVES PRACTICAL SKILLS INSTRUCTOR

INITIALS DATE

5.3.4 Ability to recognize problems.

5.3.4 Ability to use codes and standards.

5.3.4 Ability to read reports, plans, and specifications.

CATEGORY: FIRE SAFETY INSPECTOR NFPA STANDARD: 5.3.5

Analyze the egress elements of a building or portion of a building, given observations made during a field inspection, and so that means of egress elements are provided and located in accordance with applicable codes and standards and deficiencies are identified, documented, and reported in accordance with the policies of the jurisdiction.

COGNITIVE SKILLS NFPA REFERENCE

Identify acceptable means of egress devices. 5.3.5

OBJECTIVES PRACTICAL SKILLS INSTRUCTOR

INITIALS DATE

5.3.5 Ability to calculate egress requirements.

5.3.5 Ability to read plans.

5.3.5 Ability to make decisions related to the adequacy of egress.

CATEGORY: FIRE SAFETY INSPECTOR NFPA STANDARD: 5.3.6

Evaluate hazardous conditions involving equipment, processes, and operations, given field observations and documentation, so that the equipment, processes, or operations are installed in accordance with applicable codes and standards and deficiencies are identified, documented, and reported in accordance with the policies of the jurisdiction.

COGNITIVE SKILLS NFPA REFERENCE

Identify applicable codes and standards, accepted fire protection practices. 5.3.6

Identify fire behavior, ignition sources, safe housekeeping practices, and additional reference materials related to protection of hazardous processes and code enforcement.

5.3.6

OBJECTIVES PRACTICAL SKILLS INSTRUCTOR

INITIALS DATE

5.3.6 Ability to observe, communicate, and interpret codes.

5.3.6 Ability to recognize problems and make decisions.

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CATEGORY: FIRE SAFETY INSPECTOR NFPA STANDARD: 5.3.7

Evaluate emergency planning and preparedness procedures, given existing or proposed plans and procedures and applicable codes and standards, so that compliance is determined.

COGNITIVE SKILLS NFPA REFERENCE

Identify occupancy requirements for emergency evacuation plans. 5.3.7

Identify fire safety programs for crowd control. 5.3.7

Identify roles of agencies and individuals in implementation and development of emergency plans. 5.3.7

OBJECTIVES PRACTICAL SKILLS INSTRUCTOR

INITIALS DATE

5.3.7 Ability to compare submitted plans and procedures with applicable codes and standards adopted by the jurisdiction.

CATEGORY: FIRE SAFETY INSPECTOR NFPA STANDARD: 5.3.8

Verify code compliance for storage, handling, and use of flammable and combustible liquids and gases, given field observations and inspection guidelines from the authority having jurisdiction, so that deficiencies are identified, documented, and reported in accordance with the applicable codes and standards and the policies of the jurisdiction.

COGNITIVE SKILLS NFPA REFERENCE

Identify flammable and combustible liquids properties and hazards. 5.3.8

Identify material safety data sheet. 5.3.8

Identify safe handling practices. 5.3.8

Identify applicable codes and standards. 5.3.8

Identify fire protection systems and equipment approved for the material. 5.3.8

Identify fire behavior, safety procedures, and storage compatibility. 5.3.8

OBJECTIVES PRACTICAL SKILLS INSTRUCTOR

INITIALS DATE

5.3.8 Ability to identify typical fire hazards associated with processes or operations utilizing flammable and combustible liquids.

5.3.8 Ability to observe, communicate, interpret codes, recognize problems, and make decisions.

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CATEGORY: FIRE SAFETY INSPECTOR NFPA STANDARD: 5.3.9

Evaluate code compliance for the storage, handling, and use of hazardous materials, given field observations, so that deficiencies are identified, documented, and reported in accordance with the applicable codes and standards and the policies of the jurisdiction.

COGNITIVE SKILLS NFPA REFERENCE

Hazardous materials properties and hazards. 5.3.9

Identify material safety data sheet. 5.3.9

Identify safe handling practices. 5.3.9

Identify applicable codes and standards. 5.3.9

Identify fire protection systems and equipment approved for the material. 5.3.9

Identify fire behavior, safety procedures, chemical reactions, and storage compatibility. 5.3.9

OBJECTIVES PRACTICAL SKILLS INSTRUCTOR

INITIALS DATE

5.3.9 Ability to identify fire hazards associated with processes or operations utilizing hazardous materials.

5.3.9 Ability to observe, communicate, interpret codes, recognize problems, and make decisions.

CATEGORY: FIRE SAFETY INSPECTOR NFPA STANDARD: 5.3.10

Determine fire growth potential in a building or space, given field observations or plans, so that the contents, interior finish, and construction elements are evaluated for compliance, and deficiencies are identified, documented, and corrected in accordance with the applicable codes and standards and the policies of the jurisdiction.

COGNITIVE SKILLS NFPA REFERENCE

Identify basic fire behavior; flame spread and smoke development ratings of contents interior finishes, building construction elements, decorations, decorative materials, and furnishings.

5.3.10

Identify safe housekeeping practices. 5.3.10

OBJECTIVES PRACTICAL SKILLS INSTRUCTOR

INITIALS DATE

5.3.10 Ability to observe, communicate, interpret codes and standards.

5.3.10 Ability to recognize hazardous conditions and make decisions.

CATEGORY: FIRE SAFETY INSPECTOR NFPA STANDARD: 5.3.11

Verify compliance with construction documents, given a performance-based design, so that life safety systems and building services equipment are installed, inspected, and tested to perform as described in the engineering documents and the operations and maintenance manual that accompanies the design, so that deficiencies are identified, documented, and reported in accordance with the applicable codes and standards and the policies of the jurisdiction. COGNITIVE SKILLS NFPA REFERENCE

Identify applicable codes and standards for installation and testing of fire protection systems. 5.3.11

Identify means of egress, and building services equipment. 5.3.11

OBJECTIVES PRACTICAL SKILLS INSTRUCTOR

INITIALS DATE

5.3.11 Ability to witness and document tests of fire protection systems and building services equipment.

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CATEGORY: FIRE SAFETY INSPECTOR NFPA STANDARD: 5.3.12

Verify code compliance of heating, ventilation, air conditioning, and other building service equipment and operations, given field observations, so that the systems and other equipment are maintained in accordance with applicable codes and standards and deficiencies are identified, documented, and reported in accordance with the policies of the jurisdiction.

COGNITIVE SKILLS NFPA REFERENCE

Identify types, installation, maintenance, and use of building service equipment. 5.3.12

Identify operations of smoke and heat vents. 5.3.12

Identify installations of kitchen cooking equipment (including hoods and ducts), laundry chutes, elevators, and escalators.

5.3.12

Identify applicable codes and standards adopted by the jurisdiction. 5.3.12

OBJECTIVES PRACTICAL SKILLS INSTRUCTOR

INITIALS DATE

5.3.12 Ability to observe, recognize problems, interpret codes and standards, and write reports.

CATEGORY: FIRE SAFETY INSPECTOR NFPA STANDARD: 5.4.1

Classify the occupancy, given a set of plans, specifications, and a description of a building, so that the classification is made in accordance with the applicable codes and standards and the policies of the jurisdiction.

COGNITIVE SKILLS NFPA REFERENCE

Identify occupancy classification. 5.4.1

Identify applicable codes and standards. 5.4.1

Identify regulations, operational features, and fire hazards presented by various occupancies. 5.4.1

OBJECTIVES PRACTICAL SKILLS INSTRUCTOR

INITIALS DATE

5.4.1 Ability to read plans.

CATEGORY: FIRE SAFETY INSPECTOR NFPA STANDARD: 5.4.2

Compute the maximum allowable occupant load, given a floor plan of a building or portion of the building, so that the calculated occupant load is in accordance with the applicable codes and standards and the policies of the jurisdiction.

COGNITIVE SKILLS NFPA REFERENCE

Identity how to calculate occupant loads for an occupancy and building use. 5.4.2

Identify code requirements, regulations, operational features such as fixed seating, and fire hazards presented by various occupancies.

5.4.2

OBJECTIVES PRACTICAL SKILLS INSTRUCTOR

INITIALS DATE

5.4.2 Ability to calculate accurate occupant loads.

5.4.2 Ability to identify occupancy factors related to various occupancy classifications.

5.4.2 Ability to use measuring tools.

5.4.2 Ability to read plans and use a calculator.

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CATEGORY: FIRE SAFETY INSPECTOR NFPA STANDARD: 5.4.3

Review the proposed installation of fire protection systems, given shop drawings and system specifications for a process or operation, so that the system is reviewed for code compliance and installed in accordance with the approved drawings, and deficiencies are identified, documented, and reported in accordance with the applicable codes and standards and the policies of the jurisdiction.

COGNITIVE SKILLS NFPA REFERENCE

Identify proper selection, distribution, location, and testing of portable fire extinguishers. 5.4.3

Identify methods used to evaluate the operational readiness of water supply systems used for fire protection.

5.4.3

Identify proper evaluation and testing of automatic sprinkler, water spray, and standpipe systems and fire pumps.

5.4.3

Identify proper evaluation and testing of fixed fire suppression systems. 5.4.3

Identify proper evaluation and testing of automatic fire detection and alarm systems and devices. 5.4.3

OBJECTIVES PRACTICAL SKILLS INSTRUCTOR

INITIALS DATE

5.4.3 Ability to read basic floor plans or shop drawings.

5.4.3 Ability to identify symbols used by the jurisdiction.

CATEGORY: FIRE SAFETY INSPECTOR NFPA STANDARD: 5.4.4

Review the installation of fire protection systems, given an installed system, shop drawings, and system specifications for a process or operation, so that the system is reviewed for code compliance and installed in accordance with the approved drawings, and deficiencies are identified, documented, and reported in accordance with the applicable codes and standards and the policies of the jurisdiction.

COGNITIVE SKILLS NFPA REFERENCE

Identify proper selection, distribution, location, and testing of portable fire extinguishers. 5.4.4

Identify methods used to evaluate the operational readiness of water supply systems used for fire protection.

5.4.4

Identify evaluation and testing of automatic sprinkler, water spray, and standpipe systems and fire pumps.

5.4.4

Identify evaluation and testing of fixed fire suppression systems. 5.4.4

Identify evaluation and testing of automatic fire detection and alarm systems and devices. 5.4.4

OBJECTIVES PRACTICAL SKILLS INSTRUCTOR

INITIALS DATE

5.4.4 Ability to read basic floor plans or shop drawings.

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CATEGORY: FIRE SAFETY INSPECTOR NFPA STANDARD: 5.4.5

Verify that means of egress elements are provided, given a floor plan of a building or portion of a building, so that all elements are identified and checked against applicable codes and standards and deficiencies are discovered and communicated in accordance with the policies of the jurisdiction.

COGNITIVE SKILLS NFPA REFERENCE

Identify applicable codes and standards adopted by the jurisdiction. 5.4.5

Identify the identification of standard symbols used in plans and field verification practices. 5.4.5

OBJECTIVES PRACTICAL SKILLS INSTRUCTOR

INITIALS DATE

5.4.5 Ability to read basic floor plans or shop drawings.

CATEGORY: FIRE SAFETY INSPECTOR NFPA STANDARD: 5.4.6

Verify the construction type of a building or portion thereof, given a set of approved plans and specifications, so that the construction type complies with the approved plans and applicable codes and standards.

COGNITIVE SKILLS NFPA REFERENCE

Identify building construction with emphasis on fire-rated construction. 5.4.6

Identify and evaluate the methods of construction and assemblies for fire rating. 5.4.6

Identify the analysis of test results and manufacturer’s specifications. 5.4.6

OBJECTIVES PRACTICAL SKILLS INSTRUCTOR

INITIALS DATE

5.4.6 Ability to identify characteristics of each type of building construction.

INSTRUCTOR AND PROGRAM DIRECTOR ATTESTATION:

The attached Fire Safety Inspector course objectives check-offs shall be completed by the student, verified by the certified lead fire instructor and by the charter program director.

We attest that the fire training objectives for the course listed on the cover page of this packet have been met and that all information provided is true and accurate to the best of our knowledge. We hereby give permission to the Ohio Department of Public Safety, Division of Emergency Medical Services to verify any of the above information.

LEAD INSTRUCTOR (PRINT NAME)

LEAD INSTRUCTOR SIGNATURE

X

DATE

PROGRAM DIRECTOR (PRINT NAME)

PROGRAM DIRECTOR SIGNATURE

X

DATE