Pack
Test–Arduous The
3-mile test with a 45 pound pack in 45 minutes is strenuous, but
no more so than the duties of wildland firefighting.
Field
Test–Moderate The
2-mile test with a 25 pound pack in 30 minutes is fairly
strenuous, but no more so than the field duties.
Walk
Test–Light
The 1-mile walk in 16 minutes is moderately strenuous, but no
more so than the duties assigned.
Risks
There
is a slight risk of complications from participating in this
test, including injuries (blisters, sore legs, sprains) but also
heart attack, rhabdomyolysis, compartment syndrome, heat
illness, and possibly death. If you have been inactive and have
not practiced or trained for the test, you should engage in
several weeks of specific training before you take the test. Be
certain to warm up and stretch before taking the test, and to
cool down after the test. By completing theHealth
Screening
Questionnaire and/or a physical exam, the potential risk of
serious consequences is reduced.
I
have read the information on this form and in the brochure “Work
Capacity Test”, understood and truthfully answered the
Health Screening Questionnaire (if applicable), and understand
the purpose, instructions, and risks of the job related to work
capacity test.
Test
to be Taken (check one) Pack test Field
Test Walk Test
Signature Date
Printed
Name
Privacy
Statement
The
information obtained in the completion of this form is used to
help determine whether an individual being considered for
wildland firefighting can carry out those duties in a manner that
will not place the candidate unduly at risk due to inadequate
physical fitness and health. Its collection and use are covered
under Privacy Act System of Records OPM/Govt-10 and are
consistent with the provisions of 5 USC 552a (Privacy Act of
1974).
Paperwork
Reduction Act Statement
According
to the Paperwork Reduction Act of 1995, an agency may not conduct
or sponsor, and a person is not required to respond to a
collection of information unless it displays a valid OMB control
number. The valid OMB control number for this information
collection is 0596-0164. The time required to complete this
information collection is estimated to average 5.5 minutes per
response, including the time for reviewing instructions,
searching existing data sources, gathering and maintaining the
data needed, and completing and reviewing the collection of
information. The U.S. Department of Agriculture (USDA) prohibits
discrimination in all its programs and activities on the basis of
race, color, national origin, gender, religion, age, disability,
political beliefs, sexual orientation, and marital or family
status. (Not all prohibited bases apply to all programs.)
Persons with disabilities who require alternative means for
communication of program information (Braille, large print,
audiotape, etc.) should contact USDA’s TARGET Center at
202-720-2600 (voice and TDD). To file a complaint of
discrimination, write USDA, Director, Office of Civil Rights,
1400 Independence Avenue, SW, Washington, DC 20250-9410 or call
(800) 975-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal
opportunity provider and employer.