# Medical Form for Atlantic Police Academy Programs {The physician's examination must be completed within 12 months of the Program Start Date.} | | | |---|---| | Type | 1629822412 | | Size | 94 KB | [Open original PDF →](https://sam.hollandcollege.com/shared/QMS/Forms/QF151-200/QF189-APAMedicalForm.pdf?_ga=2.129706828.136326322.1657823573-1026465707.1629822412) Referenced from: [Health Clinics](/pages/student-experience/index-html/) ## Document text ## Medical Form for Atlantic Police Academy Programs {The physician's examination must be completed within 12 months of the Program Start Date.} Admission/Office of the Registrar 140 Weymouth Street Charlottetown, PE ~ C1A 4Z1 Tel: 902-629-4217 (1-800-446-5265) Fax: 902-629-4239 Applicant Name: Phone No: Address: Month/Year of Birth: / Program (Please check one): - [ ] Police Science (Cadet) - [ ] Sheriff & Public Safety Officer - [ ] Correctional Officer - [ ] Conservation Enforcement This questionnaire is to be completed by a physician following their medical examination of the above applicant. 1. Does the applicant suffer from any physical problems, which would require special consideration? ………… - [ ] Yes - [ ] No 2. Does the applicant suffer from any chronic physical illness? ………… ………… ………… ………… ………… - [ ] Yes - [ ] No 3. Does the applicant suffer from any chronic emotional illness? ………… ………… ………… ………… ………… - [ ] Yes - [ ] No 4. Does the applicant suffer from any communicable disease? ………… ………… ………… ………… ………… - [ ] Yes - [ ] No 5. Does the applicant suffer from any skin disease? ………… ………… ………… ………… ………… ………… - [ ] Yes - [ ] No 6. Does the applicant suffer from allergies? ………… ………… ………… ………… ………… ………… ………… - [ ] Yes - [ ] No 7. Does the applicant suffer from any cardiovascular disease that would require special consideration? ………… - [ ] Yes - [ ] No 8. Does the applicant suffer from any respiratory disease that would require special consideration? ………… - [ ] Yes - [ ] No 9. Does the applicant suffer from any muscular or skeletal disease that would require special consideration? ………… - [ ] Yes - [ ] No 10. Is there any factor not covered by the above questions which would affect the applicant's suitability to successfully complete the above noted program? Note: Please refer to the outline of physical stressors for the programs that are outlined on the reverse side this medical form. ………… - [ ] Yes - [ ] No ## Physician declaration: After completion of an examination of the individual named above, it is my opinion that the 'applicant' is - [ ] Medically Fit, or - [ ] NOT Medically Fit , to undergo a rigorous physical training program with full regard to all the stressors indicated on reverse side of this form. Comments: Date of Examination: Physicians Signature: Physician Contact Information: (Please Print) Physician Name: Business Phone No: Clinic/Office Business Address: ## Note to Physician: 1. The purpose of the information in this medical report is not to exclude the applicant, but rather to ensure that the applicant and the College are aware of any potential health concerns. When appropriate, applicants with health concerns are provided with the opportunity to demonstrate that they can meet the requirements of the program. 2. Please refer to the reverse of this form for acceptance standards for hearing. Also, brief descriptions are included to allow the physician a better understanding of the physical stressors that impact a student while attending an APA program. The personal information requested on this form is collected under the authority of Section 31(c) of the PEI Freedom of Information and Protection of Privacy Act and will be protected under Part 2 of that Act. It will be used to assess the medical fitness of applicants to Atlantic Police Academy programs. If you have any questions about the collection or use of this information, please contact the Chief Privacy Officer at privacy@hollandcollege.com or 902-566-9542, 140 Weymouth St., Charlottetown, PE, C1A 4Z1. ## Information for Physicians Regarding the Physical Requirements of Atlantic Police Academy Programs ## HEARING REQUIREMENTS FOR ALL PROGRAMS LISTED ON THIS FORM - a) Hearing loss no greater than 30 dbs in both ears in the 500 to 6,000 Hz frequency range. - b) Hearing loss no greater than 30 dbs in the better ear in the 500 to 3000 Hz frequency range; - c) Hearing loss no greater than 30 dbs in the worst ear in the 500 to 2900 Hz frequency range, and no more than 50 dbs in the worst ear at 3000 Hz frequency range. ## PHYSICAL STRESSORS OF THE POLICE SCIENCE, SHERIFF & PUBLIC SAFETY OFFICER, CORRECTIONAL OFFICER & CONSERVATION ENFORCEMENT PROGRAMS ## Fitness Training ~ Averaging a minimum of 120 hours for the duration of the program. There is regular weekly strength & cardiovascular training. The program has a strong emphasis on fitness as a necessity to meet the standards in the officer safety skills competencies of training. Fitness standards for this program include running, weight lifting and scoring above 65% in the Cooper Fitness Test. You will also be required to complete the Police Abilities Response Evaluation (PARE) Test with 80 pounds on the push-pull machine in 4 minutes or less. The PARE test simulates the pursuit of a suspect for 6 city blocks, with jumping, stair climbing, & vaulting, a push-pull exercise, which would be necessary to detain, control and restrain the suspect on arrest, followed by a dead lift of 80 pounds, which is carried in a bent arm position for 25 meters. ## Drill ~ Averaging a minimum of 50 hours for the duration of the program. Foot drill in all basic movements stresses the ankles, knees and hips/lower back with inherent twisting & jarring movements. The shoulders and elbows are stressed by the snap & sudden bending movements of saluting and standing-at-ease. The entire activity that is foot drill with the striking of the heel while marching and halting can severely stress the leg joints & jar the whole body. ## Control & Defense Tactics ~ Averaging a minimum of 100 hours for the duration of the program. An essential officer safety & self defense skill. C&DT requires that an above average stress be placed on virtually every part of the body. This includes the hand, fist, & elbow strikes; foot & knee strikes. There are also forced take-downs and handcuffing with virtually every defense & control tactical move which requires a forced and controlled rotation of the hips & lower back. Also key to teaching reflexive response skills such as these are that each movement is repeated as many as 20 times in the fundamental training stage, and then reviewed in every subsequent class throughout the program. ## Patrol Driver Training ~ Averaging a minimum of 100 hours for the duration of the program. Patrol driver training is most stressful during backing up training. A student driver is required to brace their left foot on the floor, extend their right arm and brace their right hand on the top of the front passenger seat or head rest, raise their left hip up & rest it on the arm-rest of the drivers door, turn their head & shoulders 90 degrees to the right so they can look out the back window of the patrol car. Physical stress to all the joints & muscles used in this movement are extreme. They must negotiate all the braking, accelerating, turns, serpentines, slaloms, parking, road-side drop-offs & recovery, and highway turn exercises the same as when driving forward. ## Weapons Training ~ Averaging 33-50 hours over the duration of the program. Firing the pistol is an exercise with the arm extended in front of the body while a pistol weighing about 2 pounds is held in the grasp of their hand. This exercise can be protracted when the arm is not lowered between repeated shots. This requires a level of fitness in the muscles of the shoulder, elbow, arm, and wrist that will enable the student to meet their weapon skill compet ency standards for the program. A recurring physical weakness in weapons training is the student's (trigger) finger strength, and an inability to pull the trigger repeatedly due to a pistol trigger spring pressure as high as 13 psi. ## Fire Extinguisher Training ~ Averaging a minimum of 3 hours for the duration of the program. A student is required to lift in one hand and use a 5 gallon (50 lbs) fire extinguisher, operating it with their opposite hand in an active practical fire setting, extinguishing a fire. ## Traffic Control Training ~ Averaging a minimum of 3 hours for the duration of the program. Traffic control technique requires the sharp and snappy waving of the arms, at shoulder level, in repeated distinctive gestures. Like tennis elbow, a lack of fitness that stretches the ligaments and maintains both strength and flexibility of the muscles & joints may easily result in damage to the shoulder and/or elbow joint. (…page 2) --- Source: [https://sam.hollandcollege.com/shared/QMS/Forms/QF151-200/QF189-APAMedicalForm.pdf?_ga=2.129706828.136326322.1657823573-1026465707.1629822412](https://sam.hollandcollege.com/shared/QMS/Forms/QF151-200/QF189-APAMedicalForm.pdf?_ga=2.129706828.136326322.1657823573-1026465707.1629822412)