Professional Firefighter Program Vision Examination
{The Ophthalmologist/Optometrist ‘s examination must be completed within 12 months prior of the Program Start Date.}
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Referenced from: Professional Firefighter
Document text
Section titled “Document text”Professional Firefighter Program Vision Examination
Section titled “Professional Firefighter Program Vision Examination”{The Ophthalmologist/Optometrist ‘s examination must be completed within 12 months prior 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:
NOTE TO APPLICANT:
Section titled “NOTE TO APPLICANT:”-
PLEASE ENSURE ALL AREAS ARE FULLY COMPLETED
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All expenses relating to this examination are the responsibility of the applicant.
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Submit completed form with your application.
VISION REQUIREMENTS FOR APPLICANTS
Section titled “VISION REQUIREMENTS FOR APPLICANTS”Note: The vision standards are based on the National Fire Protection Association (NFPA) 1582 - 2022 Standard on Comprehensive Occupational Medical Program for Fire Departments. (a copy of this document can be viewed on the NFPA website)
Category A Medical Condition
Section titled “Category A Medical Condition”(An applicant with any medical condition falling under Category A is NOT MEDICALLY FIT to apply.)
Condition is Present
- 4.1 Far visual acuity worse than 20/40 binocular when corrected with contact lenses or spectacles, or for wearers of hard contacts or spectacles the uncorrected (when not wearing contacts or spectacles) far visual acuity is worse than 20/100 binocular.
Note: Successful long-term soft contact lens wearers (i.e., 6 months without a problem) are not subject to the uncorrected standard.
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Yes
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No
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4.2 Color perception - monochromatic vision resulting in inability to use imaging devices such as thermal imaging cameras.
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Yes
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No
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4.3 Any eye condition that results in the candidate not being able to safely perform one or more of the essential job tasks.
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Yes
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No
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4.4 Monocular vision.
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Yes
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No
Category B Medical Condition
Section titled “Category B Medical Condition”(An applicant who presents with any medical condition falling under Category B may be considered MEDICALLY FIT ONLY if they can perform the essential job tasks without posing a significant safety and health risk to themselves, members or civilians.)
Condition is Present
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5.1 Diseases of the eye such as retinal detachment, progressive retinopathy, or optic neuritis. (*see Note)
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Yes
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No
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5.2 Ophthalmological procedures such as radial keratotomy, Lasik procedure, or repair of retinal detachment. (*see Note)
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Yes
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No
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5.3 Peripheral vision in the horizontal meridian of less than 110 degrees in the better eye or any condition that significantly affects peripheral vision in both eyes
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Yes
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No
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5.4 Amblyopia
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Yes
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No
*Note: Sufficient time (approximately 2 weeks for radial keratotomy and Lasik-type surgeries, and 3 months for retinal detachment) must have passed to allow stabilization of visual acuity and to ensure that there are no post-surgical complications.
Ophthalmologist/Optometrist’s declaration:
Section titled “Ophthalmologist/Optometrist’s declaration:”After completion of an examination of the individual named above, it is my opinion that the ‘applicant’ is cleared for firefi ghting training and the performance of a firefighter’s essential job tasks (see back of this form for a list of the NFPA 1582 Firefighter’s Essential Job Tasks).
Comments:
Date of Examination:
Ophthalmologist/Optometrist’s Signature:
Ophthalmologist/Optometrist’s Contact Information: (Please Print)
Section titled “Ophthalmologist/Optometrist’s Contact Information: (Please Print)”Name:
Business Phone No:
Clinic/Office Business Address:
Firefighter’s Essential Job Tasks
Section titled “Firefighter’s Essential Job Tasks”(NFPA 1582 - 2022 -Chapter 5)
- Wearing personal protective equipment (PPE) and self-contained breathing apparatus (SCBA) while performing firefighting tasks (e.g., hose line operations, extensive crawling, lifting and carrying heavy objects, ventilating roofs or walls using power or hand tools, forcible entry), rescue operations, and other emergency response actions under stressful conditions, including working in extremely hot or cold environments for prolonged time periods
- Wearing the respirators required by the jurisdiction (e.g., N-95, half-face elastomeric, PAPR, SCBA), which includes a demand-valve-type positive-pressure facepiece or filter respirator, achieving a successful fit-test and tolerating increased respiratory workloads
- Exposure to toxic fumes, irritants, particulates, biological (i.e., infectious) and nonbiological hazards, or heated gases, despite the use of PPE and SCBA
- Climbing at least six flights of stairs or walking a similarly strenuous distance and incline in jurisdictions without tall buildings while wearing PPE and SCBA, commonly weighing 40 -50 lb (18 -23 kg) and carrying equipment/tools weighing an additional 20 -40 lb (9 -18 kg)
- Wearing PPE and SCBA that is encapsulating and insulated, which will result in significant fluid loss that frequently progresses to clinical dehydration and can elevate core temperature to levels exceeding 102.2°F (39°C)
- Working alone while wearing PPE and respirators required by the jurisdiction, searching, finding, and rescuedragging or carrying victims to safety in hazardous conditions and low visibility
- While wearing PPE and SCBA, advancing water-filled hose lines up to 1 3/4 in. (45 mm) in diameter from fire apparatus to occupancy [approximately 150 ft (50 m)], which can involve negotiating multiple flights of stairs, ladders, and other obstacles
- While wearing PPE and SCBA, climbing ladders, operating from heights, walking or crawling in the dark along narrow and uneven surfaces that might be wet or icy, and operating in proximity to electrical power lines or other hazards
- Unpredictable, prolonged periods of extreme physical exertion as required by emergency operations without benefit of a warm-up period, scheduled rest periods, meals, access to medication(s), or hydration
- Operating fire apparatus or other vehicles in an emergency mode with emergency lights and sirens
- Critical, time-sensitive, complex problem solving during physical exertion in stressful, hazardous environments, including hot, dark, tightly enclosed spaces, that is further aggravated by fatigue, flashing lights, sirens, and other distractions
- Ability to communicate (i.e., give and comprehend written or verbal orders) while wearing PPE and respirators required by the jurisdiction under conditions of high background noise, poor visibility, and drenching from hose lines or fixed protection systems (e.g., sprinklers)
- Functioning as an integral component of a team, where sudden incapacitation of a member can result in mission failure or in risk of injury or death to members of the public or other team members
- Working in shifts, including during nighttime, that can extend beyond 12 hours
- Performing emergency medical service (EMS) tasks, such as cardiopulmonary resuscitation (CPR) or lifting or moving patients, while wearing PPE and respirators required by the jurisdiction
Source: NFPA1582-2022
*NFPA (National Fire Protection Association), 1 Batterymarch Park, Quincy, MA 02269-9101