APPENDIX 5: DOCTORS MEDICAL ASSESSMENT RESULT
(Rural Fire Authority postal address)
Fitness for Fire-Fighting Duties Report
I have assessed (Firefighter name):______________________________________________________
DOB:_____________________________________________
And do not know of any medical condition that would endanger his/her health while firefighting or prevent him/her from
undertaking a task-based fitness assessment in the form of a pack test, at this time, for the following fitness level:
High
Moderate
Low
OR:
I have advised the candidate, due to medical risk, not to undertake any task based assessment in the form
of a Pack Test at this time.
Name:______________________________________________________________
(Doctor)
Signed:_____________________________________________________________
(Doctor)
Date:_______________________________________________________________
Please return this form to the Rural Fire Authority