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Injury Forms

Clinicians Return to Work Form

Firefighting is a dynamic and physically challenging activity and all members must be fully capable to do their job safely and effectively.  To that end, it is imperative that all members be able to perform the necessary job functions without restrictions that may affect the safety of themselves or others on their crew.  The following list of essential job functions is taken from NFPA 1582, Standard on Comprehensive Occupational Medical Program for Fire Departments, 2013 Edition, to guide the physician in evaluating the ability of a member with specific medical conditions to perform specific job tasks.

This form ensures the Fire Department that it has a clear understanding of the types of restrictions you may have placed on the firefighter.  Please check all boxes appropriately and sign below.  Return this form to the firefighter.  Questions can be directed to your Fire Department Human Resources Manager.
Clinicians Return to Work Form Download


PAT LAB Protocol

(Some departments/districts may vary)
PAT LAB Protocol PDF Download