1. #1
    MembersZone Subscriber

    Join Date
    Dec 2002

    Default Looking for medical form

    I am looking for a form that needs to be filled out before entry into hot zone. A medical pre entry form or something like that.

  2. #2
    Forum Member

    Join Date
    Nov 2006
    N. Ridgeville, Ohio


    While I do not have it in the form format, here is what is on our forms. This is from our SOP's

    Medical Screening Prior to use of Chemical Protective Clothing
    1) All personnel selected for work in chemical or thermal protective
    clothing, including the entry, back-up and decon teams shall be
    screened by the Haz-Mat Medical Officer prior operations. Screening
    shall include:
    a) Time of examination
    b) Resting Pulse Rate
    c) Resting Respiratory Rate
    d) Resting Blood Pressure
    e) Oral Body Temperature
    f) Body Weight
    g) Insure adequate hydration with water or Gatorade.
    2) The following guidelines shall be used by the Entry Officer, Medical
    Officer and Safety Officer in making decisions about the medical
    suitability of team members to work in chemical or thermal protective
    equipment in order to work on the entry, back-up or decon team.
    a) Any member who has any of the following conditions during
    medical screening shall not be permitted to serve on an entry or
    back-up team, and should not perform "suit-work":
    (1) Pulse Rate Greater than 100
    (2) Blood Pressure Systolic less than 100
    Systolic greater than 150
    Diastolic greater than 100
    (3) Respiratory Rate Less than 12 or Greater than 28
    (4) Oral Temperature Equal to or greater than 100 degrees
    (5) Skin Rashes or open wounds
    (6) Lung Sounds Wheezing/rales
    (7) ECG Abnormal Arrhythmia
    (8) General Nausea/Vomiting/Diarrhea
    within past 24 hours
    (9) Medications Any taken in past 24 hrs
    (10) Alcohol Any in past 12 hours
    (11) Hydration Inability to prehydrate
    with 8-16 oz of water
    Jason Brooks
    IAFF Local 2388

  3. #3
    Forum Member

    Join Date
    Mar 2007
    Pine Bluff, AR.


    Trav, email me and I will send you our pre and post entry form.

  4. #4
    MembersZone Subscriber

    Join Date
    Aug 2008

    Default Looking for medical form

    We currently only take entry and post entry vitals signs. All of our Haz Mat team members have yearly physicals with baseline vitals. We currently do not have any high vital sign bench marks for entry into any IDLH atmoshpheres. We reley on personal judgement on whether entry will be made. We do have a rehab unit that responds but may not arrive before our team enters.

  5. #5
    MembersZone Subscriber

    Join Date
    Mar 2004


    Try this: Hit read only if it comes up.
    Entry Personnel Exam.doc

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