Individual_Employee_Training_Verification_Form.pdf

INDIVIDUAL EMPLOYEE TRAINING VERIFICATION FORM

Interagency Water Handling Agreement Region 5

Employee Name:

Government Issued Photo Identification Verified (e.g. Driver’s License, Passport, etc.)

Y __________________

Qualified ICS Position:

Pack Test (Arduous) Completion Date: ________________ Time:______________

CDL with tank endorsement if required, verify Y ________ N________

Contractor/Company: Hiring Date:

WILDLAND FIRE COURSES & POSITION TASK BOOKS (PTB) COMPLETED

(Certification of Training Must Be In Employee's Training File)

ICS

Position

Required Course/PTB Month & Year Of Training Or PTB

Completed

Instructor, Institution or PTB Certifier

Location &/or Phone # of Instructor, Institution or

Certifier

Firefighter II S-130

FFT2 S-190

I-100 (1/06+) L-180 (1/06+)

Firefighter I S-131*

FFT1 S-133* (1/06-9/16)

PTB

Engine Boss ICS-200 (10/12+)

ENGB S-230 (3/99+)

S-290

PTB

All Positions (except WTOP)

IS-700a

All Positions

(FFT2, FFT1,

ENGB, WTOP)

RT-130 Annual Fireline Safety Refresher

Wildland Fire Experience (List the Previous 5 Years Wildland Fire Experience)

YEAR POSITION INCIDENT NAME LOCATION (City & Agency) Fire Size (Acres)

Number of Days

Worked

Signature of Contractor (or representative) Contractor/Representative (Print Name) Phone Number Date of Submission

* From 1/06 to 9/30/16, FFT1 required training included both S-131 and S-133. Beginning on 10/1/16, only the S-131 course material dated September 2016 is required and S-133 and the earlier version of S-131 are discontinued.