EXHIBIT_D_-_Tier_4_Health_Assessment.pdf
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- Solicitation number
- RFP PS-26-0128
- Issued by
- Maricopa County, Phoenix City, Arizona
About this file
This is an Exhibit D file defining the Tier 4 Health Assessment program for the Phoenix Fire Department's Health and Wellness Center, which categorizes firefighters into four health tiers based on annual physical assessments. The program is rehabilitative in nature, designed to track member health and return non-fit-for-duty personnel to operational status. Tier placement is determined by three assessment components: exercise stress testing to evaluate cardiac health and cardiorespiratory fitness using validated assessment tools, fasting blood sugar testing, and blood pressure measurements. Tier 1 represents minimal health parameters required for field conditioning (fit-for-duty status), Tier 2 indicates declining health parameters requiring lifestyle interventions, Tier 3 mandates mandatory wellness and fitness intervention without immediate removal from operational duty, and Tier 4 results in removal from firefighting operations and mandatory wellness intervention. Health parameters for tier assignment include blood pressure ranges from less than 120/80 (Tier 1) to greater than 160/100 (Tier 4), blood sugar and HbA1c levels ranging from less than 140 and 6.5 respectively (Tier 1) to greater than 210 and 9 (Tier 4), and age-adjusted METs levels with Tier 4 thresholds below 12.0 for all age groups, though firefighters with MET levels between 11.0 and 12.0 may remain in operational duty if there are no other clinical indicators of cardiac disease and it is their first Tier 4 designation.
The program clarifies that any single Tier 4 classification in measured health categories, except body fat percentage, results in overall Tier 4 status. Medical staff at the Health and Wellness Center assign tier levels during annual comprehensive physicals, with the Medical Director making final determinations regarding removal from operational duty. Tier 4 members are offered transitional work assignments based on department needs and individual limitations, or may elect to take personal leave. The program has received union approval and emphasizes individualized decision-making that considers current conditions and efforts, with the goal of maintaining member health and safety while facilitating return to firefighting operations. Contact information is provided for the Health Center, Deputy Chief, Transitional Work Assignment Coordinator, and Medical Director for member inquiries regarding tier status and support services.
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TieredProgramDefined Nov2025.doc Page 1 of 3 Updated: November 2025
Health & Wellness Center
The Tier 4 Health Assessment
The Tier 4 Health Assessment is a program that places members in a category or tier based on their annual physical assessment. Historically, we have always removed people from operational duty if we saw something during their physical that was unhealthy, dangerous, or physically limiting. These not-fit-for-duty members were prescribed rehabilitation methods with the goal of returning them back to operational duty as soon as possible. This program is rehabilitative, not punitive.
Currently, we now place members in one of four tiers to better track and assess their health. These are:
Tier 1: Minimal health parameters to which Phoenix Fire Department members should maintain for field conditioning. What does this mean? You are fit-for-duty.
Tier 2: Health issues noted where interventional support or change is recommended. What does this mean? Some of your health parameters are starting to decline when compared to previous health physicals. It’s recommended that you reverse this trend and stay healthy.
Tier 3: Health issues sufficient for mandatory referral for wellness/fitness intervention, but removal from operational duty is not yet required. What does this mean? Noticeable health parameters have declined compared to previous physicals and/or are in unhealthy ranges. You need to participate in a program to resolve your health issues.
Tier 4: Health issues sufficient enough to mandate removal from operational duty and mandatory referral for wellness/fitness intervention. What does this mean? You are not fit-for-duty, thus not cleared to work in the firefighting field. We will help you resolve your health issues and return you to the firefighting field as soon as possible.
The three items of the Tier Program are:
Exercise stress test to assess cardiac health and cardiorespiratory fitness using an empirically validated assessment tool.
Blood sugar testing during a fasting state Blood pressure.
TieredProgramDefined Nov2025.doc Page 2 of 3
Health Parameters for Firefighters With Tier Levels to Assess Need for Health/Wellness Intervention
Based on the most recent medical information and assessment of firefighter health parameters, the Tier levels have been adjusted as follows:
Health Standards
Tier 1 Tier 2 Tier 3 Tier 4
Blood Pressure < 120/80 120/80 – 139/89 140/90 – 159/99 > 160/100
Blood Sugar HbA1c
< 140 < 6.5
141-179 6.5-8.0
180-210 8.0-8.9
> 210 > 9
** If sugar and HbA1c indicate different Tier’s, the HbA1c will determine Tier status.
Age adjusted MET’s level expected of fire members for Tier Management
Age Range Tier 1 Tier 2 Tier 3 Tier 4
< 40 > 14.0 13.0-13.9 12.0-12.9 < 12.0***
40-49 > 13.5 12.7-13.5 12.0-12.6 < 12.0***
50+ > 13.0 12.4-13.0 12.0-12.3 < 12.0***
*** Firefighters may be immediately removed from operational duty for MET levels below 11.0, or if the member is a repeat Tier 4 level for any reason. Members with a MET level between 11.0 and 12.0 may be considered for remaining in operational duty, provided there are no other clinical indications of cardiac disease, and it is the first time designated a Tier 4.
See Frequently Asked Questions on page 3.
TieredProgramDefined Nov2025.doc Page 3 of 3
FAQ’s
What if I’m in Tier 4 for one thing and Tier 1 for everything else?
Apart from body fat percentage, levels in any Tier 4 category will make you a Tier 4 candidate.
What if I’m Tier 4 in only Body Fat percentage, and everything else is OK?
Elevated Body Fat percentage alone does not mandate removal from active duty.
What do I need to do to based on my Tier category?
Tier 1 - Keep up the good work.
Tier 2 - Participate in some lifestyle changes.
Tier 3 - Intervention is required based on the medical recommendation.
Tier 4 - Follow the medical requirements prescribed to return to operational duty as quickly as possible.
Who decides what Tier I am in?
The medical staff at your annual comprehensive physical will assess your health and will assign you a Tier number.
Who will remove me from the field?
The same medical staff, along with the Medical Director will ultimately decide to remove you from operational duty in firefighting operations.
Where will I work while in Tier 4?
We will work to try and find you a Transitional Work Assignment, or you can choose to take personal leave. You will be assigned to temporary transitional work based on department needs and your limitations.
Is the Union on-board with this?
Yes.
Please note that all decisions are made on an individual basis by our health staff. Current situations, conditions and efforts are taken into consideration with the goal of not mandating removal from operational duty, or firefighting operations. We would like to see everyone healthy and safe, and it is our goal to help you get there and stay there.
If you have any questions, you can call the Health Center at 602-495-5797 or our health staff directly:
Deputy Chief of the Health Center - 602-534-3939 Transitional Work Assignment Coordinator-Angie Baker 602-534-5337 Medical Director - 602-534-8393
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