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 document detailing the Tier 4 Health Assessment program for the Phoenix Fire Department Health and Wellness Center, which establishes health evaluation criteria and tier classifications for firefighters. The program categorizes firefighters into four tiers based on annual physical assessments, with Tier 1 representing fitness for duty and Tier 4 indicating removal from operational duty pending wellness intervention. The assessment utilizes three core health metrics: exercise stress testing for cardiac and cardiorespiratory fitness, fasting blood sugar testing, and blood pressure measurements. Tier classifications are determined by specific health parameters, including blood pressure ranges (Tier 1: <120/80 mmHg; Tier 4: >160/100 mmHg), HbA1c blood sugar levels (Tier 1: <6.5; Tier 4: >9), and age-adjusted MET levels for aerobic capacity, with firefighters under age 40 requiring MET levels exceeding 14.0 for Tier 1 status and below 12.0 constituting Tier 4. The program is rehabilitative rather than punitive, with Tier 2 members receiving recommended lifestyle interventions, Tier 3 members requiring mandatory wellness referrals while remaining operationally active, and Tier 4 members mandatorily removed from firefighting operations but offered transitional work assignments or personal leave while pursuing health remediation.
Medical staff at annual comprehensive physicals assign tier classifications, with the Medical Director and health personnel making final removal determinations from operational duty. Firefighters in Tier 4 status due to MET levels between 11.0 and 12.0 may potentially remain operational if no other cardiac disease indicators exist and the designation represents their first Tier 4 assignment, though MET levels below 11.0 or repeat Tier 4 classifications result in immediate removal. Individual decisions consider current situations, conditions, and member rehabilitation efforts, with union approval obtained for the program framework. Contact information for program administration includes the Health Center at 602-495-5797, the Deputy Chief of the Health Center at 602-534-3939, the Transitional Work Assignment Coordinator Angie Baker at 602-534-5337, and the Medical Director at 602-534-8393.
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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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