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HomeMy WebLinkAboutAudit Reports - Public - Fire Department NFPA 1500 Compliance Assessment - 8/14/2024 X Proprietary& Confidential FINAL REPORT City of Glendale FIRE DEPARTMENT NFFA ISUU GUMNLIANCE ASSESSMENT August 14, 2024 Moss Adams LLP 999 Third Avenue, Suite 2800 Seattle, WA 98104 (206) 302-6500 (:D MOSSADAMS This report is intended for the internal use of City of Glendale, and may not be provided to, used, or relied upon by any third parties. Table of Contents I. Executive Summary 1 II. Detailed Report 3 A. Introduction 3 B. Background 3 C. Objectives 3 D. Scope and Methodology 4 III. Non-Compliance Findings and Recommendations 6 A. Chapter 5: Training, Education, and Professional Development 6 B. Chapter 12: Behavioral Health and Wellness Programs 10 Appendix A: NFPA 1500 Compliance Standards Assessed 12 Appendix B: Definitions of Assessment Finding Rankings 17 City of Glendale Fire Department NFPA 1500 Compliance Assessment Report FOR INTERNAL USE OF CITY OF GLENDALE ONLY I. EXECUTIVE SUMMARY The City of Glendale (the City) engaged Moss Adams LLP (Moss Adams)to evaluate the City's Fire Department (the GFD) in compliance with the National Fire Protection Association (NFPA) 1500 Standard on Fire Department Occupational Safety, Health, and Wellness Program, 2021 Edition. NFPA 1500 is recognized as the most comprehensive fire and emergency services consensus standard available to the industry. According to NFPA's website, NFPA delivers information and knowledge through more than 300 consensus codes and standards, research, training, education, outreach and advocacy; and by partnering with others who share an interest in furthering its mission. NFPA's mission is to help save lives and reduce loss with information, knowledge, and passion. The objectives for this compliance assessment were to evaluate whether GFD was compliant with select NFPA 1500 standards from the following chapters: Chapter 5: Training, Education, and Professional Development Chapter 11: Medical and Physical Requirements Chapter 12: Behavioral Health and Wellness Programs To complete this compliance assessment, Moss Adams interviewed GFD employees who were responsible for overseeing the training, education, professional development, medical, physical, and behavioral health departments. We reviewed the activities of each department for Fiscal Year(FY) 2023-2024 against select standards developed by NFPA 1500. Conclusions The following non-compliance findings compares the GFD activities to the standards set forth by the NFPA 1500 for chapters 5 and 12. We did not identify any findings relating to the NFPA 1500 chapter 11 standards that we reviewed. Recommendations are intended to help the GFD ensure compliance with standards set forth by the NFPA 1500. NON-COMPLIANCE FINDINGS AND RECOMMENDATIONS Chapter 5: Training, Education, and Professional Development Medium Risk Finding The GFD did not have a documented risk assessment that determines the appropriate emergency medical capabilities to be available at the training site. 1. Recommendation The GFD should develop a risk assessment that will identify the appropriate emergency medical capabilities to be available at non-live fire training exercises sites to comply with NFPA 1500 Chapter 5 Index 5.6.3. Finding The GFD did not have documented policies and procedures governing the 2. requirements related to their"train the trainer"process prior to becoming a qualified instructor. City of Glendale Fire Department NFPA 1500 Compliance Assessment Report 1 FOR INTERNAL USE OF CITY OF GLENDALE ONLY NON-COMPLIANCE FINDINGS AND - • • Recommendation The GFD should develop a policy and procedure that will require all instructors to be prequalified as instructors before instructing trainings to comply with NFPA 1500 Chapter 5 Index 5.3.8. Chapter 12: Behavioral Health and Wellness Programs Medium Risk Finding The GFD Personnel Records Policy did not include a specific section that address how employee records related to the behavioral health programs will be maintained separate from employee personnel records. 3. Recommendation The GFD should update the Personnel Records Policy to include a policy that will restrict employee behavioral health records from being combined with employee personnel records to comply with NFPA 1500 Chapter 12 Index 12.1.2.3.2. Although the focus of this compliance assessment was to identify opportunities for improvement, it is important to note the areas of commendable operations. The GFD should be commended for the following accomplishments: Commitment to Excellence: Based on our interviews and observations, the GFD continues to strive for greatness by partnering with different entities to ensure their compliance with NFPA 1500 standards. This includes a partnership with Lexipol to develop policies and procedures that are in compliance with NFPA 1500 standards and with Vector/Target Solutions to provide and log trainings that are in compliance with NFPA 1500 standards. Dedicated Employees: The GFD has a lot of team members who have worked for the GFD for a long time, indicating a sense of dedicated and committed team members who share the same values and mission as the GFD. These long-term employees also bring with them the experiences and knowledge needed to ensure compliance with NFPA 1500 standards. Compliance Execution: Based on the testing performed, the GFD appeared to be substantially compliant with the NFPA 1500 standards that we reviewed in part to the two bullets listed above. We would like to thank GFD staff and leadership for their willingness to assist with this project. City of Glendale Fire Department NFPA 1500 Compliance Assessment Report 2 FOR INTERNAL USE OF CITY OF GLENDALE ONLY II. DETAILED REPORT A. INTRODUCTION The City engaged Moss Adams to evaluate the GFD's compliance with select NFPA 1500 standards. We performed interviews and conducted testing to determine whether the GFD met the compliance requirements for select NFPA 1500 standards. This compliance assessment was performed as part of the FY 2024 Annual Audit Plan developed by the City's Independent Internal Audit Program (IIAP). Our compliance assessment was performed between April and August 2024. Please refer to Appendix B for definitions of assessment finding rankings. B. BACKGROUND The GFD serves the community with a variety of resources and services amongst its nine fire stations and the Glendale Regional Public Safety Training Center(GRPSTC). The GFD's services include fire suppression, emergency medical response, hazardous materials response, technical rescue, trainings, and special events. The mission of the GFD is to "make the community safer through innovative fire, medical, and customer services" using its core vision of being fast, caring, innovative, and professional. The GFD utilizes the NFPA 1500 Standard for a few reasons: Compliance with regulations: The NFPA 1500 Standard is recognized as a national consensus standard for fire department occupational safety, health, and wellness. Following the standard helps the GFD comply with applicable regulations and requirements. Best practices: The NFPA 1500 Standard is based on best practices and the latest research in fire department occupational safety, health, and wellness. Following the standard helps the GFD implement effective and evidence-based practices to protect the health and safety of personnel. Risk reduction: The NFPA 1500 Standard is designed to help fire departments identify and mitigate risks associated with fire department operations. Following the standard helps the GFD reduce the risk of injuries, illnesses, and fatalities among personnel. Improved performance: Following the NFPA 1500 Standard can help fire departments improve their overall performance by ensuring that personnel are properly trained, equipped, and prepared to respond to emergencies safely and effectively. Public trust: Following the NFPA 1500 Standard can help fire departments maintain public trust and confidence by demonstrating a commitment to the safety, health, and well-being of personnel. The NFPA Standard applies to all GFD employees who are involved in the occupational safety, health, and wellness functions of the GFD. C. OBJECTIVES This compliance assessment evaluated the GFD's compliance with the NFPA 1500 Standards set forth in the following chapters: City of Glendale Fire Department NFPA 1500 Compliance Assessment Report 3 FOR INTERNAL USE OF CITY OF GLENDALE ONLY Chapter 5: Training, Education, and Professional Development This chapter outlines the requirements for training programs, including the need for initial and ongoing training for all personnel working within the Department. It also addresses the need for specialized training for certain types of incidents, such as hazardous materials incidents and technical rescue operations. The chapter also emphasizes the importance of professional development for fire department personnel. It recommends that fire departments provide opportunities for personnel to attend conferences, workshops, and other training events to enhance their knowledge and skills. In addition, the chapter addresses the need for training and education on health and wellness topics, such as nutrition, physical fitness, and mental health. It recommends that fire departments provide resources and support to help personnel maintain their health and well- being. Chapter 11: Medical and Physical Requirements This chapter emphasizes the importance of medical evaluations for all personnel, including pre-employment medical evaluations, periodic medical evaluations, and medical evaluations following an injury or illness. It also addresses the need for medical evaluations for personnel who may be exposed to hazardous materials or other health hazards on the job. The chapter also outlines the physical fitness requirements for fire department personnel. It recommends that fire departments establish physical fitness standards and develop fitness programs to help personnel maintain their fitness levels. It also addresses the need for fitness assessments and the importance of addressing any physical limitations or injuries that may impact a firefighter's ability to perform their duties. In addition, the chapter addresses the need for medical clearance for duty following an injury or illness. It recommends that fire departments establish protocols for medical clearance and return to duty to ensure that personnel are fully recovered and able to perform their duties safely. Chapter 12: Behavioral Health and Wellness Programs This chapter outlines the requirements for behavioral health and wellness programs, including the need for education and training on mental health topics, such as stress management, depression, and suicide prevention. It also addresses the need for peer support programs and employee assistance programs to provide resources and support to personnel who may be struggling with mental health issues. The chapter also emphasizes the need for confidentiality and privacy in behavioral health and wellness programs. It recommends that fire departments establish policies and procedures to protect the privacy of personnel who seek assistance for mental health issues. In addition, the chapter addresses the importance of addressing substance abuse and addiction among fire department personnel. It recommends that fire departments establish policies and programs to address substance abuse and provide resources and support to personnel who may be struggling with addiction. D. SCOPE AND METHODOLOGY To obtain an understanding of the GFD processes, as it relates to the select NFPA 1500 standards being assessed, we conducted the following procedures: Interviews: We conducted interviews with staff from GFD departments directly related to the areas under review for compliance including the following positions: City of Glendale Fire Department NFPA 1500 Compliance Assessment Report 4 FOR INTERNAL USE OF CITY OF GLENDALE ONLY Assistant Fire Chief(Personnel/Fire Marshals Office/Health and Fitness) Assistant Fire Chief(GRPSTC/Training/Logistics) Deputy Chief(Training) Deputy Chief(Personal Health and Fitness) Deputy Chief(Logistics) Battalion Chief Captain Health and Fitness Coordinator Compliance Testing: For 49 selected compliance requirements across NFPA 1500 chapters 5, 11, and 12, we reviewed documentation, which helped demonstrate compliance with the requirements, including: Organizational charts Policies and procedures Training programs Training certifications Completion of physical requirements Wellness programs Behavioral health flyers Physician evaluation forms We worked with GFD personnel and leadership to obtain the most currently available information for this compliance assessment. See Appendix A for a listing of all 49 compliance requirements reviewed. City of Glendale Fire Department NFPA 1500 Compliance Assessment Report 5 FOR INTERNAL USE OF CITY OF GLENDALE ONLY III. NON-COMPLIANCE FINDINGS AND RECOMMENDATIONS A. CHAPTER 5: TRAINING, EDUCATION, AND PROFESSIONAL DEVELOPMENT Risk Assessment - Emergency Medical Capabilities at Training Sites - Medium Risk Finding The GFD did not have a documented risk assessment that determines the appropriate emergency medical capabilities to be available at the training site. • • . The GFD should develop a risk assessment that will identify the appropriate emergency medical capabilities to be available at non-live fire training exercises sites to comply with NFPA 1500 Chapter 5 Index 5.6.3. Criteria NFPA 1500 Chapter 5 Index 5.6.3 states that"for non-live fire training exercises, fire departments shall conduct a risk assessment to determine the appropriate emergency medical capabilities to be available at the training site." Condition The GFD did not have a process established for documenting a formal risk assessment that determines the appropriate emergency medical capabilities to be available at the training site. Based on discussions with the GFD, they believed they met this requirement by taking into consideration what appropriate resources were needed prior to each drill. Cause The risk assessment to determine the appropriate emergency medical capabilities available at training sites was not completed possibly because the GFD was unaware of this specific requirement. E,f�'eet By not utilizing a formal documented risk assessment process, as required by NFPA 1500 Chapter 5 Index 5.6.3, the GFD has an increased likelihood that training sites for non-live fire training exercises might not have the appropriate emergency medical capabilities available, if needed. Although none of our discussions or testing suggested that training sites did not have the appropriate emergency medical capabilities available, not having the risk assessment in place to determine what emergency medical equipment available increases that risk. A training site without the appropriate medical capabilities might lead to a delayed or inadequate response to aid a firefighter in distress during a non-live fire training exercise. City of Glendale Fire Department NFPA 1500 Compliance Assessment Report 6 FOR INTERNAL USE OF CITY OF GLENDALE ONLY Recommendation The GFD should develop a risk assessment that will identify the appropriate emergency medical capabilities to be available at non-live fire training exercises sites in compliance with NFPA 1500's Chapter 5 Index 5.6.3 standards. This risk assessment process should be formally documented for each non-live fire training exercise and should include the following considerations: Identification of Potential Hazards: The risk assessment should identify potential hazards associated with the training site, such as the risk of falls, exposure to hazardous materials, or other types of injuries. Assessment of the Likelihood and Severity of Potential Hazards: The risk assessment should evaluate the likelihood and severity of potential hazards, taking into account factors such as the type of training being conducted, number of personnel involved, and location and condition of the training site. Evaluation of the Effectiveness of Existing Emergency Medical Capabilities: The risk assessment should evaluate the effectiveness of existing emergency medical capabilities at the training site, such as the availability of first aid kits, automated external defibrillators (AEDs), and trained personnel. Identification of Additional Emergency Medical Capabilities Needed: Based on the assessment of potential hazards and effectiveness of existing emergency medical capabilities, the risk assessment should identify any additional emergency medical capabilities needed at the training site. This may include the need for additional first aid supplies, the presence of an ambulance or other emergency medical services (EMS) personnel on site, or the need for specialized medical equipment or personnel. Development of an Emergency Medical Response Plan: Based on the results of the risk assessment, the GFD should develop an emergency medical response plan that outlines the appropriate emergency medical capabilities to be available at the training site. The plan should include procedures for responding to medical emergencies, such as the activation of EMS personnel or the use of first aid supplies. City of Glendale Fire Department NFPA 1500 Compliance Assessment Report 7 FOR INTERNAL USE OF CITY OF GLENDALE ONLY RESPONSEMANAGEMENT Management We concur with the finding. Agreement Owner Glendale Fire Department Training Division Target Completion This project will be completed by January 30, 2025. Date The Glendale Fire Department Training division is gathering data and best practices for development and implementation of a risk assessment Action Plan and Emergency Medical Response Plan for the appropriate emergency medical capabilities for non-live fire training exercises. Training the Trainer Policies and Procedures — Low Risk FindingThe GFD did not have documented policies and procedures governing the requirements related to their"train the trainer" process prior to becoming a qualified instructor. • • • The GFD should develop a policy and procedure that will require all instructors to be prequalified as instructors before instructing trainings to comply with NFPA 1500 Chapter 5 Index 5.3.8. Criteria NFPA 1500 Chapter 5 Index 5.3.8 states that"all training and exercises shall be conducted under the direct supervision of a qualified instructor." The GFD stated that they met this requirement by having their instructors go through a "train the trainer" process prior to becoming an instructor. We would expect this process to be documented in policies and procedures to capture all requirements and standardize the process for future training sessions. Condition Based on interviews, the GFD utilized a "train the trainer" approach; however, they did not have policies and procedures governing the requirements related to the "train the trainer" process prior to becoming a qualified instructor. Cause Per the GFD, there are no current policies or procedures put in place by the GFD to ensure that instructors are required to be qualified before conducting training. Effect By not having documented policies and procedures for the "train the trainer" process, the GFD has an increased likelihood that some of its trainings might not be conducted by qualified instructors. Although none of our discussions or testing suggested that instructors were unqualified, not having policies and procedures in place to standardize the process increases that risk. Having an unqualified City of Glendale Fire Department NFPA 1500 Compliance Assessment Report 1 8 FOR INTERNAL USE OF CITY OF GLENDALE ONLY instructor lead a training might result in insufficient or incorrect information being passed on to GFD employees. Recommendation The GFD should develop a policy and procedure that will require all instructors to be prequalified as instructors before instructing trainings to comply with NFPA 1500's Chapter 5 Index 5.3.8 standards. This policy and procedure should include the following sections: Definition of a Qualified Instructor: The GFD should define what constitutes a qualified instructor, including the required qualifications, certifications, and experience. Instructor Selection and Assignment: This section should cover selecting and assigning qualified instructors to conduct training and exercises. This should include ensuring that instructors have the necessary expertise and experience to deliver the required training. Instructor Training and Development: This section should cover training and developing qualified instructors, including ongoing professional development and training on new technologies and techniques. Training and Exercise Planning: This section should cover planning and scheduling training and exercises, including the identification of training objectives, development of training materials, and selection of appropriate training methods. Supervision of Training and Exercises: This section should cover direct supervision of training and exercises by qualified instructors. This should include ensuring that instructors are present during all training and exercises and that they are actively engaged in supervising and providing feedback to participants. Evaluation of Training and Exercises: This section should cover evaluating the effectiveness of training and exercises, including the use of feedback from participants and analysis of performance data. This should include a process for identifying areas for improvement and making necessary changes to training programs. RESPONSEF MANAGEMENT Management We concur with the finding. Agreement Owner Glendale Fire Department Training Division The Glendale Fire Department Training Division is currently creating a Target Completion Date policy and procedure related to a process for becoming a "qualified instructor". Action Plan This project will be completed prior to December 31, 2024. City of Glendale Fire Department NFPA 1500 Compliance Assessment Report 9 FOR INTERNAL USE OF CITY OF GLENDALE ONLY B. CHAPTER 12: BEHAVIORAL HEALTH AND WELLNESS PROGRAMS Personnel Records Policy— Medium Risk • The GFD Personnel Records Policy did not include a specific section that address how employee records related to the behavioral health programs will be maintained separate from employee personnel records. • . The GFD should update the Personnel Records Policy to include a policy that will restrict employee behavioral health records from being combined with employee personnel records to comply with NFPA 1500 Chapter 12 Index 12.1.2.3.2. Criteria NFPA 1500 Chapter 12 Index 12.1.2.3.2 states that"member records maintained by a behavioral health program shall not become part of a member's personnel file." Condition During review of the GFD Personnel Records Policy 1018, we did not identify a specific policy that requires behavioral health programs to maintain member records separate from member personnel records. We did note that this policy was in draft form during our review and was not the finalized policy. Cause There are no current policies or procedures put in place by the GFD to ensure that employee records maintained by a behavioral health program shall not become part of an employee's personnel file possibly because the GFD was unaware of this requirement. The GFD is in the process of working with a third-party, Lexipol, to update its policies and procedures, and including a section within the Personnel Records Policy that specifically addresses the separation of behavioral health records may have been missed during the update. Effect By not having documented policies and procedures to comply with NFPA 1500 Chapter 12 Index 12.1.2.3.2, the GFD has an increased likelihood that employees' behavioral health records become comingled with their personnel file. This could compromise the confidentiality and privacy of the employee's health information and could ultimately lead to legal action against the GFD. City of Glendale Fire Department NFPA 1500 Compliance Assessment Report 10 FOR INTERNAL USE OF CITY OF GLENDALE ONLY Recommendation As the GFD works to update its policies and procedures, it should update the Personnel Records Policy to include a policy that explains how the GFD will restrict employee behavioral health records from being combined with employee personnel records to comply with NFPA 1500 Chapter 12 Index 12.1.2.3.2 requirements. This policy should also include who will be responsible for verifying that this information stays separate to help promote accountability. If needed, the GFD should work with the City's Human Resources and Risk Management Department to help verify that these records are maintained separately. RESPONSEMANAGEMENT Management We concur with the finding. Agreement Owner Glendale Fire Department Personnel Division The Glendale Fire Department Personnel Division will update the GFD Records Policy to restrict employee behavioral health records from being Target Completion combined with employee personnel records. The GFD Personnel Date Division will work internally as well as with COG Human Resources to ensure this process is secure and the policy is implemented. Action Plan This plan will be completed by October 25, 2024. City of Glendale Fire Department NFPA 1500 Compliance Assessment Report 11 FOR INTERNAL USE OF CITY OF GLENDALE ONLY APPENDIX A: NFPA 1500 COMPLIANCE STANDARDS ASSESSED For this compliance assessment, we reviewed 49 compliance requirements from NFPA 1500 Chapter 5, 11, and 12. See the table below for each compliance requirement that we reviewed and the results of our assessment. � iTESTING PROCEDURES �Ili Aft AL Chapter 5— Training, Education, and Professional Development 5.1.3 The fire department shall establish training and education programs that provide new members initial training, Obtained evidence of fire academy training proficiency opportunities, and a method of skill and knowledge evaluation for duties assigned to the member prior to completion for sample of three employees. Yes engaging in emergency operations. 5.1.4 The fire department shall restrict the activities of new members during emergency operations until the member has Obtained evidence of fire academy training demonstrated the skills and abilities to complete the tasks expected. completion for sample of three employees. as 5.1.6 The fire department shall provide all members with training and education on the department's written procedures. Obtained evidence of fire academy training completion for sample of three employees and reviewed copy of General Order Policy Yes 202. 5.1.8 The fire department shall provide all members with a documented training and education program that covers all Obtained evidence of fire academy training assigned personal protective equipment(PPE). completion for sample of three employees Yes and reviewed copy of Personal Protective Equipment Policy 914. 5.1.13 All members who are likely to be involved in emergency operations shall be trained in the incident management and Obtained evidence that the emergency accountability system used by the fire department. operations employees were trained in the incident management and accountability Yes system used by the department in quarter one and quarter two of fiscal year 2024. 5.2.2 All driver/operators shall meet the requirements of NFPA 1002. Reviewed the Job Performance Requirements(JPRs)that are used each Yes during quarterly drills to track and monitor driver's qualifications. 5.2.4 All fire officers shall meet the requirements of NFPA 1021. Reviewed a copy of the quarterly training programs/agenda for Fire Officers I-IV provided from June 30, 2023 through Yes April 30, 2024. 5.2.6 All members responding to hazardous materials incidents shall meet the operations level as required in NFPA 472. Reviewed training certificates for sample of Yes five employees. 5.3.1 The fire department shall adopt or develop training and education curriculums that meet the minimum requirements Reviewed a copy of the 24-month training Yes outlined in professional qualification standards covering a member's assigned function. calendar. 5.3.4 The fire department shall provide specific training to members when written policies, practices, procedures, or guidelines Reviewed a copy of the General Order Yes are changed and/or updated. Policy 202. 5.3.7 All live fire training and exercises shall be conducted in accordance with NFPA 1403. Reviewed a copy of the Tower Incident Yes Action Plan. City of Glendale Fire Department NFPA 1500 Compliance Assessment Report 12 FOR INTERNAL USE OF CITY OF GLENDALE ONLY INDEX NFPA 1500 STANDARD TESTING PROCEDURES COMPLIANT? COMMENT 5.3.8 All training and exercises shall be conducted under the direct supervision of a qualified instructor. Attempted to review policies and See Non-Compliance Finding#2. procedures for the GFD's"train the trainer" No process. 5.3.13 All members shall be provided initial and ongoing training in the risks associated with workplace exposure to products of Reviewed the Advanced Cleaning and combustion, carcinogens, contaminants, and other incident-related health hazards. Inspection personal protective equipment Yes logs from July 2023 through June 2024. 5.3.14 The fire department shall provide all members with training and education on behavioral health issues in the fire service Reviewed the Wellness Fitness February to include the importance of addressing behavioral health problems, including, but not limited to,the impact of stigma 2024 Newsletter(Craig Tiger Act associated with behavioral health and how to overcome it, substance use disorder, depression, post-traumatic stress, Information),Wellness Fitness January family and relationship concerns,factors that enhance resilience, suicide prevention, and available resources for 2024 Newsletter, City of Glendale Human Yes behavioral health treatment. Resource Policy No. 505 Drug,Alcohol and Substance Abuse,Wellness Fitness April 2024 Newsletter, Wellness Fitness June 2024 Newsletter 5.4.1 The fire department shall provide specific and advanced training to members who engage in special operations as a Reviewed training certificates for sample of Yes technician. five employees. 5.4.3 Members expected to perform hazardous materials mitigation activities shall meet the training requirements of a Reviewed training certificates for sample of Yes technician as outlined in NFPA 472 and NFPA 1072. five employees. 5.5.1 The fire department shall develop a recurring proficiency cycle with the goal of preventing skill degradation and potential Reviewed the GFD Mid Rise Department for injury and death of members. Training Packet, Forcible Entry Packet, and Yes GFD Save your own Department Training Packet 5.5.2 The fire department shall develop and maintain a system to monitor and measure training progress and activities of its Obtained evidence of training completion for Yes members. sample of three employees. 5.6.3 For non—live fire training exercises,fire departments shall conduct a risk assessment to determine the appropriate Attempted to review a risk assessment for See Non-Compliance Finding#1. emergency medical capabilities to be available at the training site. determining the appropriate emergency No medical capabilities to be available at the training site. Chapter 11 — Medical and Physical Requirements 11.1.2 Members of a fire department shall be evaluated as specified in NFPA 1582, Chapter 7 and meet the medical Reviewed the completed Fire Department requirements specified in NFPA 1582, Chapter 9. Medical Examination for a sample of three Yes employees. 11.1.3 Medical evaluations shall take into account the risks and the functions associated with the individual's duties and Reviewed the completed Fire Department responsibilities. Medical Examination for a sample of three Yes employees. 11.2.1 The fire department shall develop physical performance requirements for candidates and members who engage in Reviewed the completed physical emergency operations. performance requirements developed for Yes candidates and employees in emergency operations for a sample of three employees. City of Glendale Fire Department NFPA 1500 Compliance Assessment Report 13 FOR INTERNAL USE OF CITY OF GLENDALE ONLY INDEX NFPA 1500 STANDARD TESTING PROCEDURES COMPLIANT? COMMENT 11.2.2 Candidates shall be qualified as meeting the physical performance requirements established by the fire department prior Reviewed the completed Fire Department to entering into a training program to become a fire fighter. Medical Examination for a sample of three Yes employees. 11.2.3 Members who engage in emergency operations shall be annually qualified as meeting the physical performance Reviewed the completed physical requirements established by the fire department. performance requirements developed for Yes candidates and employees in emergency operations for a sample of three employees. 11.2.4 Members who do not meet the required level of physical performance shall not be permitted to engage in emergency Reviewed the Fire Department Medical operations. Examination Certification for one employee, which documented that this firefighter was Yes restricted from engaging in emergency operations and entered a performance rehabilitation program. 11.2.5 Members who are unable to meet the physical performance requirements shall enter a physical performance Reviewed the Fire Department Medical rehabilitation program to facilitate progress in attaining a level of performance commensurate with the individual's Examination Certification for one employee, assigned duties and responsibilities. which documented that this firefighter was Yes restricted from engaging in emergency operations and entered a performance rehabilitation program. 11.3.1 The fire department shall establish and provide a health and fitness program that meets the requirements of NFPA 1583 Reviewed the Wellness Program Policy to enable members to develop and maintain a level of fitness that allows them to safely perform their assigned functions. 1021,Wellness Fitness Committee Meeting Yes Minutes for April 2024, and Wellness Fitness May 2024 Newsletter. 11.3.2 The maintenance of fitness levels specified in the program shall be based on fitness standards determined by the fire Reviewed the Wellness Program Policy department physician that reflect the individual's assigned functions and activities and that are intended to reduce the 1021, Wellness Fitness Committee Meeting Yes probability and severity of occupational injuries and illnesses. Minutes for April 2024, and Wellness Fitness May 2024 Newsletter. 11.5.1 The fire department shall actively attempt to identify and limit or prevent the exposure of members to infectious and Reviewed the GO108.01A Infection Control contagious diseases in the performance of their assigned duties. Exposure Protocol and G0108.01 B Yes Infectious Disease Prevention &Disinfection Procedures 11.5.2 The fire department shall operate an infection control program that meets the requirements of NFPA 1581. Reviewed the Target Solutions Training Yes Module. 11.6.1 The fire department shall have an officially designated physician who shall be responsible for guiding, directing, and Reviewed the HeartFit for Duty-Annual Yes advising the members with regard to their health and fitness for various duties. Medical Exam Process. 11.7.1 Fire departments shall establish a process to evaluate the ability of a member to perform essential job functions. Reviewed the HeartFit for Duty-Annual Yes Medical Exam Process. 11.7.2 The process to evaluate the fitness of a member to perform essential job functions shall be conducted by a qualified Reviewed the HeartFit for Duty-Annual Yes person and confirmed by the fire department physician. Medical Exam Process. City of Glendale Fire Department NFPA 1500 Compliance Assessment Report 14 FOR INTERNAL USE OF CITY OF GLENDALE ONLY INDEX NFPA 1500 STANDARD TESTING PROCEDURES COMPLIANT? COMMENT 11.7.3 When a member is determined to be unable to perform the essential job functions,the member shall be provided Reviewed the Fire Department Medical assistance, treatment,or both that is intended to return the member to a condition that will allow him or her to perform Examination Certification for one employee, the essential job functions. which documented that this firefighter was Yes restricted from engaging in emergency operations and entered a performance rehabilitation program. 11.7.4 A member who has been determined to be unable to perform the essential job functions will only be returned to duty Reviewed the Fire Department Medical when the fire department physician has confirmed that the member can perform the essential job functions. Examination Certification for one employee, which documented that this firefighter was Yes restricted from engaging in emergency operations and entered a performance rehabilitation program. Chapter 12 - Behavioral Health and Wellness Programs 12.1.1.1 The behavioral health program shall at a minimum include the capability to provide diagnostic assessment, short-term Reviewed the Professional Service counseling, crisis intervention, and referral for the following behavioral health and personal problems that could Agreement between City of Glendale and a adversely affect the member, as well as fire department work performance: healthcare consultant.,who provided (1)Substance use disorder behavioral health services. (2)Anxiety (3)Depression (4)Suicidality Yes (5)Potentially traumatic events (6)Acute stress reactions (7)Grief (8)Financial problems (9)Relationship and/or family problems 12.1.1.2 Behavioral health programs that include a peer support component shall ensure that peers are provided with the Reviewed the Critical Incident Stress knowledge and skills to provide support, educate members about behavioral health, serve as a bridge to behavioral Management Policy 1023. Yes health programs and community resources, and build or enhance their peer support programs. 12.1.2.1 The fire department shall adopt and follow clear written policies regarding alcoholism, substance use disorder, and other Reviewed the Drug and Alcohol-Free Yes behavioral conditions that can adversely affect performance or fitness for duty, or both. Workplace Policy 1027. 12.1.2.2 Confidentiality of Behavioral Health Information. Reviewed the Patient Medical Record Security and Privacy Policy 803, Personnel Records Policy 1018, and Health Insurance Yes Portability and Accountability Act(HIPPA) Policy. 12.1.2.3 The fire department shall adopt and follow clear,written policies consistent with applicable statutes, regulations,and Reviewed the Patient Medical Record standards respecting records, confidentiality, data gathering and reporting, and protection and release of privileged Security and Privacy Policy 803, Personnel Yes information related to its behavioral health program. Records Policy 1018, and HIPPA Policy. 12.1.2.3.1 These policies shall identify to whom and under what conditions information can be released and what use, if any, can Reviewed the Patient Medical Record be made of records for purposes of research, program evaluation, and quality assurance. Security and Privacy Policy 803, Personnel Yes Records Policy 1018, and HIPPA Policy. City of Glendale Fire Department NFPA 1500 Compliance Assessment Report 15 FOR INTERNAL USE OF CITY OF GLENDALE ONLY INDEX NFPA 1500 STANDARD TESTING PROCEDURES COMPLIANT? COMMENT 12.1.2.3.2 Member records maintained by a behavioral health program shall not become part of a member's personnel file. Reviewed the Patient Medical Record See Non-Compliance Finding#3. Security and Privacy Policy 803, Personnel No Records Policy 1018, and HIPPA Policy. 12.1.5 Members shall be permitted to utilize accrued leave, including medical leave, or be assigned alternate duty where Reviewed Sick Leave Policy 1046. Yes possible,to access behavioral health services. 12.2.1 The wellness program shall provide prevention strategies and health promotion activities related to identified risk factors Reviewed the Wellness Program Policy for fire fighter health and safety. 1021,Wellness Fitness Committee Meeting Yes Minutes for April 2024, and Wellness Fitness May 2024 Newsletter. 12.2.3 The fire department shall develop a policy on the use of tobacco products for all members. Reviewed the Smoking and Tobacco Use Yes Policy 1026. 12.2.3.1 The fire department shall provide a smoking/tobacco use cessation program to incumbent tobacco users that is Reviewed the Tobacco Cessation Program Yes nonpunitive and operates with short-term and long-term goals. from 2021. 12.2.3.2 The fire department shall develop a policy that candidates be tobacco-free upon appointment and throughout their Reviewed the Smoking and Tobacco Use Yes length of service to the department. Policy 1026. 12.2.3.3 Members shall not use tobacco products inside the worksite,within or on fire department apparatus, or inside training Reviewed the Smoking and Tobacco Use Yes facilities. Policy 1026. 12.2.3.4 The fire department shall develop and implement SOP/Gs to provide strategies to manage the effects of acute and Reviewed the Wellness Fitness May 2024 Yes chronic sleep and circadian rhythm disruption that lead to sleep deprivation,fatigue, and other adverse health effects. Newsletter. City of Glendale Fire Department NFPA 1500 Compliance Assessment Report 16 FOR INTERNAL USE OF CITY OF GLENDALE ONLY APPENDIX B: DEFINITIONS OF ASSESSMENT FINDING RANKINGS We utilized the City IIAP's risk rankings, presented below, and assigned rankings based on our professional judgment. A qualitative assessment of high, medium, or low helps to prioritize implementation of corrective action as shown in the following table. Critical control deficiencies that expose the City to a high degree of combined risks. Recommendations from high-risk findings should be implemented HIGH immediately (preferably within three months)to address areas with the most significant impact or highest likelihood of loss, misappropriation, or damage related to the City's assets. Represents less than critical deficiencies that expose the City to a moderate degree of combined risks. Recommendations arising from medium risk MEDIUM findings should be implemented in a timely manner(preferably within six months), to address moderate risks and strengthen or enhance efficiency in internal controls on areas with moderate impact and likelihood of exposure. Represents low risk or control deficiencies and the exposure is not likely to expose the City and its assets to significant losses. However, they should be LOW addressed to improve efficiency and effectiveness of operations. Recommendations arising from low-risk findings should be implemented within 12 months. City of Glendale Fire Department NFPA 1500 Compliance Assessment Report 17 FOR INTERNAL USE OF CITY OF GLENDALE ONLY P� MOSSADAMS