<p> Incident Qualifications and (Note: this form is to be Certification used only for updating employee records that are Individual Employee Update already established in the IQCS)</p><p>Header Information First Name Employment Kind Last Name (Career, Career Seasonal, Casual Hire, Temporary, Volunteer) Fitness Rating Middle Initial (Arduous, Moderate, Light, None) Employee Number Fitness Date (IQCS #) (MM/DD/YYYY) Group NOT NEEDED UNLESS Org Code (IMT Member and Team name) YOU ARE ON AN IMT IRDP Incident Responder NOT NEEDED AT THIS Unit ID Development Plan TIME (Y/N) Salary plan/Grade OPM Job Code NOT NEEDED (GS, WG,WL, WS, AD, (this can be found on the SF 50) ES, EM) </p><p>Incident Qualification Card (only the jobs you want on your incident qualifications card) Qualified Jobs Trainee Jobs Job Code Job Code Job Code Job Code</p><p>JOB CODE = Four digit code for the job performed (ex.: FFT2 = Firefighter Type 2)</p><p>Training administered within IQCS will automatically be applied to the individual’s record when the course session is completed Employee Training Entry (Documentation Required) Course Code Date Completed (MM/DD/YYYY) Course Code Date Completed (MM/DD/YYYY) EXAMPLE: S190 02/21/04</p><p>Page 1 of 4 EMPLOYEE SIGNATURE DATE</p><p>SUPERVISOR DATE</p><p>EMPLOYEE WILDLAND AND PRESCRIBED FIRE EXPERIENCE Management Job Type of Incident Type or Fire Size Incident Order # Code Incident Arrival Operational Complexity Fuel Type Class Incident Name (Incident (Event Date Periods Level (See (See (Resource Order) Request # Position) Code) MM/DD/YY State (Shifts) (See Below) Below) Below) (Fire code/ Fire number) (EXAMPLE) NM-SNF-0304 FRED (C-1) WF 07/21/00 NM 19 1 B G FFT1 P3EKU8 (EXAMPLE) CA-SNF-0102 WILD (O-21) WF 08/05/01 CA 2 3 T C DIV(T) P5EKT8 (EXAMPLE) CA-SNF-0102 WILD (O-21) WF 08/08/01 CA 4 3 T C FALC P5EKT8</p><p>Fuel Type/ Model # Complexity (select primary ICS Management Types Levels carrier code G-S) Fire Sizes (in acres) A .1 - .25 TYPE A - national area command team assigned TYPE 1 B .26 - 9.9 TYPE 1 - national type 1 team assigned G – Grass/1-3 TYPE 2 C 10 - 99.9 TYPE 2 - regional type 2 team assigned B – Brush/4-7 TYPE 3 D 100 - 299.9 TYPE 3 - extended attack with multiple resources T – Timber/8-10 (For Prescribed E 300 - 999.9 TYPE 4 - initial attack S – slash/11-13 Fires) F 1,000 - 4,999.9 TYPE 5 - initial attack with very few resources G 5,000 +</p><p>Instructor Experience Entry Course Code Course Start Date (MM/DD/YY) Instructor Level IQCS Session # (If Applicable) / Course Location (Training Facility Page 2 of 4 L=lead U=unit Name)/Course Coordinator (if known) EXAMPLE: S390 04/01/04 U 0224/WFTC/JOECOORD </p><p>Page 3 of 4 Task Books</p><p>Initiated, But Not Completed</p><p>Event Code Job Code Initiated Date Example: WF Example: FFT1 Example: MM/DD/YYYY</p><p>Initiated And Completed (1 column per Task Book) Job Code, and Initiated Date Job Code, and Initiated Date Job Code, and Initiated Date</p><p>Example: WF-FFT1 MM/DD/YYYY </p><p>Final Evaluator Final Evaluator Final Evaluator</p><p>Example: Last Name, First Name, Middle Initial Title Title Title</p><p>Example: Station Manager</p><p>Home Unit Home Unit Home Unit</p><p>Example: NMNPA, Northern Pueblos Agency Phone Number Phone Number Phone Number</p><p>Example: 801-354-5678</p><p>Certifier’s IQCS Empl ID (NOT SSN) Certifier’s IQCS Empl ID Certifier’s IQCS Empl ID</p><p>Example: This Person Must Be In The IQCS Data Base Title Title Title</p><p>Example: District FMO</p><p>Home Unit Home Unit Home Unit</p><p>Example: ORWSA, Warm Springs Agency Phone Number Phone Number Phone Number</p><p>Example: 801-456-9875</p><p>Certification Date Certification Date Certification Date</p><p>Example: MM/DD/YYYY</p><p>Page 4 of 4</p>