HomeMy WebLinkAboutAgenda - 03-16-2010 - 4f • 1
ORANGE COUNTY
BOARD OF COMMISSIONERS
ACTION AGENDA ITEM ABSTRACT
Meeting Date: March 16, 2010
Action Agenda
Item No.
SUBJECT: NC State Firemen's and Rescue Squad Annual Certification Roster
DEPARTMENT: Emergency Services PUBLIC HEARING: (YIN) No
ATTACHMENT(S): INFORMATION CONTACT:
Certification Form
Roster Frank Montes de Oca, 919-245-6100
Training Records Database (2) David Sykes, 919-245-6100
PURPOSE: To approve the certification requirements for the life safety branch manager and
staff to participate in the North Carolina State Firemen's Association for the year 2010.
BACKGROUND: The North Carolina State Firemen's Association requires that in order to be
eligible to participate in Association, members must attend thirty-six (36) hours of training in
each calendar year. The Life Safety Branch Manager received one-hundred and fifty-one (151)
hours of training in fire/arson investigations, NC Fire Prevention Code updates, fire behavior,
and emergency medical services. The Fire Training Staff Officer received one-hundred and
sixty-nine (169) hours of training in fire/arson investigations, NC Fire Prevention Code updates,
communications, and emergency medical services. The training received is required to maintain
various certifications held by staff. A training records database of hours and training topics is
included with the agenda abstract.
North Carolina General Statute 58-86-25 requires submission of a complete and certified roster
of eligible staff annually. As the governing body, the Board of County Commissioners must
certify the annual certification roster. The certified roster and minimum training requirements
determine eligibility for benefits through the Association, including line of duty death benefits,
accidental death and dismemberment benefits and participation in the pension fund. The
certification roster is attached and lists two individuals. As an additional point of information,
individual County fire departments submit their own certification rosters based on approval by
their respective boards of directors and signature of approval by the board's president.
FINANCIAL IMPACT: The County provides funding for the costs associated with staff
attending various training classes to maintain certifications and membership in the NC State
Firemen's Association. The cost to attend classes for certification for the branch manager and
staff was approximately $500.
RECOMMENDATION(S): The Manager recommends that the Board approve the certification
roster and authorize the Chair to sign the certification documents.
North Carolina State Firemen's Association 2
323 West Jones Street, Suite 401
Raleigh,NC 27603
1-800-253-4733
2009
ANNUAL CERTIFICATION OF FIREMEN
North Carolina General Statute 58-86-25 requires that all certified fire departments submit a complete roster of
its eligible firemen annually. This certified list determines eligibility for the $50,000 line-of-duty death
benefit as well as eligibility for Pension Fund credit. Failure to accurately and promptly report this
information is violation of G.S. 58-86-25 and will automatically result in a loss or reduction of benefits.
REPORT BY FIRE DEPARTMENT CHIEF
As Fire Department Chief, I have determined that the attached roster is a valid and accurate list of all eligible
firemen, within the definition contained in North Carolina General Statute 58-86-25.
Name of Fire Department _Ou,f c ScdeTy h1a.✓lw,mef\t
Fire Department Mailing Address 9/0 A e ctdouj iand S U i^V-E-
City 56Z7CC'mk State (�'L- Zip Code
Name of Fire Chief
(Please print or type)
Signature of Fire Chief
Al
Date c. �j "z�O Daytime Telephone_c q ff) 15- 6100
County O c ay)l N
CERTIFICATION BY GOVERNING BODY
Pursuant to G.S. 58-86-25, the governing body of a fire department operated by (i) a county is the county board
of commissioners, (ii) a city is the city council, (iii) a sanitary district is the sanitary district board, (iv) a
corporation, whether profit or nonprofit, is the corporation's board of directors and (v) any other entity is that
group designated by the board. Therefore, in our capacity as the governing body of the above-named fire
department, we certify and find that the attached roster is a valid and accurate list of all eligible firemen in
accordance with G.S. 58-86-25.
Name of Governing Body
Name of Governing Body Official
(Please print or type)
Authorized Signature Title
Date Daytime Telephone_(
3
2010 ADDITION/DELETION FORM
To: N C State Firemen's Association c ��
323 West Jones Street, Suite 401 IF T]
Raleigh,NC 27603
B C�j�6t1► ,S luzgncsfa.com or sandie@a,ncsfa.com
Fire Department Name L y {�eLil Telephone (919) 821-2132
51D AAe_c atn-AcAM Toll Free 1-800-253-4733
Address Fax(919) 821-9382
r-
ADDITIONS:
X V I D J'YJ.:�CS-
Name Social Security Number DO 2-1/x--
Phone Number
Address E-mail Address
/// /-,-7
Effective bate
al Female Married Single Paid/Volunteer/Retired
DELETIONS:
/y 7-
Name Name
Name Name
Chief Signature a
You may add one member for each member deleted at no charge. There is a membership fee of$17.00 for all
other members added. You have 30 days to send in membership dues if you fax this information in. It is
understood that no claims will be paid against this New Member until membership dues are received in our
office. After 30 days, if no membership dues are received,this New Member will not be covered.
Department may duplicate this form.
Effective January 1,2010
4
2010 ADDITION/ DELETION FORM
To: N C State Firemen's Association
323 West Jones Street, Suite 401
Raleigh,NC 27603
luzgncsfa.com or sandie@rLicsfa.com
Fire Department Name �_ ,� ,�y 1Y} 'r Telephone (919) 821-2132
51t7 Toll Free 1-800-253-4733
Address Fax(919) 821-9382
ADDITIONS:
Name Social Security Number DOB
Phone Number
Address r E-m Ad ess
0/%t Z
Effective Dad
Male/ emale Married Single ("Paii1 Volunteer/Retired
DELETIONS:
re-, �
Name Name
Name Name
Chief Signature
You may add one member for each member deleted at no charge. There is a membership fee of$17.00 for all
other members added. You have 30 days to send in membership dues if you fax this information in. It is
understood that no claims will be paid against this New Member until membership dues are received in our
office. After 30 days,if no membership dues are received,this New Member will not be covered.
Department may duplicate this form.
Effective January 1,2010
Orange County Firemarshal
Participation Detail by Staff 5
01/01/2009 to 12/31/2009
Staff IDs: SY1KE01
All Stations
All Shifts .
All Units
If staff availability detail is not found, assume staff member is: Don't Use Availability
Training Participation
Include all training classes
Total Staff being Reported: 1
Total Training Classes For Period: 123
'raining Participation Available Attended Percent
staff Id/ Name Cnt Hours Cnt Hours Cnt Hours
>YKE01 Sykes, David 23 151.00 23 151.00 100.00% 100.00%
Date Category Description Hours
* 05/04/2009 FV30 NC IAAI Testing 32.00
* 05/18/2009 EMS43 Bloodborne Pathogens 3.00
* 08/03/2009 FAll Fire Rescue-Class/Certification 16.00
* 09/01/2009 EMS27 BLS Skills Test/Scope of Practice 4.00
* 10/19/2009 FI74 Fire Testing & Codes 2.50
* 10/20/2009 AD06 Quality Management / Assessment / Improv 8.00
* 10/21/2009 FI70 Fire Protection Systems 2.00
* 10/21/2009 FI01 Fire Inspections 1.00
* 10/21/2009 FI01 Fire Inspections 1.00
* 10/27/2009 AD03 Workplace Violence Training 8.00
* 11/05/2009 FI73 Commercial Hood Systems 1.00
* 11/10/2009 AD10 Management Topics 9.00
* 11/12/2009 FI75 Fire Code Administration 2.00
* 11/17/2009 AD10 Management Topics 9.00
* 11/18/2009 FI71 Fire Inspections Upgrade 8.00
* 11/19/2009 FI71 Fire Inspections Upgrade 8.00
* 11/19/2009 FI71 Fire Inspections Upgrade 8.00
* 11/20/2009 IS-015 Special Events Contingency Planning 7.00
* 12/08/2009 AD06 Quality Management / Assessment / Improv 8.00
* 12/10/2009 FA10 Alarm Procedures 0.50
* 12/15/2009 AD06 Quality Management / Assessment / Improv 8.00
* 12/16/2009 CON09 Firehouse Software 4.00
* 12/17/2009 FI72 Sprinkler Systems 1.00
* Denotes Participation
03/03/2010 17:01 Page 1
Orange County Firemarshal
Participation Detail by Staff 6
01/01/2009 to 12/31/2009
Staff IDs: 5600
All Stations
All Shifts
All Units
If staff availability detail is not found, assume staff member is: Don't Use Availability
Training Participation
Include all training classes
Total Staff being Reported: 1
Total Training Classes For Period: 123
'raining Participation Available Attended Percent
taff Id/ Name Cnt Hours Cnt Hours Cnt Hours
i600 Gregory, Elizabeth 38 169.50 38 169.50 100.00% 100.00%
Date Category Description Hours
* 03/31/2009 PQCE ProQA Continuing Education - General 3.00
* 04/26/2009 PQCE ProQA Continuing Education - General 3.00
* 05/27/2009 PQCE ProQA Continuing Education - General 3.00
* 06/23/2009 PQCE ProQA Continuing Education - General 3.00
* 07/26/2009 PQCE ProQA Continuing Education - General 3.00
* 08/23/2009 PQCE ProQA Continuing Education - General 3.00
* 09/28/2009 PQCE ProQA Continuing Education - General 3.00
* 10/19/2009 PQCE ProQA Continuing Education - General 3.00
* 10/19/2009 FI74 Fire Testing & Codes 2.50
* 10/20/2009 AD06 Quality Management / Assessment / Improv 8.00
* 10/21/2009 FI70 Fire Protection Systems 2.00
* 10/21/2009 FI01 Fire Inspections 1.00
* 10/21/2009 FI01 Fire Inspections 1.00
* 10/21/2009 FI01 Fire Inspections 1.00
* 10/26/2009 PRINEM Principles of Emergency Management 8.00
* 10/27/2009 AD03 Workplace Violence Training 8.00
* 11/01/2009 TRTC Terrorism Awareness for Telecommunicator 8.00
* 11/03/2009 HZ01 Hazardous Materials Overview 16.00
* 11/03/2009 CERT Cert Review 2.50
* 11/05/2009 CERT Cert Review 2.50
* 11/05/2009 FI73 Commercial Hood Systems 1.00
* 11/10/2009 AD10 Management Topics . 9.00
* 11/12/2009 INSTR Instructor Class 2.00
* 11/12/2009 FI75 Fire 'Code Administration 2.00
* 11/17/2009 AD10 Management Topics 9.00
* Denotes Participation
03/03/2010 17:00 Page 1
A '
Orange County Firemarshal
Participation Detail by Staff 7
* 11/18/2009 FI71 Fire Inspections Upgrade 8.00
* 11/19/2009 FI71 Fire Inspections Upgrade 8.00
* 11/19/2009 FI71 Fire Inspections Upgrade 8.00
* 11/20/2009 IS-015 Special Events Contingency Planning 7.00
* 11/24/2009 CERT Cert Review 2.50
* 12/02/2009 PQCE ProQA Continuing Education - General 3.00
* 12/08/2009 AD06 Quality Management / Assessment / Improv 8.00
* 12/10/2009 FE01 Portable Fire Extinguishers 2.00
* 12/10/2009 IS-001 Emergency Planning 2.00
* 12/10/2009 FA10 Alarm Procedures 0.50
* 12/15/2009 AD06 Quality Management / Assessment / Improv 8.00
* 12/16/2009 CON09 Firehouse Software 4.00
* 12/17/2009 FI72 Sprinkler Systems 1.00
— — — — — — — — — — — — — — — — — — — — — — — — — —
Participation Summary for: Gregory, Elizabeth
Total Available 38 Total Attended 38 Participation Percentage 100.00%
—3r — — — — — — — — — — — — — — — — — — — — — — — — —
and Total Participation:
Total Available 38 Total Attended 3B Participation Percentage 100.00%
* Denotes Participation
03/03/2010 17:00 Page 2