In the realm of ensuring the safety and capability of individuals tasked with wildland firefighting, the FS-5100-30 form, revised as of August 2009 and backed by the USDA Forest Service/Department of the Interior, serves a critical function. This document, with its validity underscored by the OMB control number 0596-0164 and an expiration in January 2013, is designed to govern the Work Capacity Test, a cornerstone in assessing the physical readiness of candidates for the arduous responsibilities of fighting wildfires. The form delineates three levels of testing: the Pack Test, categorized as arduous, involving a 3-mile trek carrying a 45-pound pack within 45 minutes; the Field Test, deemed moderate, requiring a 2-mile walk with a 25-pound pack in 30 minutes; and the Walk Test, seen as light, entailing a 1-mile walk to be completed in 16 minutes. Each test level mirrors the physical demands expected on the field, ensuring candidates’ fitness aligns with their prospective duties. Beyond the test descriptions, the form emphasizes the importance of informed consent, highlighting potential risks such as injury and severe health consequences, while advocating for prior training and preparation to mitigate these risks. Furthermore, it encapsulates a commitment to privacy and non-discrimination, aligning with the Privacy Act of 1974 and the Paperwork Reduction Act of 1995, ensuring that the collection and use of personal information are handled with the utmost regard for individual rights and confidentiality.
| Question | Answer |
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| Form Name | Form Fs 5100 30 |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | arduous pack test, work capacity test data sheet, work capacity test for wildland firefighters, work capacity test record |
USDA Forest Service/Department of Interior |
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OMB |
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Work Capacity Test: Informed Consent |
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Pack Test- Arduous The |
Risks |
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pound pack in 45 minutes is strenuous, but no |
There is a slight risk of injury (blisters, sore |
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more so than the duties of wildland firefighting. |
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legs, sprained ankles) especially for those |
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Field |
who have not practiced the test. If you have |
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been inactive and have not practiced or |
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pound pack in 30 minutes is fairly strenuous, |
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trained for the test, you should engage in |
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but no more so than the field duties. |
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several weeks of specific training before you |
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Walk |
take the test. Be certain to warm up and |
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stretch before taking the test, and to cool |
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moderately strenuous, but no more so than the |
down after the test. The risk of more serious |
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duties assig. |
consequences (such as respiratory or heart |
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problems) is diminished by completing the |
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(HSQ) physical activity readiness |
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questionnaire. |
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I have read the information on this form, the brochure “Work Capacity Test” and understand the purpose, instructions, and risks of the job related to work capacity test.
I have read the information, understood, and truthfully answered the HSQ.
Test to be Taken (check one) Pack test
Field Test
Walk Test
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Printed Name
Privacy Statement
The information obtained in the completion of this form is used to help determine whether an individual being considered for wildland firefighting can carry out those duties in a manner that will not place the candidate unduly at risk due to inadequate physical fitness and health. Its collection and use are covered under Privacy Act System of Records
Paperwork Reduction Act Statement
According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is
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