safety codes council sco certification nfpa certification ... · jan 2020 safety codes council sco...
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Page 1 of 21 Jan 2020
Safety Codes Council SCO Certification NFPA Certification
Group A none
Group B Level 1 1031 Inspector Level I
Group B Level 2 1031 Inspector Level II
Group C Level 1 none
Group C Level 2 1033 Investigator
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Page 3 of 21 Jan 2020
Print clearly. Do NOT use initials.
Candidate’s last name First name Department
PROCEDURES
DECLARATION
I, _____________________________________, understand that failure to follow these instructions and/or engaging in plagiarism/dishonesty may result in the suspension from the Safety Codes Council’s certification program.
_____________________________________________ _____________________________________
Signature Date
Collection of personal information is necessary to support the certification and accreditation programs of the Safety Codes Council. The collection is authorized under
Section 33(c) of the Freedom of Information and Protection of Privacy Act and will be managed in accordance with the Act. Questions? Contact the manager, policy
and legislation, at the Council (780-413-0099).
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Practicum supervisor’s last name
First name
Email Phone
Training host
PROCEDURES AND DECLARATION
o
o
DECLARATION
I, ______________________________________________________, have complied with the procedures and expectations listed above. I understand that failure to follow these procedures may result in my being suspended as practicum supervisor for the Safety Codes Council.
_____________________________________________ _____________________________________
Signature Date
Collection of personal information is necessary to support the certification and accreditation programs of the Safety Codes Council. The collection is authorized under
Section 33(c) of the Freedom of Information and Protection of Privacy Act and will be managed in accordance with the Act. Questions? Contact the manager, policy
and legislation, at the Council (780-413-0099).
Page 5 of 21 Jan 2020
Candidate’s name Practicum supervisor’s name
Type of occupancy Date of inspection
Street address or GPS coordinates of inspected site
Owner Phone or email
STANDARD:
Competent
YES NO
5.3.1 Max. Occupant Load
THE ABILITY TO USE MEASURING TOOLS, READ PLANS, AND USE A CALCULATOR TO CALCULATE OCCUPANT LOADS
IDENTIFY OCCUPANCY FACTORS RELATED TO VARIOUS OCCUPANCY CLASSIFICATIONS
5.3.2 Occupancy Classifications
5.3.3 Verify Building Construction and Classification
THE ABILITY TO IDENTIFY CHARACTERISTICS OF EACH TYPE OF BUILDING CONSTRUCTION AND OCCUPANCY CLASSIFICATION
5.3.4/5.4.4 Fire Protection Systems
THE ABILITY TO RECOGNIZE PROBLEMS, USE CODES AND STANDARDS, READ REPORTS, READ PLANS, AND READ SPECIFICATIONS
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Competent
YES NO
o
o
o
o
o
o
5.3.5 Means of Egress
THE ABILITY TO CALCULATE EGRESS REQUIREMENTS AND READ PLANS
o
o
o
o
o
o
o
o
o
o
o
O
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Competent
YES NO
MAKE DECISIONS RELATED TO THE ADEQUACY OF EGRESS
5.3.6 Hazardous Conditions
THE ABILITY TO OBSERVE, RECOGNIZE PROBLEMS, INTERPRET CODES, MAKE DECISIONS AND COMMUNICATE
Identify, document and report deficiencies in accordance with the policies of the jurisdiction
5.3.7 Emergency Planning and Preparedness Measures
THE ABILITY TO COMPARE SUBMITTED PLANS AND PROCEDURES WITH APPLICABLE CODES AND STANDARDS ADOPTED BY THE JURISDICTION
5.3.8 Flammable and Combustible Materials
THE ABILITY TO OBSERVE, INTERPRET CODES, RECOGNIZE PROBLEMS AND COMMUNICATE
V
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Competent
YES NO
THE ABILITY TO IDENTIFY TYPICAL FIRE HAZARDS ASSOCIATED WITH PROCESSES OR OPERATIONS UTILIZING FLAMMABLE AND COMBUSTIBLE LIQUIDS
5.3.9 Dangerous Goods
THE ABILITY TO OBSERVE, INTERPRET CODES, RECOGNIZE PROBLEMS, MAKE DECISIONS AND COMMUNICATE
THE ABILITY TO IDENTIFY FIRE HAZARDS ASSOCIATED WITH PROCESSES OR OPERATIONS UTILIZING HAZARDOUS MATERIALS
5.3.10 Fire Growth Potential
THE ABILITY TO OBSERVE, INTERPRET CODES AND STANDARDS, RECOGNIZE HAZARDOUS CONDITIONS, MAKE DECISIONS AND COMMUNICATE
o
o
o
o
o
o
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Competent
YES NO
5.3.11 Life Safety Systems and Building Services Equipment
THE ABILITY TO WITNESS AND DOCUMENT TESTS OF FIRE PROTECTION SYSTEMS AND BUILDING SERVICES EQUIPMENT
5.3.12 Heating, Ventilation, Air Conditioning
THE ABILITY TO OBSERVE AND TO RECOGNIZE PROBLEMS, INTERPRET CODES AND STANDARDS AND WRITE REPORTS
Inspection Reports
THE ABILITY TO COMMUNICATE IN WRITING
Page 10 of 21 Jan 2020
Competent
YES NO
THE ABILITY TO COMMUNICATE ORALLY
o
o
o
o
PRACTICUM SUPERVISOR’S COMMENTS
NAME SIGNATURE DATE (mm/dd/yy) (Print)
Page 11 of 21 Jan 2020
Candidate’s name Date
Supervisor Signature
Score 1 (Beginner) to
5 (Mastery)
PASS = 21/30 TOTAL /30
Page 12 of 21 Jan 2020
Score 1 (Beginning) to
5 (Mastery)
PASS = 28/40 TOTAL /40
Page 13 of 21 Jan 2020
Candidate’s name
Practicum supervisor’s name
STANDARD: NFPA 1031, 2014 Edition, 5.4.1, 5.4.2, 5.4.3, 5.4.5, 5.4.6
Competent
YES NO
5.4.1 Occupancy type
5.4.2 Occupant load
o
o
o
o
o
5.4.3 Fire protection systems
5.4.5 Means of egress
5.4.6 Construction type
Page 14 of 21 Jan 2020
Competent
YES NO
PRACTICUM SUPERVISOR’S COMMENTS
SUPERVISOR Name (print) Signature Date (mm/dd/yyyy)
Page 15 of 21 Jan 2020
Candidate’s name
Practicum supervisor’s name
STANDARD: NFPA 1031, 2014 Edition, 5.2.1, 5.2.2, 5.2.3, 5.2.4, 5.2.5
Competent
YES NO
5.2.1 Permit applications
5.2.2 Plan review applications
5.2.3 Complex complaints
o
o
o
o
o
5.2.4 Recommending modifications to the adopted codes
r
o
o
o
o
o
5.2.5 Recommending inspection policies and procedures
Page 16 of 21 Jan 2020
Competent
YES NO
o
o
o
o
o
o
PRACTICUM SUPERVISOR’S COMMENTS
PRACTICUM SUPERVISOR
Name (print) Signature Date (mm/dd/yy)
Page 17 of 21 Jan 2020
Print clearly. Do NOT use initials.
Evaluator’s last name First name Evaluation (mm/dd/yyyy)
Training host
PROCEDURES
DECLARATION
I, ______________________________________________________, have complied with the procedures listed above. I confirm that the results in this document are a true account of my assessment of the candidate’s skills. I understand that failure to follow the above procedures or to conduct the evaluation professionally and responsibly may result in my suspension as an evaluator with the Safety Codes Council. ________________________________________ ________________________________________ Signature Date
Collection of personal information is necessary to support the certification and accreditation programs of the Safety Codes Council. The collection is authorized under
Section 33(c) of the Freedom of Information and Protection of Privacy Act and will be managed in accordance with the Act. Questions? Contact the manager, policy
and legislation, at the Council (780-413-0099).
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PASS/FAIL
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EVALUATOR’S COMMENTS
EVALUATOR
Name (print) Signature Date (mm/dd/yyyy)
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Candidate’s name Date
Evaluator Signature
Score 1 (Beginner) to
5 (Mastery)
PASS = 21/30 TOTAL /30
Page 21 of 21 Jan 2020
Candidate’s name Practicum supervisor’s name
EVALUATOR
Name (print) Signature Date (mm/dd/yyyy)