Initial Evaluation

Medical History

The same medical history form should be used for every applicant. Applicants should sign and date each page of the medical history questionnaire and certify that it is true and correct. The police physician or delegated medical provider should review medical history forms with each applicant and co-sign them. The medical history is the most important step in identifying applicants who may not be medically qualified (see Appendix B | Medical History Form).

The sample history form in Appendix B contains the following sections:

• Demographic information
• Work historyc
• Social history
• Health history
• Review of systems
• Certification

The review of systems contains law-enforcement specific questions, such as allergy to cayenne peppers (to evaluate tolerance to pepper spray), screening questions for alcoholism and sleep apnea, and the questions from the U.S. Occupational Safety and Health Administration (OSHA) respirator medical evaluation (29 CFR §1910.134, Appendix C) relevant to N, R, P disposable respirators, half-mask respirators, and powered air purifying respirators. This history form does not cover questions relevant to clearance for using full-face masks and SCBA.7-11