WORK CAPACITY TEST RECORD APPENDIX O
Appendix O
Work Capacity Test Record
Units will document the administration of the WCT to all employees and job
applicants. This documentation must be retained until the next WCT is
administered. Units may also be requested to provide data from these records to
assist in the evaluation of the WCT process.
Privacy Act – No employee may disclose records subject to the Privacy Act
unless the disclosure is permitted under 43 CFR 2.56 or to the individual to
whom the record pertains. The Privacy Act contains a criminal penalty for
unauthorized disclosure of records. (5 U.S.C. 552a)
To be com
pleted by employee:
Name (Last, First): Where employed:
Date test taken: Test administered by: (Print Name)
ICS position for which test is required (highest needed)
Performance level needed (circle one):
Arduous Moderate Light
Type of test taken (circle one):
Pack Test Field Test Walk Test
Work Capacity Test Descriptions:
To be completed by test administrator:
Test result time:
Employee passed test (circle one): Yes/No
I certify that the work capacity test was administered according to agency
guidelines.
(Title) (Date)
(Signature of Test Administrator)
Release Date: January 2020
Appendix O-1
