customs and border protection officer candidate pre ... · pdf fileu.s. department of homeland...

16
U.S. Department of Homeland Security U.S. Customs and Border Protection (CBP) Customs and Border Protection Officer Candidate Pre-employment Fitness Test (PFT-1) Test Administrator Manual

Upload: vuongphuc

Post on 06-Mar-2018

231 views

Category:

Documents


5 download

TRANSCRIPT

Page 1: Customs and Border Protection Officer Candidate Pre ... · PDF fileU.S. Department of Homeland Security U.S. Customs and Border Protection (CBP) Customs and Border Protection Officer

U.S. Department of Homeland Security

U.S. Customs and Border Protection (CBP)

Customs and Border Protection Officer Candidate

Pre-employment Fitness Test (PFT-1) Test Administrator Manual

Page 2: Customs and Border Protection Officer Candidate Pre ... · PDF fileU.S. Department of Homeland Security U.S. Customs and Border Protection (CBP) Customs and Border Protection Officer

Updated 06/24/2014 1

Background The primary mission of the U.S. Customs and Border Protection (CBP) Officer position is to perform critical duties related to securing our nation’s borders while facilitating the orderly and efficient flow of legitimate trade and lawful travelers. It is a physically demanding position that requires the candidate demonstrate his/her ability to meet the rigorous demands of training and the physical requirements of the position.

Purpose The CBP Officer Pre-employment Fitness Test (PFT-1) consists of a battery of physical tests designed to predict a candidate’s ability to successfully complete the pre-employment physical fitness requirements, meet the requirements of the Academy, and to perform the essential duties of the position. Consistent and proper administration of the test battery is a critical step in the pre-employment process and a requirement of all Test Administrators (TA). This Test Administrator Manual provides the TA with the proper protocol for the CBP Officer PFT-1. The protocol has been validated and must be followed at all times and in the proper order to ensure accurate, safe, and consistent administration of the PFT-1. It is imperative that all TAs receive adequate training and review this document in full prior to administering the CBP Officer PFT-1.

Pre-Test Protocol On the day of testing, the TA shall complete the following steps prior to administering the PFT-1:

Step One. Set up all equipment needed to administer the PFT-1 including tape lines on the floor for the side step test (see Appendix E for illustration) prior to the candidate’s appointment.

Step Two. Confirm the identification of the candidate being tested by verifying the candidate’s

government-issued picture identification. Acceptable forms of identification include a passport, valid driver’s license, or other form of government-issued identification.

If the candidate does not present valid government -issued identification, DO NOT administer the PFT-1. Document the issues on the “Statement Regarding the CBP Officer Fitness Test Failure” section of the CBP Officer Pre-employment Fitness Testing Score Sheet (Appendix A) and submit as required.

Step Three. Review the Candidate Health History Questionnaire (CHHQ) (Appendix B). Only proceed

if the candidate answered “no” to all questions. If a candidate answered “yes” to one or more questions, DO NOT administer the PFT-1 and inform the candidate that the Minneapolis Hiring Center (MHC) will contact them with further instructions. Document why the test was not administered on the “Statement Regarding the CBP Officer Fitness Test Failure” section of the CBP Officer Pre-employment Fitness Testing Score Sheet and submit as required.

Step Four. Take the candidate’s height and weight and record the results on the CBP Officer Pre-

employment Fitness Testing Score Sheet. Step Five. Witness the candidate signing the Participant Waiver, Appendix C, and conduct the PFT-1.

Page 3: Customs and Border Protection Officer Candidate Pre ... · PDF fileU.S. Department of Homeland Security U.S. Customs and Border Protection (CBP) Customs and Border Protection Officer

Updated 06/24/2014 2

Materials Needed The following materials are needed to administer the CBPO PFT-1:

Narrated CBP Officer Pre-employment Fitness Test - Test Administrator Audio

4” or 5” Foam Block (5” block is used for candidates 5 feet 9 inches or taller)

Stop Watch

Three sturdy tape lines, no more than two (2) inches wide, clearly and neatly adhered to the floor as follows (Appendix E):

o In the center of the testing area (dividing the area in half); o 6 feet to the right of and parallel to the center line; and, o 6 feet to the left of and parallel to the center line.

Square milk crate with loose free weights (totaling 50 pounds)

30-inch high table

Stop Watch

One 12” high step bench, or one bench and enough risers to bring the bench to a height of exactly twelve (12) inches.

Other Requirements

1. For every PFT-1 administered, an Emergency Responder shall be onsite and available in case of

emergency during the PFT-1. The Emergency Responder shall possess current CPR/AED and First Aid certifications by recognized organizations such as the American Heart Association (AHA) or the American Red Cross. The Emergency Responder shall ensure that the AED is maintained in accordance with manufacturer requirements and/or Federal law as applicable. The TA may serve as the Emergency Responder ONLY if they have the required certifications.

2. If at any time during the testing, the TA feels that the candidate is in danger of harming him/herself, the TA shall discontinue administering the test and clearly indicate the reason for stopping the test in the “Statement Regarding the CBP Officer Fitness Test Failure” section of the CBP Officer Pre-employment Fitness Testing Score Sheet. The TA shall also complete a PFT-1 Injury/Accident/Incident Report Form (Appendix D) and submit to the Program Manager immediately after the incident is resolved, but no more than twenty-four (24) hours after the incident occurs.

3. The PFT-1 shall be conducted in an area with at least 25 feet by 25 feet of available space and a

minimum ceiling height of eight (8) feet.

CBP Officer Pre-employment Fitness Test (PFT-1) The CBP Officer PFT-1 is divided into two parts. Part 1 consists of four test components and Part 2 consists of one test component. The TA shall administer all components of each part in the following order:

Page 4: Customs and Border Protection Officer Candidate Pre ... · PDF fileU.S. Department of Homeland Security U.S. Customs and Border Protection (CBP) Customs and Border Protection Officer

Updated 06/24/2014 3

PART 1

The Push-Up Test is a timed test, requiring completion of as many proper form push-ups as possible in 60 seconds. The depth of the push-ups will be measured using a 4” or 5” foam block. The Side Step Test is a timed test, requiring completion of as many outside line touches and center line crosses as possible in 10 seconds. Candidates are given two trials and the highest number of outside line touches and centerline crosses will be scored. Both trials shall be recorded on the score sheet. The candidate has the option to perform one (1) trial if the desired minimum was obtained in first trial. See Appendix E for illustrations. The Sit-Up Test is a timed test, requiring completion of as many proper form sit-ups as possible in 60 seconds. The Lift/Lower Test is a timed test that requires the completion of eight lift/lower cycles as quickly as possible within a maximum time of 60 seconds. A lift/lower cycle consists of lifting a 50-pound crate with weights from the floor to a 30-inch high table. A full cycle is counted when the crate has been returned to the floor.

PART 2

The Step Test is a timed test requiring that the candidates step up on a twelve (12) inch high bench in cadence at a rate of 120 beats per minute.

CBP Officer Pre-employment Fitness Test Requirements

PART ONE

Test Requirement Time Push-ups as many as possible 60 seconds

Side Step as many line crosses/touches as possible 10 seconds

Sit-ups as many as possible 60 seconds

Lift/Lower 8 cycles 60 seconds or less

PART TWO Step Test 120 beats per minute 5 minutes

CBP Officer Pre-employment Fitness Test - 1 Protocol Part 1 The TA shall set up the testing area(s) prior to the candidate’s arrival. Part 1 of the CBP Officer PFT-1 shall be administered using the Narrated CBP Officer Pre-employment Fitness Test - Test Administrator Audio (provided by CBP) at all times. Once the audio has begun, it should not be stopped for any reason (unless otherwise noted) until Part 1 of the PFT-1 has been completed in full. The audio has been developed to provide the candidate with all of the instructions needed to perform each test in Part 1 and includes timed 3-minute rest intervals between each test component. Any deviation from use of the audio and the testing protocol will result in a retest of the candidate.

Page 5: Customs and Border Protection Officer Candidate Pre ... · PDF fileU.S. Department of Homeland Security U.S. Customs and Border Protection (CBP) Customs and Border Protection Officer

Updated 06/24/2014 4

Push-up Test

Instructions to the TA:

Instruct the candidate to assume the starting or “up position” with elbows straight and hands spaced shoulder width apart, with the thumbs aligned with the crease of the shoulder. The body must be kept in a straight line with feet no more than 8 to 12 inches apart. Once the candidate is in the “up position,” place the 4” or 5” foam block directly below the sternum/chest and hold it in position throughout the entire test.

Remind the candidate throughout the test to keep the body straight and to drop down until the sternum touches the foam block. Maintaining a straight body, the candidate shall be instructed to push up until the elbows are straight. This completes one proper form push-up.

A candidate may rest in the up position only, but the time continues. At the end of 60 seconds, the audio will inform the candidate to stop.

Count proper form push-ups aloud as each are completed, and inform the candidate immediately if any push-ups are performed improperly.

The candidate shall perform as many push-ups as possible in 60 seconds.

The Push-Up Test shall be stopped: o When 60 seconds have expired – OR – o If the candidate voluntarily stops the test – OR – o If the candidate’s knees touch the ground.

Record the number of proper form push-ups completed on the score sheet and allow the three (3) minute rest period.

Side Step Test Instructions to the TA:

Have the candidate stand facing the TA with one foot on each side of the centerline. Make sure the feet are parallel to the center line.

Have the candidate slide or side step to one side until the closest foot touches or crosses the outside line without crossing his/her feet. The candidate then slides or side steps in the other direction until the closest foot touches or crosses the other outside line. The candidate continues this action for 10 seconds attempting to touch or cross the outside lines as many times as possible in 10 seconds.

For a center line cross to count, both feet must have crossed the center line and be on the same side.

Review Appendix E for how to administer the Side Step test component.

Two trials shall be given. Allow the candidate 20 seconds to rest between trials. The candidate has the option to perform only one trial if the desired minimum was obtained in the first trial. If the candidate declines the second trial, allow the audio to continue to the start of the next test. Additionally, if the candidate missteps by crossing his/her feet in the first trial mark a zero (0) in first trial area of the score sheet and pause the audio. Administer the second trial manually for ten seconds using the stopwatch. After the completion second trial, resume playing the audio.

Page 6: Customs and Border Protection Officer Candidate Pre ... · PDF fileU.S. Department of Homeland Security U.S. Customs and Border Protection (CBP) Customs and Border Protection Officer

Updated 06/24/2014 5

If the candidate fails to maintain the proper positioning during the second trial, the score on that trial shall be marked zero (0) on the score sheet. The candidate shall not be given any further trials.

The audio will instruct the candidate when to start and stop.

The TA shall count aloud all line touches/crosses.

Each trial will stop: o When 10 seconds have expired – OR – o If the candidate voluntarily stops the test – OR – o If the candidate fails to maintain proper positioning during a trial by crossing

his/her feet. Record the total number of touches/crosses properly completed on the score sheet and

allow the three (3) minute rest period.

Sit-up Test

Instructions to the TA:

The audio will instruct the candidate to assume the starting or “down position” on his/her back with the knees bent and the hands crossed in front of the chest, shoulder blades touching the mat.

With the candidate’s knees bent at a 90-degree angle, the heels shall be 12 to 18 inches from the candidate’s buttocks.

The candidate is required to sit-up until the forearms touch the upper third of the thighs.

The candidate shall return to the starting position where the shoulder blades touch the mat to complete a full cycle.

A candidate may rest in the up position only, but the audio must continue.

The audio will instruct the candidate when to start and stop.

The TA shall count aloud all proper form sit-ups. Inform the candidate immediately if he/she has displayed incorrect form, but encourage the candidate to continue until the time is up.

A Sit-up will not count if: o The buttocks are raised – OR – o The arms/hands are used to get up from the down position to the up position –

OR – o If the candidate fails to touch forearms to the upper third of the thighs – OR – o Shoulder blades do not touch the mat.

The Sit-Up Test will stop: o When 60 seconds have expired – OR – o If the candidate voluntarily stops the test – OR – o If the candidate stays in the starting position (down) for three (3) seconds or

more.

Record the number of proper form sit-ups completed on the score sheet and allow the three (3) minute rest period.

Page 7: Customs and Border Protection Officer Candidate Pre ... · PDF fileU.S. Department of Homeland Security U.S. Customs and Border Protection (CBP) Customs and Border Protection Officer

Updated 06/24/2014 6

Lift/Lower Test

Instructions to the TA:

Have the candidate stand behind the crate with his/her feet slightly wider than the crate.

The candidate shall be standing beside the table with line of site running parallel to the table (not directly facing the table or with their back to the table).

The candidate shall use proper lifting technique to lift the crate to the 30-inch high table.

This is a timed test, requiring the candidate to complete 8 lift/lower cycles as quickly as possible within one minute.

To ensure the candidate’s safety during this test, the audio will instruct the candidate to: o Move his/her feet when turning to position the crate on the table o Use his/her leg muscles to extend and lower o Keep his/her back as straight as possible throughout the test.

The candidate shall lift the 50 pound crate from the floor, turn to place it on the 30-inch high table, release his/her grip, re-grip, turn to the starting view, and lower the crate back to the floor. A full cycle is counted when the crate is returned to the floor. If the candidate does not complete the cycle as described here, the cycle shall not be counted.

The audio will instruct the candidate when to start and stop.

The TA shall count aloud all completed lift/lower cycles.

The lift/lower test will stop: o When the candidate has completed 8 lift/lower cycles – OR – o When one minute has expired – OR – o If the candidate voluntarily stops the test.

Record the time on the score sheet rounded to the next whole second (do NOT use fractions, and do not round down).

o For example, if the candidate completes 8 cycles in 30.2 seconds, this shall be recorded as “31 seconds.”

If the time has expired before the candidate completes 8 lift/lower cycles, write “time expired” and the number of cycles completed on the score sheet.

PART 2

Step Test

Instructions to the TA:

Allow the candidate a practice opportunity to step in cadence (up, up, down, down).

Instruct the candidate to step up with the lead foot followed by the lag foot (up, up), then step down with the lead foot followed by the lag foot (down, down).

Advise the candidate that they may switch their lead foot at any time if they wish to, but must not break cadence or stop moving while doing so.

The audio will instruct you when to start and stop the test.

Instruct the candidate to step in cadence with the audio.

The Step Test will stop:

Page 8: Customs and Border Protection Officer Candidate Pre ... · PDF fileU.S. Department of Homeland Security U.S. Customs and Border Protection (CBP) Customs and Border Protection Officer

Updated 06/24/2014 7

o If the candidate is unable to maintain cadence in accordance with the audio for three (3) consecutive sequences – OR –

o If the candidate is unable to maintain cadence in accordance with the audio for a total of six (6) sequences within the 5 minute test – OR –

o If the candidate uses their hands/arms to push on their legs to assist in stepping – OR –

o If the candidate voluntarily stops the test.

If the candidate does not complete the full 5 minute step test in cadence, record the time the test was stopped on the score sheet, and record the reason for stopping the test on the Statement Regarding the Customs and Border Protection Officer Fitness Test Failure.

Score Sheet Accuracy

The TA shall ensure that each section of the score sheet is completed thoroughly except the scoring area and the “Test Summary” section; otherwise DO NOT LEAVE ANY BLANKS.

1. The Candidate Information section shall be completed by the TA prior to administering the PFT-1.

2. The Individual Test Results section shall be completed by the TA during the administration of the PFT-1.

3. The Test Administrator Information section shall be completed by the TA by legibly printing his/her first and last names.

4. The Candidate Information, Test Administrator Information, and the “Statement Regarding the Customs and Border Protection Officer Fitness Test Failure” sections of the PFT-1 Score Sheet shall be thoroughly and legibly completed by the TA.

5. The Candidate Signature section shall be completed by the candidate following the administration of the PFT-1.

6. The TA shall NOT complete the Scoring section of the score sheet.

Page 9: Customs and Border Protection Officer Candidate Pre ... · PDF fileU.S. Department of Homeland Security U.S. Customs and Border Protection (CBP) Customs and Border Protection Officer

Updated 06/24/2014 8

APPENDICES

Page 10: Customs and Border Protection Officer Candidate Pre ... · PDF fileU.S. Department of Homeland Security U.S. Customs and Border Protection (CBP) Customs and Border Protection Officer

Updated 06/24/2014

Appendix A

Customs and Border Protection Officer Pre-Employment Fitness Test (PFT-1) Score Sheet

(Please Print)

CANDIDATE INFORMATION

Last Name First M.I. Gender

M F

Social Security Number

Date of Birth (MM/DD/YYYY) Age Height (inches) Weight (pounds)

Part One: INDIVIDUAL TEST RESULTS SCORING

Push-up Test

No. completed in 60 seconds __________

Score:

Side Step Test

No. of line touches/crosses ________ (trial 1) ________ (trial 2)

Score:

Sit-up Test

No. completed in 60 seconds _________ Score:

Lift/Lower Test

8 cycles completed in _________ seconds*

*If time expired, note number of cycles completed here: _______

Score:

TOTAL:

Part Two:

12” Step Test

Candidate completed the 5 minute step test in cadence Yes No* Time stopped: _______ minutes _______ seconds

**If “No,” document the reason on the Statement Regarding the Customs and Border Protection Officer Fitness Test Failure.

CANDIDATE SIGNATURE

I ACKNOWLEDGE THE INDIVIDUAL TEST RESULTS ABOVE

NAME ______________________________________________________________________________DATE_________________

TEST ADMINISTRATOR INFORMATION

Test Date Test Site Location (City/State)

Print Name

Signature

Phone Number (xxx-xxx-xxxx)

TEST SUMMARY

Based on the Pre-employment Fitness Test results listed above, the candidate has:

PASSED

FAILED

Page 11: Customs and Border Protection Officer Candidate Pre ... · PDF fileU.S. Department of Homeland Security U.S. Customs and Border Protection (CBP) Customs and Border Protection Officer

Updated 06/24/2014

Candidate Name (Last, First)

Social Security Number (Last 4)

Date of Statement (same as test date)

Statement Regarding the Customs and Border Protection Officer Fitness Test Failure (please write legibly and describe all details clearly)

Sworn Statement: I do so declare under penalty of law this is an accurate and truthful documentation of the circumstances of the CBP

Pre-employment Fitness Test-1 battery administered to the candidate named above.

Test Administrator Signature

Date Telephone Number

Page 12: Customs and Border Protection Officer Candidate Pre ... · PDF fileU.S. Department of Homeland Security U.S. Customs and Border Protection (CBP) Customs and Border Protection Officer

Updated 06/24/2014

Appendix B

Pre-employment Fitness Test-1 Candidate Health History Questionnaire & Medical Provider Statement

You have been tentatively selected for one of U.S. Customs and Border Protection’s physically demanding law

enforcement occupations. You must successfully complete the Pre-employment Fitness Test-1 (PFT-1) in order to have

continued consideration for this position. The PFT-1 requirements are attached for your review.

Instructions: You must complete the following health screening questionnaire and bring it with you to your PFT-1

appointment. You will not be allowed to participate in the PFT-1 without this signed form. The answers provided

will be reviewed to determine your eligibility to participate in the PFT-1. Please read carefully and respond to each

question below.

Yes No

□ □ 1. Has your medical provider told you that you have a heart problem or other condition that limits your

activity?

□ □ 2. In the last 6 months, have you had palpitations (fluttering sensations of the heart), pain, tightness or

pressure in your chest while at rest or when you do physical activity/work/exercise?

□ □ 3. Have you ever become lightheaded or dizzy, passed out, or nearly passed out during or after exercise?

□ □ 4. Do you have a bone or joint problem that is made worse by performing physical activity/exercise or could

become worse by participating in the PFT-1?

□ □ 5. Do you take any prescribed or over the counter medications that may preclude or affect your ability to take

the PFT-1?

□ □ 6. Do you know of any other reason (medical/physical problem, condition or impairment) that may preclude or

affect your ability to take the PFT-1?

If you answered “yes” to any questions above, take the PFT-1 Screening & Medical Provider Statement forms to

your medical provider for their approval prior to your fitness test appointment. Your medical provider will need to

review your health history, PFT-1 screening responses, and the PFT-1 requirements to determine your ability to

participate in the PFT-1. If you answered “no”, be prepared to participate in the PFT-1 after scheduling your

appointment.

By signing below I acknowledge that the information provided above is accurate.

__________________________________________________________________________________________________

Candidate’s Printed Name Candidate’s Signature Date

__________________________________________________________________________________________________

Position Applicant ID

FOR USE BY FITNESS TEST ADMINISTRATOR ONLY

Date Test Administrator Printed Name Signature Participation Approved/Denied

Page 13: Customs and Border Protection Officer Candidate Pre ... · PDF fileU.S. Department of Homeland Security U.S. Customs and Border Protection (CBP) Customs and Border Protection Officer

Updated 06/24/2014

Appendix B

Dear Provider,

Please review the Fitness Test Requirements for the appropriate position below, and certify whether or not the candidate

is cleared to participate.

Candidate’s Name (print): _____________________________________ Date: _______________________

Position: ______________________________________________ Applicant ID: ______________________

If your medical provider determines that you cannot safely participate in the required fitness test,

please fax or email the PFT-1 Screening and the Medical Provider Statement form to 952-806-0845

or [email protected]

Pre-Employment Fitness Test Requirements Border Patrol Agent 20 push-ups in 60 seconds

25 sit-ups in 60 seconds

Cadence of 120 steps per minute for five (5) minutes on a bench

fourteen (14) inches in height

Customs and Border Protection Officer 60-second push-up test

Two (2) 10-second side step tests

60-second sit-up test

60-second lift/lower test in which the candidate must lift a 50-

pound crate onto a 30-inch high table eight (8) times

Cadence of 120 steps per minute for five (5) minutes on a bench

twelve (12) inches in height

Air & Marine Positions (AEA, AIA, MIA) 60-second push-up test

60-second sit-up test

60-second lift/lower test in which the candidate must lift a 50-

pound crate onto a 30-inch high table eight (8) times

Cadence of 120 steps per minute for five (5) minutes on a bench

twelve (12) inches in height

Provider Certification I have reviewed the candidate’s health history questionnaire responses and the fitness test requirements and give the

following opinion:

CLEARED TO SAFELY PARTICIPATE IN THE PFT-1

-1

Medical Provider’s Printed Name/Specialty:

Medical Provider’s Signature:

Office Address:

Telephone Number:

Date:

Fax Number:

Medical Provider Statement

Page 14: Customs and Border Protection Officer Candidate Pre ... · PDF fileU.S. Department of Homeland Security U.S. Customs and Border Protection (CBP) Customs and Border Protection Officer

Updated 06/24/2014

Appendix C

Customs and Border Protection (CBP) Officer Candidate Waiver and Release of

Liability

I, ___________________________________________ (print full legal name), a candidate for a physically demanding position with Customs and Border Protection (CBP), certify and declare that I am currently engaged in a regular physical exercise program and can complete CBP’s Pre-employment Fitness Test-1 without harm to myself. I understand that the CBP Officer PFT-1 is divided into two parts and that each part is scored separately. Part 1 consists of four tests: (1) 60-second push-up test; (2) 60-second sit-up test; (3) two 10-second side step tests; and, (4) 60-second lift-lower test, during which I will be lifting a crate weighing 50-pounds from the floor to a 30-inch table and back to the floor for 8 repetitions. Part 2 consists of one test, a 5 minute step test in which I must complete in cadence at 120 beats per minute. I further understand that the purpose of the PFT-1 is to measure my general level of physical fitness and my present ability to safely and successfully complete CBP Officer basic training. List any health or physical problems that could, in any way, cause danger to you during physical exercise or elevate the risk factors associated with physical exertion.

_____________________________________________________________________________________________

_____________________________________________________________________________________________

(Use back if additional space is required.)

I acknowledge that there are risks inherent with any physical activity and understand that it is my responsibility to notify testing personnel of any known pre-existing conditions that might, in any way, adversely affect my ability or safety during the PFT-1. Furthermore, I understand that it is my responsibility to monitor individual physical performance during the physical activities and testing and to immediately stop and notify the Test Administrators administering the testing should any unusual or adverse reactions be experienced.

Understanding the risks inherent with the physical activities that are part of the PFT-1, and in consideration of being permitted to participate in the above-identified events comprising the PFT-1, I hereby assume for myself and my guardians, heirs, executors, administrators, and assigns all risks, whether currently known or unknown, associated with and arising out of my participation or execution of the events comprising the PFT-1. Further, I hereby release, waive, discharge, and relinquish any causes of action which may arise for myself and my estate, and agree that under no circumstances will I or my guardians, heirs, executors, administrators, and assigns prosecute or present any claim for personal injury, property damage, or wrongful death against the U.S. Government, U.S. Customs and Border Protection, the test administration facilities, or any of the officers, agents, or employees thereof for any causes of action, whether the same shall arise by the negligence of any of said persons or otherwise.

By my signature, I acknowledge that I have read the foregoing certification, waiver, and release in its entirety; that I understand fully the contents thereof; that I have been completely advised of the potential dangers incident to engaging in the PFT-1; and that I am fully aware of the legal consequences of signing this instrument.

__________________________________________________________________________ ________________

Candidate’s Signature Date ___________________________________________________________________________ ________________ Witness’ Signature Date

Page 15: Customs and Border Protection Officer Candidate Pre ... · PDF fileU.S. Department of Homeland Security U.S. Customs and Border Protection (CBP) Customs and Border Protection Officer

Updated 06/24/2014

Appendix D

Customs and Border Protection Officer

PRE-EMPLOYMENT FITNESS TEST (PFT-1)

INJURY/ACCIDENT/INCIDENT REPORT FORM

Testing Discontinued

Reasons:

Candidate injured him/herself during testing

Other incident detailed below

Date of Incident: _______________ Time: ________ AM/PM

Name of candidate: ___________

Candidate ID Number: _________________________

Testing Location: _________________________________________________________

Test Administrator’s Name(s):

Indicate specific test being administered at the time of incident: ___________________________

Type of injury/accident/incident: ____________________________________________________

Details of incident: _______________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Details of immediate care provided to the candidate: ___________________________________

____________________________________________________________________________

Injury required hospital visit? Yes _____ No _____

Name of physician/hospital:

Address:

Signature of Candidate _________________________________ Date __________________

Signature of Test Administrator ___________________________ Date__________________

Provide electronically to Program Manager and submit to CBP within 24 hours of the incident.

Page 16: Customs and Border Protection Officer Candidate Pre ... · PDF fileU.S. Department of Homeland Security U.S. Customs and Border Protection (CBP) Customs and Border Protection Officer

Updated 06/24/2014

Figure 2 – Touch outside line

Count 1

Figure 4 – Touch outside line

Count 3

Notes:

Repeat side step motion

until 10 seconds expires

Count each outside line

touch/cross and every center

line cross Figure 5 – Cross center line with both feet

Count 4

Figure 3 – Cross center line with both feet

Count 4

Figure 1 – Straddle the center line

SIDE STEP

DIAGRAM

Appendix E