Fire-Related Health Screening Form


Yes, employers have a duty to protect workers during emergencies, such as hurricanes, explosions and fires. But dealing with the aftermath of an emergency can also pose safety hazards to workers. For example, responding to or cleaning up after forest fires, such as the wildfire that impacted Fort McMurray in Alberta, can expose workers to health hazards such as smoke, dust and particulates; carbon monoxide; heat stress; long working hours; strenuous work; and physical injury. And if workers have certain medical conditions, participating in the emergency response to a fire—or cleaning up after one—may put them at greater risk.


This questionnaire was created by Alberta’s Ministry of Labour to help identify whether workers have medical conditions that would endanger their health if they participated in emergency response or cleanup efforts related to the Ft. McMurray wildfire. But you can adapt it for use in dealing with any fire that’s impacted your workplace and workforce.

If a worker answers “yes” to any of the questions on the form, ensure he gets clearance from his personal physician or an occupational health professional before getting involved in emergency response or cleanup efforts.


Alberta Ministry of Labour Fort McMurray Fire Resources

Fire Preparedness & Response: What the OHS Laws Require

Natural Disaster Preparedness Infographic

Emergency Preparedness Compliance Centre