Testing Sites and Forms

Employment Testing Sites 
 
Emergency Services Worker Medical Screening and Certification

The goal of the pre-hospital medical screening program is to ensure that you are physically able to perform the essential tasks of a pre-hospital worker.

For field workers, (non-admin) the following checklist MUST be completed, submitted and verified PRIOR to your Academy and/or patient contact. In most cases, a package of medical paperwork will be sent to you prior to your examination. However, if the paperwork is not received before your appointment date, do not stress, for each clinic has extra copies onsite.

Immediately make an appointment for your preplacement screening using the list below
Fill out the medical screening paperwork BEFORE your appointment date above AND be sure to BRING it with you.
OSHA Respiratory questionnaire (9 pages) – EITHER fill out and mail with enclosed envelope OR follow the online instructions and complete the form on the Internet.
Fill out the highlighted sections of the DL-51 (DMV) form and green card
Fill out the highlighted sections of the N95 fitting form
Fill out the TB screening form and follow the directions on obtaining your tuberculosis screening.
Fill out the highlighted sections and bring the enclosed drug screen and Hepatitis B lab forms to your appointment.

I hope that you will have a long, healthy and injury-free EMS career. Should you have any questions regarding this process, please don’t hesitate to contact Dr. Terribilini directly at 408-371-0260 ext. 101 or drcasey@cohm.org .

The following offices have been selected, trained, credentialed and equipped to provide your required pre-employment or periodic employment testing.

 Scheduling questions? Call 888-641-2225 ext. 100

 A. Pre-placement and Biannual Testing Locations:

These Sites are equipped for ALL testing levels New hire(Field and Admin) and Biannual renewals.

1. San Jose     888-641-2225 ext. 100 
2. Modesto     888-641-2225 ext. 100
3. Redding     530-722-9010
4. Sacramento      888-641-2225 ext. 100
5. Visalia     559-732-7680
6. Santa Barbara/ Buellton     805-686-8322
7. Honolulu     808-839-7474

B. Additional Administrative Evaluation Locations:
Admin ONLY -- Sites Not equipped for agility tests

 1. San Francisco     415-781-2225 
 2.  Stockton     209-474-3764
 3. Oakland     510-654-6611
 4. Antioch     925-754-6780
 5. Modesto     209-527-5346
 6. Pasadena     626-798-7805
 7. Whittier     562-943-7125
 8. Portland, OR     PENDING
 9. Seattle, WA     PENDING
10. Greenwood, CO     PENDING

C. Additional Biannual Renewal Locations:

Not equipped for agility tests

 1. Santa Maria Santa Barbara County 
 2. Santa Rosa Sonoma County  
 3. Oakland Alameda County 
 4. Antioch Contra Costa County
 5. San Francisco City & County of SF
 6. Stockton San Joaquin County
 7. Roseville Sacramento County

IMPORTANT NOTE -- Please check to make sure you are using the correct forms for each specific position.

1. Field Personnel - EMT / Paramedic / CCT  Pre-placement Form
Required to perform a New Hire Examination for EMT's & Paramedics.
[Preplacement-EMS.doc]

2. Admin / Dispatch / VST / Pre-placement Form
For Admin, Dispatch, VST, CCT personnel.
[Preplacement-Admin.doc]

3. Bi-Annual Renewal Exam Form
For EMS personnel (EMT/Paramedics).
[BiAnnual-EMS.doc]

4. Appointment / Coversheet
For EMS personnel (EMT/Paramedics)
[Appt-Coversheet.doc]

5. Billing Form
For EMS personnel (EMT/Paramedics)
[BillingForm.doc]

6. Respiratory Protection
For EMS personnel (EMT/Paramedics/CCT Personnel)