Medical Review and Waiver Process

In some cases, the exam will reveal a medical condition that precludes individuals from safely performing the essential firefighting functions. Many medical conditions will require you to provide additional information for clarification. Asthma or high blood pressure medication, recent surgeries, or chronic conditions are some examples. Reminder: the examinee is responsible for any costs associated with obtaining additional documentation or any follow up visits or testing as a result of a not qualified determination. 

Shasta Lake Hotshots at the North Complex. Photo by Kye Funk, USDA Forest Service.

Medical Review Process 

The intent of the medical review process is to either change a Not Qualified determination to Qualified, or to determine if a non-qualifying condition is static & stable. The medical review process will take place when additional medical documentation is provided at any time through the wildland firefighter representative to address a non-qualifying condition. Please contact us at for assistance with a medical review.

Risk Mitigation/Waiver Process

An examinee with a Not Qualified (Static & Stable) determination can request to participate in the Risk Mitigation/Waiver process. An interactive risk assessment and agency review is facilitated by the Fire Management Officer. 

It is up to you to work with your Fire Management Officer and Human Resource staff to initiate and file a Risk Mitigation/Waiver and ensure you take the agreed upon medical mitigations while fighting fire. Until the Risk Mitigation/Waiver is processed you’ll be prohibited from completing the Work Capacity Test and participating in arduous duty.

Firefighters will receive instructions from your agency for participating in the Risk Mitigation/Waiver process within five days of receiving a ‘Not Qualified’ determination letter.

  • The Risk Mitigation/Waiver Process includes two levels of appeal. During the first level you’ll work with your Fire Management Officer and your Human Resource staff to conduct a risk assessment and determine if your non-qualifying medical condition can be mitigated. This process must take no more than 60 days.
  • For non-complex medical conditions the process may take less than two weeks. You have the option to request a 15-day extension or opt out of the process at any time.
  • If you don’t receive an acceptable decision in the first level of the process and you have received a Not Qualified ‘static and stable’ determination from the reviewing medical officer, you can request a second level agency review and have your case forwarded to the Department of the Interior Medical Review Board.

There are two levels of risk-mitigation. Once the exam has been completed, the reviewing medical officer will draft a determination letter that is sent to the individual.  If the individual is Not Qualified -- static and stable, the Human Resources staff sends a letter that includes instructions on how to participate in the Risk Mitigation/Waiver process.

Below is additional information about the the Level 1 and 2 Risk Mitigation/Waiver processes, as well as Frequently Asked Questions about the medical exam program. 

Graphic showing the wildland firefighter risk-mitigation waiver steps. Identical information is contained on the adjoining website.
Wildland firefighter medical examination risk-mitigation waiver process.


We understand the complexity of medical exams and the medical standards program, but each of these processes help to enhance the safety of our firefighting workforce. These frequently asked questions are here to help you through the process! 

For one-on-one technical assistance or questions please contact us at:


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