Tier 4 Program

Tier 4 Health Assessment 

Tier 4 is a program that places members in a category or tier based on their annual physical assessment.  Historically, we have always removed people from active duty if we saw something during their physical that was unhealthy, dangerous, or physically limiting. These not-fit-for-duty members were prescribed rehabilitation methods with the goal of returning them back to active duty as soon as possible.  This program is rehabilitative, not punitive.

Currently, we now place members in one of four tiers to better track and assess their health.  These are:

Tier 1: Minimal health parameters to which Phoenix Fire Department members should maintain for field conditioning.  What does this mean?  You are fit-for-duty.
Tier 2:    Health issues noted where interventional support or change is recommended.  What does this mean?  Some of your health parameters are starting to decline when compared to previous health physicals.  It’s recommended that you reverse this trend and stay healthy.
Tier 3: Health issues sufficient for mandatory referral for wellness/fitness intervention, but removal from the field is not yet required.  What does this mean?  Noticeable health parameters have declined compared to previous health physicals and/or are in unhealthy ranges.  You need to participate in a healthy regiment.
Tier 4:

Health issues sufficient enough to mandate removal from field, at the clinicians discretion, and mandatory referral for wellness/fitness intervention.  What does this mean?  You are not fit-for-duty, thus not cleared to work in the firefighting field.  We will help you become better to return you to the firefighting field as soon as possible.

Health Parameters for Firefighters

With Tiers to Assess the Need for Health/Wellness Intervention

  • Body Fat percentage*
  • Cardiac Stress Test*** using the Gerkin Protocol
  • Blood Sugar Testing during a fasting state
  • Blood Pressure

Based on the most recent medical information and assessment of firefighter health parameters, the Tier levels have been adjusted as follows:

Per Dr. James Fleming July 2010

Health Standards Tier 1 Tier 2 Tier 3 Tier 4
Body Fat %* < 20% Male
< 24% Female
20-24% Male
24-29% Female
25-30% Male
30-34% Female
> 30% Male
> 34% Female
Blood Pressure < 120/80 120/80 – 139/89 140/90 – 159/109 > 160/110
Blood Sugar HbA1c+ 65-99
< 6.0
6.0 –7.5
> 7.5-8.0
> 300
> 8.0**

*Tier 4 for Body Fat % is only indicated if also includes other clinical risk factors

** HbA1c will not be used as a factor for removal from field unless above 10.1 (even though NFPA still considers values above 8.0 as significant and recommends duty restriction). However, firefighter must show improvement to below 8.0 within 3 months, or duty restrictions will be indicated.
Age adjusted MET’s level expected of fire members for Tier Management

Age Range Tier 1 Tier 2 Tier 3 Tier 4
< 40 > 14.0 13.0-13.9 12.0-12.9 < 12.0***
40-49 > 13.5 12.7-13.5 12.0-12.6 < 12.0***
50+ > 13.0 12.4-13.0 12.0-12.3 < 12.0***

*** Firefighters will be removed from field activity immediately for MET levels below 11.0. For those who are between 11.0 and 12.0 members may be considered for remaining in field activities, as long as they do not demonstrate any clinical indications of cardiac disease, and they demonstrate improvement of their status within 3 months.


What if I’m in Tier 4 for one thing and Tier 1 for everything else?
With the exception of Body Fat percentage, levels in any Tier 4 category will make you a Tier 4 candidate.

What if I’m Tier 4 in only Body Fat percentage, and everything else is OK?
Elevated Body Fat percentage alone will not automatically make you a Tier 4 candidate, since it is possible to carry elevated body fat and still be healthy.  The medical staff will make a decision based on the individual.

What do I need to do to based on my Tier category?
Tier 1 - Keep up the good work.
Tier 2 - Participate in some lifestyle changes.
Tier 3 - Intervention is required based on the medical recommendation.
Tier 4 - Follow the medical requirements prescribed to return to active duty as quickly as possible.

Who decides what Tier I am in?  
The medical staff at your annual comprehensive physical will assess your health and will assign you a Tier number.

Who will remove me from the field?  
The same medical staff, along with the Medical Director will ultimately decide to remove you from active duty in fire fighting operations.

Where will I work while in Tier 4?
An alternative duty will be assigned to you based on your limitations.

Is the Union on-board with this?  

Please note that all decisions are made on an individual basis by our health staff.  Current situations, conditions and efforts are taken into consideration with the goal of not mandating removal from active duty or fire fighting operations.  We would like to see everyone healthy and safe and it is our goal to help you get there and stay there.  

If you have any questions, you can call the Health Center at 495-5797.