                                       



                    POSITION TASK BOOK FOR THE POSITION OF




ALL-HAZARDS
STRIKE TEAM/TASK FORCE LEADER






	Version: April 2011







                        Position Task Book Assigned To:

Individual's Name:
Duty Station:
Phone Number:


                       Position Task Book Initiated By:

Official's Name:
Title:
Duty Station:
Phone Number:


Location Position Task Book was Initiated: ____________________

Date Position Task Book was Initiated: _____________________

                                       


                                   EVALUATOR
                                       
DO NOT COMPLETE THIS UNLESS YOU ARE RECOMMENDING THE TRAINEE FOR CERTIFICATION
                                       
                                       
VERIFICATION/CERTIFICATION OF COMPLETED POSITION TASK BOOK FOR THE POSITION OF:
                                       
                       FINAL EVALUATOR'S VERIFICATION
                                       
I verify all tasks have been performed and are documented with appropriate initials.
I also verify_________________________________________________________
has performed as a trainee and should therefore be considered for certification in this 
position.
                                       
                                       
FINAL EVALUATOR'S SIGNATURE: ____________________________________ 

DATE: ____________________

Evaluator's Printed Name:
Title:
Duty Station:
Phone Number:

                                       
                 AGENCY HEAD RECOMMENDATION FOR CERTIFICATION
                                       
I certify ____________________________________________________________
has met all requirements for qualification in this position and I recommend he/she be
certified for the position.
                                       

OFFICIAL'S SIGNATURE: _____________________________________

DATE: ______________________________

Official's Name:
Title:
Duty Station:
Phone Number:
                                       
                                       
                                       
                                       
                                       
                                       
                  NATIONAL INCIDENT MANAGEMENT SYSTEM (NIMS)
                         INCIDENT COMMAND SYSTEM (ICS)
                          POSITION TASK BOOKS (PTBs)
                                       
Position Task Books (PTBs) are designed to be used by any individual (trainee) interested in becoming certified under the National Incident Management System (NIMS). The PTBs are intended to be used to document experiences that indicate successful completion of tasks specific to an Incident Command System (ICS) position. The performance requirements for each position are associated with core ICS competencies, behaviors, and tasks as suggested to the Federal Emergency Management Agency (FEMA) by a multi-disciplined, highly-experienced expert panel. 

Trainees are evaluated during this process by qualified evaluators, and the trainee's performance is documented in the PTB for each task by the evaluator's initials and date of completion. An Evaluation Record will be completed by all evaluators documenting the trainee's progress after each evaluation opportunity. 

Successful performance of all tasks, as observed and recorded by an evaluator, will result in a recommendation to the trainee's Authority Having Jurisdiction (AHJ), that the trainee be certified in that position. Evaluation and confirmation of the trainee's performance while completing all tasks will normally require more than one training assignment and several different evaluators. Incidents lasting several days may involve multiple evaluators. Tasks may be evaluated on incidents, in a classroom simulation, in training and exercises, and in other work situations as long as there is a qualified evaluator.  

It is important performances be critically evaluated and accurately recorded by each evaluator.  All tasks should be evaluated.  

The NIMS Qualification Process Guide lists the definitions for trainee, evaluator, training officer, and AHJ. 


Responsibilities:

1. Authority Having Jurisdiction (AHJ):
   * Selecting trainees based on the needs of their organization or to fulfill their obligations to contribute to Incident Management Teams (IMTs) or other Mutual Aid agreements
   * Providing opportunities for evaluation and/or making the trainee available for evaluation

2. Trainee:
   * Reviewing and understanding instructions in the PTB
   * Identifying desired objectives/goals whenever an opportunity for evaluation is recognized
   * Providing background information to an evaluator
   * Assuring the evaluation record is complete
   * Completing all tasks for an assigned position within the timeframe allowed for that position (all tasks with an approval older than the allowed timeframe should be reevaluated)
   * Notifying the local AHJ /training officer when the PTB is completed, and obtaining a signature recommending certification
   * Retaining the original PTB and provide a copy of the PTB to the appropriate individual/department to obtain a qualification from your agency

3. Evaluator(s):
   * Being qualified and proficient in the evaluated position 
   * Meeting with the trainee and determining past experience, current qualifications and desired objectives/goals
   * Reviewing tasks with the trainee
   * Explaining to the trainee the evaluation procedures that will be utilized and which tasks may be performed during the evaluation period
   * Accurately evaluating and recording demonstrated performance of tasks 
   * Dating and initialing completion of the task to indicate satisfactory performance 
   * Documenting unsatisfactory performance
   * Completing the Evaluation Form found at the end of each PTB
   * Completing an Incident Personnel Performance Rating (ICS 225) form
   
4. Final Evaluator:
   * Being qualified and proficient in the position being evaluated
   * Reviewing the trainee's record to ensure completeness
   * Signing the verification statement on page 2 of the PTB when all tasks have been initialed 
   * Ensuring all tasks have been completed within the three years prior to submission for final approval (any task with an approval older than three years should be reevaluated and brought up to date)
      
5. Training Officer:
   * Providing the correct version of the PTB to the individual in order to document performance
   * Explaining to the trainee the purpose and processes of the PTB as well as the trainee's responsibilities
   * Tracking progress of the trainee
   * Identifying incidents or situations where the trainee may have evaluation opportunities
   * Identifying and assigning an evaluator that can provide a positive experience for the trainee, when the evaluation opportunity is within the AHJ's jurisdiction 
   * Receiving and filing documentation from the assignment

6.   AHJ Designee
   * Issuing the PTB to document task performance
   * Explaining to the trainee the purpose and processes of the PTB as well as the trainee's responsibilities
   * Tracking progress of the trainee
   * Identifying incident evaluation opportunities
   * Identifying and assigning an evaluator who can provide a positive experience for the trainee, and make an accurate and honest appraisal of the trainee's performance
   * Documenting the assignment
   * Conducting progress reviews
   * Conducting a closeout interview with the trainee and evaluator and assuring documentation is proper and complete


Competencies, Behaviors and Tasks:

Each PTB lists the performance requirements (tasks) for specific positions set by the ICS competencies and behaviors (September 2007) recognized by FEMA's National Integration Center and posted to the NIMS Resource Center Web site, http://www.fema.gov/emergency/nims/.

There are numerous bullet statements listed under each task. The bullet statements are listed as guidelines/examples for the evaluator to follow to ensure the intent of the task has been completed. Not all bullet statements for a task are required to be completed if the overall intent of the task has been satisfied.

Each task has a code associated with the type of training assignment where the task may be completed. These include: O = other, I = incident/event and R = rare event. Definitions for these codes may be found below*. While tasks can be performed in any situation, they should be evaluated on the specific type of incident/event for which they are coded. Tasks coded "I" should be evaluated on an incident/event, and so on. Performance of any task other than the designated assignment is not valid for qualification.

*Code:	
    O 	= Task can be completed in a variety of situations, such as in a classroom, exercise or simulation, incident or event, or daily job.
    I	=	Task should be performed on an incident or event which is managed under the ICS. 
    R	=	Rare events seldom occur and opportunities to evaluate trainee performance in real settings are limited. Examples of rare events include accidents, injuries, vehicle and aircraft crashes. Through interviews, the evaluator may be able to determine if the trainee could perform the task in a real situation.




Competency: Assume position responsibilities
Description: Successfully assume role of Strike Team/Task Force Leader and initiate position activities at the appropriate time according to the following behaviors. 

Behavior: Ensure readiness for assignment.

                                     TASK
                                     CODE
                              EVALUATION RECORD #
                                   EVALUATOR
   1. Obtain and assemble information and materials needed for kit. Kit assembled and prepared prior to receiving an assignment. Kit contains critical items needed for the assignment. Kit is easily transportable. The basic information and materials needed may include, but are not limited to, any of the following: 

Reference Material
      * Reference materials appropriate to the incident kind (e.g. Hazmat, law enforcement, fire, Public Works, Public Health, etc.)
      * Emergency Response Field Operations Guide (ER FOG)
      * Agency health and safety code handbook

Forms
      * ICS 206, Medical Plan
      * ICS 214, Activity Log 
   
Supplies
      * Office supplies appropriate to the function
                                       O



Behavior: Ensure availability, qualifications, and capabilities of resources to complete assignment.

                                     TASK
                                     CODE
                              EVALUATION RECORD #
                                   EVALUATOR
   2. Inspect assigned resources.
      * Ensure qualifications of personnel. 
      * Ensure personal protective equipment (PPE). 
      * Establish and maintain personnel accountability. 
      * Ensure type(s) of equipment/tools and operating condition.  
      * Establish common communications and frequency capability. 
      * Survey assigned resources for radio frequencies and ID numbers.
                                       I


   3. Ensure assigned resources are within contract compliance as applicable.
                                       O


   4. Request additional resources, logistical support, and/or replacements through supervisors based on Incident Action Plan (IAP), briefings, and discussions.
                                       I



Behavior: Gather, update, and apply situational information relevant to the assignment.

                                     TASK
                                     CODE
                              EVALUATION RECORD #
                                   EVALUATOR
   5. Report assigned resource status to agency/organization dispatcher or supervisor (include any units that fail to arrive or fail readiness inspection).
                                       I


   6. Brief assigned resources and determine route of travel, en route logistical needs (fuel, food, etc.). Determine proper formation, communications, and en route checkpoints.
                                       I


   7. Obtain IAPs or other relevant plans.
                                       I



Behavior: Establish effective relationships with relevant personnel.

                                     TASK
                                     CODE
                              EVALUATION RECORD #
                                   EVALUATOR
   8. Establish and maintain positive interpersonal and interagency working relationships.  
                                       I



Behavior: Establish organization structure, reporting procedures, and chain of command of assigned resources.

                                     TASK
                                     CODE
                              EVALUATION RECORD #
                                   EVALUATOR
   9. Organize assigned resources into configurations that meet incident/tactical objectives.
                                       I



Behavior: Understand and comply with ICS concepts and principles.

                                     TASK
                                     CODE
                              EVALUATION RECORD #
                                   EVALUATOR
   10. Develop the organization structure necessary to manage the incident.
      * Maintain appropriate span of control.
                                       I


   11. Apply the ICS. 
      * Follow chain of command. 
      * Use appropriate ICS forms.
      * Use appropriate ICS terminology.
                                       I




Competency: Lead assigned personnel 

Description: Influence, guide, and direct assigned personnel to accomplish objectives and desired outcomes in a potentially rapidly changing environment.

Behavior: Model leadership values and principles. 

                                     TASK
                                     CODE
                              EVALUATION RECORD #
                                   EVALUATOR
   12. Exhibit principles of duty.
      * Be proficient in the job, both technically and as a leader.
      * Make sound and timely decisions.
      * Ensure tasks are understood, supervised, and accomplished.
      * Train and mentor assigned subordinates.
                                       I


   13. Exhibit principles of respect.
      * Know subordinates and look out for their well-being.
      * Keep subordinates informed.
      * Build the team.
      * Assign subordinates in accordance with their capabilities.
                                       I


   14. Exhibit principles of integrity.
      * Know yourself and seek improvement.
      * Seek responsibility and accept responsibility for your actions.
      * Set the example.
                                       I



Behavior: Ensure the safety, welfare, and accountability of assigned personnel.

                                     TASK
                                     CODE
                              EVALUATION RECORD #
                                   EVALUATOR
   15. Provide for the health, safety, and welfare of assigned resources.
      * Recognize potentially hazardous situations in the work environment.
      * Monitor condition of assigned resources.
      * Account for assigned resources.
      * Provide for care of assigned resources and notify supervisor in event of sickness, injury, or accident.
                                       I


   16. Ensure assigned resources are following health and safety guidelines appropriately.
                                       I


   17. Demonstrate ability to coordinate and use multiple frequencies.
                                       I



Behavior: Establish work assignments and performance expectations, monitor performance, and provide feedback.

                                     TASK
                                     CODE
                              EVALUATION RECORD #
                                   EVALUATOR
   18. Assign tasks to resources based on IAP or relevant operational plans, division/group assignments, and resource capabilities.
                                       I


   19. Determine and provide for assistance or corrections to assigned work task(s) during operational period.
      * Contact supervisor to review tactical effectiveness. 
      * Identify need for additional assistance, logistical support, and replacements due to slow progress or unexpected events (e.g., types of resources). 
      * Evaluate recommendations from subordinate supervisors (e.g.,split assignment with another division). 
                                       I



Behavior: Emphasize teamwork.

                                     TASK
                                     CODE
                              EVALUATION RECORD #
                                   EVALUATOR
   20. Establish cohesiveness among assigned resources.
      oo Provide for open communication.
      oo Seek commitment.
      oo Set expectations for accountability.
      oo Focus on the team result.
                                       I



Behavior: Coordinate interdependent activities.

                                     TASK
                                     CODE
                              EVALUATION RECORD #
                                   EVALUATOR
   21. Establish communication with supervisors and adjoining resources.
                                       I


   22. Ensure transportation needs are met as specified in the IAP or relevant plans.
      * Coordinate any additional transportation needs. 
      * Inform supervisor if transportation needs cannot be met.
      * Ensure assigned resources arrive at assignment location.
                                       I


   23. Coordinate activities with adjacent Strike Team/Task Force Leaders and single resources.
      * Contact adjoining resources. 
      * Make list of supervisors of adjoining resources. 
      * Inform adjoining resources of status. 
      * Receive status of adjoining resources. 
      * Determine communication channels with adjoining resources from IAP or relevant plans. 
      * Maintain communication with assigned resources.
                                       I




Competency: Communicate effectively
 
Description: Use suitable communication techniques to share relevant information with appropriate personnel on a timely basis to accomplish objectives in a potentially rapidly changing environment.

Behavior: Ensure relevant information is exchanged during briefings and debriefings.

                                     TASK
                                     CODE
                              EVALUATION RECORD #
                                   EVALUATOR
   24. Brief and keep subordinates informed and updated. 
      * Ensure expectations are communicated and understood.
                                       I


   25. Attend operational briefings and meetings as directed.
      * Provide information as requested.
      * Keep supervisor informed of issues and potential problems.
                                       I


   26. Brief assigned resources using information from IAP or relevant plans. 
      * Planned objectives and supervisor control assignments
      * Work standards and expectations
      * Weather 
      * Communication 
      * Current situation status 
      * Specific hazards and threats
      * Emergency medical procedures
                                       I


   27. Brief relief forces. 
      * Current status/conditions/concerns regarding assignment
                                       I


   28. Establish contact or communication procedures for incident camp.
      * Ensure resources arrive at remote locations (such as an incident camp) at end of shift.
      * Ensure communications with assigned resources and supervisor.
                                       I


   29. Debrief with supervisor after operational period. 
      * Provide updated status and location of assigned resources.
                                       I


   30. Participate in functional area briefings and conduct unit After Action Reviews (AARs).
                                       I



Behavior: Ensure documentation is complete and disposition is appropriate.

                                     TASK
                                     CODE
                              EVALUATION RECORD #
                                   EVALUATOR
   31. Ensure ICS 214 (Activity Log) is completed and submitted by assigned resources.
                                       I


   32. Authorize personnel and equipment time.
                                       I



Behavior: Communicate and ensure understanding of work expectations within the chain of command and across functional areas.

                                     TASK
                                     CODE
                              EVALUATION RECORD #
                                   EVALUATOR
   33. Ensure understanding of work expectations by multiple resources within the chain of command.
                                       I



   
Competency: Ensure completion of assigned actions to meet identified objectives

Description: Identify, analyze, and apply relevant situational information and evaluate actions to complete assignments safely and meet identified objectives. Complete actions within established timeframe.

Behavior: Gather, analyze, and validate information pertinent to the incident or event and make recommendations for setting priorities.

                                     TASK
                                     CODE
                              EVALUATION RECORD #
                                   EVALUATOR
   34. Monitor progress/work during operational period.
      * Receive reports from subordinate supervisors. 
      * Conduct personal observations. 
      * Assess priorities and values to be protected (life, property, infrastructure, environment, etc.).
                                       I








Behavior: Make appropriate decisions based on analysis of gathered information.


                                     TASK
                                     CODE
                              EVALUATION RECORD #
                                   EVALUATOR
   35. Plan tactical action on assigned area based on objectives and supervisor assignments.
      * Identify impacts of modified objectives on resource assignments. 
      * Determine situations that might modify tactics.
                                       I



Behavior: Take appropriate action based on assessed risks.

                                     TASK
                                     CODE
                              EVALUATION RECORD #
                                   EVALUATOR
   36. Apply the Risk Management Process found in:
      * Step 1:  Situation Awareness 
      * Step 2:  Hazard Assessment 
      * Step 3:  Hazard Control 
      * Step 4:  Decision Point 
      * Step 5:  Evaluate
                                       I


   37. Ensure assigned resources apply appropriate tactics for assignment.
                                       I



Behavior: Modify approach based on evaluation of incident situation.

                                     TASK
                                     CODE
                              EVALUATION RECORD #
                                   EVALUATOR
   38. Compare objectives with accomplishments; adjust use of combinations of resources as conditions warrant to maximize effectiveness.
                                       I



Behavior: Anticipate, recognize, and mitigate unsafe situations.

                                     TASK
                                     CODE
                              EVALUATION RECORD #
                                   EVALUATOR
   39. Ensure assigned resources identify and correct unsafe actions or conditions.
      * Review health and safety message.
                                       I



Behavior: Follow established procedures and/or health and safety procedures relevant to given assignment.

                                     TASK
                                     CODE
                              EVALUATION RECORD #
                                   EVALUATOR
   40. Ensure assigned resources follow appropriate health and safety procedures.
                                       I



Behavior: Provide logistical support as necessary.

                                     TASK
                                     CODE
                              EVALUATION RECORD #
                                   EVALUATOR
   41. Ensure assigned resources have adequate supplies/equipment to meet identified tactical objectives.
      * Food and sanitation as needed
      * Potable water as needed
      * Radios
      * Transportation
                                       I



Behavior: Plan for demobilization and ensure demobilization procedures are followed. 

                                     TASK
                                     CODE
                              EVALUATION RECORD #
                                   EVALUATOR
   42. Ensure demobilization of resources.
      * Brief subordinate staff on demobilization procedures and responsibilities.
      * Ensure incident and agency/organization demobilization procedures are followed.
      * Inspect assigned resources to ensure they are ready to leave (e.g. rest, repairs, tools, fuel).
      * Determine travel routes and en route logistical needs. 
      * Determine travel information, communication, and checkpoints. 
      * Establish communication with home unit dispatch. 
                                       I





               INSTRUCTIONS FOR COMPLETING THE EVALUATION RECORD

There are four separate blocks allowing evaluations to be made. These evaluations may be made on incidents, simulations in classroom, or in daily duties, depending on what the PTB indicates. This should be sufficient for qualification in the position if the individual is adequately prepared. If additional blocks are needed, a page can be copied from a blank task book and attached.

COMPLETE THESE ITEMS AT THE START OF THE EVALUATION PERIOD:
Evaluator's Name, Incident/Office Title and Agency:  List the name of the evaluator, his/her incident position or office title, and agency.
Evaluator's Home Unit Address and Phone:  Self-explanatory
Incident Number:  The number next to the evaluator's name in the upper left corner of the evaluation record identifies a particular incident or group of incidents. This number should be placed in the column labeled "Evaluation Record #" on the PTB for each task performed satisfactorily. This number enables reviewers of the completed PTB to ascertain the qualifications of the different evaluators prior to making the appropriate sign-off on the PTB.
Location of Incident/Simulation:  Identify the location where the tasks were performed by agency and office.
Incident Kind:  Enter kind of incident (e.g. hazmat, wildland fire, structural fire, search and rescue, flood, tornado, etc.).

COMPLETE THESE ITEMS AT THE END OF THE EVALUATION PERIOD:
Number and Type of Resources:  Enter the number of resources and types assigned to the incident pertinent to the trainee's task book position.
Duration:  Enter inclusive dates during which the trainee was evaluated. This block may indicate a span of time covering several small and similar incidents if the trainee has been evaluated on that basis (e.g. several initial response wildfires in similar fuel types).
Recommendation:  Check as appropriate and/or make comments regarding the future needs for development of this trainee.
Date:  List the date the record is being completed.
Evaluator's Initials:  Initial here to authenticate recommendations and to allow for comparison with initials in the PTB.
Evaluator's Relevant Certification:  List your certification relevant to the trainee position you supervised.
                               Evaluation Record
                                       
--------------------------------------------------------------------------------

                                 TRAINEE NAME
--------------------------------------------------------------------------------

                               TRAINEE POSITION
                                       
#1
Evaluator's name:
Incident/office title & agency:
Evaluator's home unit address & phone:
        Name and Location
of Incident or
Situation
(agency & area)
Incident Kind
(hazmat, tornado, flood, structural fire, wildfire, search & rescue, etc.)
       Number & Type of
Resources
Pertinent to
Trainee's Position
                 Duration
(inclusive dates
in trainee status)



                                       
The tasks initialed and dated by me have been performed under my supervision in a satisfactory manner by the above named trainee. I recommend the following for further development of this trainee.
______	The individual has successfully performed all tasks for the position and should be considered for certification.
______	The individual was not able to complete certain tasks (comments below) or additional guidance is required.
______	Not all tasks were evaluated on this assignment and an additional assignment is needed to complete the evaluation.
______	The individual is severely deficient in the performance of tasks for the position and needs further training in both required  knowledge and skills prior to additional assignment(s) as a trainee.

Recommendations: ______________________________________________________________________________________

_______________________________________________________________________________________________________

Date: ____________________________ Evaluator's initials: ________________________

Evaluator's relevant agency certification or rating:___________________________________________________________

#2
Evaluator's name:
Incident/office title & agency:
Evaluator's home unit address & phone:
        Name and Location
of Incident or
Situation
(agency & area)
Incident Kind
(hazmat, tornado, flood, structural fire, wildfire, search & rescue, etc.)
       Number & Type of
Resources
Pertinent to
Trainee's Position
                 Duration
(inclusive dates
in trainee status)



                                       
The tasks initialed and dated by me have been performed under my supervision in a satisfactory manner by the above named trainee. I recommend the following for further development of this trainee.
______	The individual has successfully performed all tasks for the position and should be considered for certification.
______	The individual was not able to complete certain tasks (comments below) or additional guidance is required.
______	Not all tasks were evaluated on this assignment and an additional assignment is needed to complete the evaluation.
______	The individual is severely deficient in the performance of tasks for the position and needs further training in both required knowledge and skills prior to additional assignment(s) as a trainee.

Recommendations: ______________________________________________________________________________________

_______________________________________________________________________________________________________

Date: ____________________________ Evaluator's initials: ________________________

Evaluator's relevant agency certification or rating:_____________________________________________________
                               Evaluation Record
                             (Continuation Sheet)
                                       
--------------------------------------------------------------------------------

                                 TRAINEE NAME
--------------------------------------------------------------------------------

                               TRAINEE POSITION
                                       
#3
Evaluator's name:
Incident/office title & agency:
Evaluator's home unit address & phone:
        Name and Location
of Incident or
Situation
(agency & area)
Incident Kind
(hazmat, tornado, flood, structural fire, wildfire, search & rescue, etc.)
       Number & Type of
Resources
Pertinent to
Trainee's Position
                 Duration
(inclusive dates
in trainee status)



                                       
The tasks initialed and dated by me have been performed under my supervision in a satisfactory manner by the above named trainee. I recommend the following for further development of this trainee.
______	The individual has successfully performed all tasks for the position and should be considered for certification.
______	The individual was not able to complete certain tasks (comments below) or additional guidance is required.
______	Not all tasks were evaluated on this assignment and an additional assignment is needed to complete the evaluation.
______	The individual is severely deficient in the performance of tasks for the position and needs further training in both required knowledge and skills prior to additional assignment(s) as a trainee.

Recommendations: ______________________________________________________________________________________

_______________________________________________________________________________________________________

Date: ____________________________ Evaluator's initials: ________________________

Evaluator's relevant agency certification or rating:_____________________________________________________


#4
Evaluator's name:
Incident/office title & agency:
Evaluator's home unit address & phone:
        Name and Location
of Incident or situation
(agency & area)
Incident Kind
(hazmat, tornado, flood, structural fire, wildfire, search & rescue, etc.)
       Number & Type of
Resources
Pertinent to
Trainee's Position
                 Duration
(inclusive dates
in trainee status)



                                       
The tasks initialed and dated by me have been performed under my supervision in a satisfactory manner by the above named trainee. I recommend the following for further development of this trainee.
______	The individual has successfully performed all tasks for the position and should be considered for certification.
______	The individual was not able to complete certain tasks (comments below) or additional guidance is required.
______	Not all tasks were evaluated on this assignment and an additional assignment is needed to complete the evaluation.
______	The individual is severely deficient in the performance of tasks for the position and needs further training in both required knowledge and skills prior to additional assignment(s) as a trainee.

Recommendations: ______________________________________________________________________________________

_______________________________________________________________________________________________________

Date: ____________________________ Evaluator's initials: ________________________

Evaluator's relevant agency certification or rating:_____________________________________________________

