Fire Department Safety Officers Association
2875 W. Ray Rd., 6-315 Chandler, AZ 85224
248-880-1864 •

Incident Safety Officer Skills Validation Affidavit

 Name: ___________________________________  Last 4 SS#: _______________________________
 Agency: __________________________________  Rank: ____________________________________
 Address: _________________________________  Address 2: _______________________________
 City: _____________________________________  State: _____________     Zip: ________________
 Phone: ___________________________________  Email: ___________________________________
Date of class attendance, if applicable: ________________________________________________

Required Skill Sheets
Below are your six randomly selected required skill sheet numbers.

Skill sheets can be found at
Applicant's Validation Statement (Required)

I verify that I have completed the requisite skill sheets provided by the FDSOA for ISO

certification. I am only required to return this affidavit but I understand that the FDSOA
may conduct random audits and request completed skill sheets.
Candidate's Signature: ________________________________________      Date: _______________
Employer Skills Validation Statement (Required)
I verify that I am a Chief Officer for the above applicant’s agency and the said applicant has
completed requisite skills sheets developed by the FDSOA as written in NFPA1521,
Standard for Fire Department Safety Officer Professional Qualifications (2020):
Print Name: __________________________________________________    Title: ________________

Signature: ___________________________________________________      Date: _______________

Certificates will not be issued until receipt of the signed affidavit within one year of the exam date.

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