MFPRSI. Municipal Fire & Police Retirement System of Iowa


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Employer Forms

Please utilize these forms to properly enroll new employees with MFPRSI. It is preferable to type the information on the form, but you may also handwrite the information on the form and submit.

Please utilize these forms to notify MFPRSI of changes concerning your employees who are enrolled in the retirement system.

In order to help us keep accurate records, please notify us when a member leaves the city’s employment. Please complete the form below, Termination Notification Form, for each member terminating employment and mail or fax this form to us at your earliest convenience.

MFPRSI will contact the member and inform them of their options regarding the Chapter 411 plan.

Medical Protocol Forms


The Code of Iowa provides for the creation and administration of a disability program for fire fighters and police officers covered by Iowa Code Chapter 411. The statute authorizes MFPRSI's board of trustees to select a medical board [411.5(8)] and to implement various program requirements, as follows:

  1. Creation of a statewide network for conduct of the entrance medical examinations for fire fighters and police officers, in consultation with the Medical Board. [411.5(8)] Effective January 1, 2005.
  2. Establishment of a wellness guideline for dissemination to the employing cities, for consideration as a voluntary program, which is subject to collective bargaining. [Iowa Code 400.8A]
  3. Formulation of revised protocols for pre-employment medical examinations for police officers and fire fighters. [400.8] NFPA 1582 Chapter 6 and ACOEM Guidance for Medical Evaluation of Law Enforcement Officers for firefighters and police officers, respectively.  Effective March 1, 2016.

Expiration of Medical Examination Report

The medical examination report prepared as a result of a medical examination of an applicant pursuant to the retirement system’s medical protocols may be relied upon by a city for twelve months after the date of the report, provided; however, if the date of commencement of employment is more than sixty days after the date of the medical examination, the applicant must certify whether he or she has had a material change in medical status since the date of the examination. An updated medical examination and report is required prior to hiring in the event the applicant does not begin employment within the twelve-month period, or if the applicant does not begin employment within the 60 day period and cannot certify that there has been no material change in medical status.

If a member's date of hire is more than 60 days following the date the physician signed the protocol exam form, they must fill out the following form:



Please note that the NFPA 1582 standards automatically disqualify individuals with certain medical conditions.  Under the Americans with Disabilities Act (ADA), however, an individual may not be automatically disqualified from a position based on a certain diagnosis or medical history.  Instead, the ADA requires a case-by-case evaluation of the individual’s ability to perform the essential functions of the job with or without reasonable accommodation and without posing a direct threat to self or others.  For that reason, any automatic disqualifiers in the above-referenced protocol standards must be disregarded.


In addition to the ACOEM standards police officer candidates must complete a stress test.  Candidates must achieve a level of 12 METS on a treadmill with no evidence of ischemia, arrhythmias, or other cardiovascular conditions that may interfere with the safe performance of a police officer's job duties.