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Guest crew member health questionnaire

Guest crew member health questionnaire 2026

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The document is a health questionnaire for guest crew members of the U.S. Coast Guard, designed to collect personal and medical information necessary for assessing their fitness for sea duty. It includes sections on applicant information, current health status, general and cardiac screening, immunization history, functional abilities, and applicant certification. The form must be completed and submitted 30 days prior to the project start date to ensure medical clearance.

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Click ‘Get Form’ to open the guest crew member health questionnaire in the editor.
Begin by filling out Section I: Applicant Information. Enter your name, year of birth, contact details, and emergency contact information. Ensure all fields are completed accurately.
Move to Section II: Current Health Information. List any health problems that require a physician's attention and medications you currently take. If there are none, check the 'NONE' box.
In Section III: General Screening, indicate any medical conditions experienced during adulthood by checking 'YES' or 'NO'. Provide explanations for any positive responses.
Continue to Section IV: Cardiac Screening and follow similar instructions as in the previous section regarding cardiac conditions.
Complete Sections V and VI regarding immunization and functional abilities screening, ensuring you check all applicable boxes.
Finally, sign and date Section VII: Applicant Certification to confirm the accuracy of your information before submitting the form.

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Versions	Form popularity	Fillable & printable
2018	4.8 Satisfied (177 Votes)

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