Get Noaa Form 57-17-02 - Corpscpc Noaa

This guide offers clear, step-by-step instructions for completing the NOAA Form 57-17-02, the respirator medical evaluation questionnaire. Users of all experience levels will find this guide helpful in filling out the form accurately and efficiently.

Follow the steps to complete your NOAA Form online.

1. Press the ‘Get Form’ button to access the form and open it in your preferred online editor.
2. Begin with Part A, Section I: Employee Information. Fill in your full name, duty station, job title, department or branch, and the date. Provide your height, weight, age, and gender, and include your home or cell phone number and work phone number.
3. Also in Part A, Section II: Relevant Medical History, answer questions 1-9 thoroughly. Be prepared to provide details on any medical conditions or symptoms you may have experienced. This section is mandatory for all employees who use a respirator.
4. If applicable, answer questions 10-15 concerning any additional respiratory and health concerns. Ensure that you check 'Yes' or 'No' as appropriate.
5. Review Part A, Section III, and certify that the information provided is accurate by entering your name, signature, and date.
6. Proceed to Part B, Section I, and repeat completion of the employee information fields including your full name and duty station.
7. In Part B, Section II: Respirator Clearance Recommendation, complete the necessary checkboxes regarding the types of respirators you are authorized to use based on your medical evaluation.
8. Finalize by noting any limitations related to respirator use and the expiration duration of your clearance. Fill in the medical provider’s name, signature, place of employment, date, and phone number.
9. Once all required sections are completed, save any changes, and choose whether to download, print, or share your completed form as necessary.

Ensure your health and safety by completing the NOAA Form 57-17-02 online today!