Get Cg 3822 Form

Filling out the Cg 3822 Form is an essential task for reporting injuries that occur in the line of duty within the U.S. Coast Guard. This guide will provide clear and detailed instructions to help users complete the form accurately and effectively online.

Follow the steps to fill out the form online.

1. Press the ‘Get Form’ button to access the Cg 3822 Form and open it in your preferred online editor.
2. Begin by entering your name in the designated field, ensuring to list your last name first, followed by your first name and middle initial.
3. Input your service number in the corresponding field, which is necessary for identification purposes.
4. Indicate your grade, either a rank or title, in the space provided.
5. Record the time, date, and place where the incident occurred in the appropriate fields.
6. State the name of the medical officer who first examined the individual in question.
7. Fill out the diagnosis section, specifying any conditions noted by the medical officer.
8. In the section regarding the individual's condition at the time of examination, mark whether they were under the influence of alcohol, barbiturates, narcotics, other substances, or not under the influence.
9. Provide details to support your opinion regarding substance influence in the relevant section, including any clinical findings and results from blood or other tests.
10. Describe the alleged circumstances surrounding the injury in the section provided.
11. Indicate whether a disability may result from the injury, specifying if it could be temporary, permanent partial, or permanent total.
12. Estimate the loss of duty time resulting from the injury and fill out any relevant details regarding the individual's duty status at the time of the incident.
13. Complete the military duty section by specifying what the individual was doing at the time of the injury, choosing the applicable options.
14. Detail the findings from your investigation, including time, date, place, and any pertinent documentation.
15. List sources of information, including names and addresses of witnesses, documentation, or other evidence for reference.
16. Provide remarks if necessary and ensure that the required signatures are included from the individual making the inquiry and the commanding officer.
17. Upon completion, you may save changes, download, print, or share the form as needed.

Complete your documents online with ease and accuracy.