Get Cg-4057 (rev - Uscg

Filling out the CG-4057 form is an important step for users in documenting their service and health records with the U.S. Coast Guard. This guide will provide you with clear instructions to navigate each section of the form effectively.

Follow the steps to accurately complete the CG-4057 form.

1. Click the ‘Get Form’ button to initiate the download process and access the form.
2. Begin by entering your name in the format of last name, first name, and middle name in the designated field.
3. Fill in the unit or station where you are currently assigned after 'Chronological Record of Service'.
4. Input the date you were detached from your previous assignment.
5. Enter your Social Security Number in the provided space.
6. Indicate your agreement or disagreement with the statements regarding your ability to perform your current duties at the time of separation.
7. Select one of the options to confirm whether you are able to perform your duties or have a high expectation of recovery.
8. Provide your grade or rate, the date, and your signature in the appropriate fields.
9. Complete the termination of health record section by describing any impairments documented in your health record that relate to your service.
10. Acknowledge receipt of copies of necessary documents by listing them, including CG-4057 and any medical examination reports.
11. In the command certification section, provide the date, the reason for health record termination, your title, and your signature.
12. Once all fields are completed, save your changes, and proceed to download, print, or share the form as needed.

Complete your CG-4057 form online today for an efficient documentation process.