Get Ansi Asme B30 5 Medical Qualifications Form

Filling out the ANSI/ASME B30.5 Medical Qualifications Form online is an essential step for obtaining or renewing a Massachusetts Hoisting license. This guide provides clear instructions to help users navigate each section of the form effectively.

Follow the steps to complete the form accurately.

1. Click ‘Get Form’ button to access the document and open it in your preferred editing tool.
2. Begin by entering the applicant's information. This includes the first name, middle initial (M. I.), last name, and if applicable, the Massachusetts Hoisting License number. Next, provide the home street address, social security number, city, state, zip code, and email address.
3. The medical qualifications section must be completed by the licensed primary care physician. They will confirm whether the applicant meets the specified medical qualifications by selecting 'YES' or 'NO' for each requirement. This includes visual acuity, color distinction, hearing ability, physical capabilities, depth perception, and the absence of substance abuse or medical conditions.
4. If the applicant does not meet one or more qualifications, the physician must determine whether this affects the applicant's ability to operate hoisting machinery. Select 'YES' or 'NO' and provide an explanation on any failed requirements if applicable.
5. The physician must then confirm whether the patient medically qualifies to operate hoisting machinery by checking the appropriate box and providing their signature, printed name, state license number, and date.
6. Finally, after all fields are completed, ensure that both the applicant’s and physician's signatures are added. Users can then save the changes, download, print, or share the filled form as needed.

Complete your ANSI/ASME B30.5 Medical Qualifications Form online today!