Get Uscg Cg-5197 2020-2025

Completing the USCG CG-5197, Occupational Health Surveillance Questionnaire, is essential for ensuring the health and safety of personnel. This guide provides step-by-step instructions to assist users in accurately filling out the form online, making the process straightforward and efficient.

Follow the steps to successfully complete your USCG CG-5197 form.

1. Click ‘Get Form’ button to access the USCG CG-5197 and open it for editing.
2. Begin by entering your date of submission at the top of the form to establish a clear record.
3. Fill in your full name, using the last name first followed by your first name and middle initial.
4. Enter your rank or rate in the designated field to specify your position within the Coast Guard.
5. Provide your home address or military unit to ensure proper identification and communication.
6. Indicate your sex and date of birth to complete your personal information.
7. Describe your current job by summarizing your job description in the corresponding field.
8. In Part I, list your occupational history, starting with your current position and listing all jobs held. Be specific, detailing each job title and the associated work activities.
9. For each job, record the company or military unit, along with the county and state where you worked, as well as the dates of employment.
10. Document any exposure to potential hazards in the workplace, categorizing them as physical, chemical, or protective equipment worn.
11. Include any secondary jobs you have held, followed by listing hobbies and active sports, totaling the relevant dates.
12. Move to Part II, where you will answer questions regarding respiratory symptoms experienced since your last examination. Answer by checking 'yes,' 'no,' or 'not sure.'
13. If applicable, note smoking habits, indicating age of onset and estimated quantities, making sure to be as accurate as possible.
14. Review all provided information for accuracy before proceeding.
15. Once completed, save your changes, download the form for your records, print it if necessary, or share it according to the requirements.

Ensure the health and safety of personnel by completing your USCG CG-5197 form online today.