BIRTH CURRENT JOB DESIGNATION PART I - OCCUPATIONAL HISTORY Be as specific as possible; if you held more than one job with the same employer, list each job title and activity. Use additional sheets as needed. INSTRUCTIONS: Please complete the following work history; begin with your present job or military assignment, and list all jobs you have held. DATES WORKED COMPANY OR MILITARY UNIT County and state where worked FROM MO/YR TO MO/YR FULL/PART TIME JOB CHECK FULL PART POTENTIAL HAZARDS.
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How to fill out the USCG CG-5197 online
The USCG CG-5197 form is an essential document used to collect occupational health information for individuals in the U.S. Coast Guard. This guide provides step-by-step instructions to help users complete the form online with clarity and ease.
Follow the steps to complete the USCG CG-5197 form online
- Click the ‘Get Form’ button to obtain the CG-5197 form and open it for editing.
- Fill in your name and the date of submission at the beginning of the form.
- Provide your rank or rate, home address or military unit, sex, date of birth, and current job designation in the respective fields.
- In Part I, outline your occupational history by listing each job held. Start with your present job and go backward, specifying job titles, companies, and dates worked. Indicate whether the job was full-time or part-time.
- Detail any potential hazards you were exposed to in your previous jobs, including physical and chemical hazards, as well as any protective equipment worn.
- Include any secondary (moonlighting) jobs you have held, listing job titles and dates.
- Mention your hobbies and active sports, both past and present, in the designated section.
- Reflect on any work-related experiences you feel could have impacted your health and share your comments.
- In Part II, answer the respiratory symptoms questions by selecting 'Yes,' 'No,' or 'Not Sure' for each symptom listed.
- Indicate your smoking history by providing details on when you began, how many cigarettes, cigars, or pipefuls you smoke daily.
- Review all the information provided for accuracy and completeness.
- Once all sections are completed, save changes or download, print, or share the completed form as needed.
Complete your USCG CG-5197 form online today for efficient record-keeping.
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