Special Forces Physical Exam Checklist (Dd Form 2808, Dd Form 2807-1)
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1SPECIAL FORCES PHYSICAL EXAM CHECKLIST
as of 20150730
Chapter 2, Chapter 5, para 5-3 (a-v), Chapter 8, para 8-12 (a, b, g), 8-13 (a - c), 8-14 (a7), 8-24 (a1 & 2)
NAME______________________________ CLASS / YG____________
SSN(last 4)_____________________
STN__________________
Block #
DD Form 2808 pages 1-3, Report of Medical Examination
1 - 15b
________
Examinee information / General Information, all legible and current
15c
________
Purpose of exam ( SF / SFAS / SFQC)
16
________
Name of examining location -- Hospital / Clinic / TMC
17 - 42
________
Clinical Evaluation (Any Abnormalities must be explained in notes)
30
________
Anus and Rectum (only normal) or DRE WNL
35
________
Feet (Should not be symptomatic, pes planus)
43
________
Dental ( Must be Acceptable, Class 1 or 2)
45
________
Urinalysis (Must be < than 2.00 specific gravity)
45a
________
Albumin (Negative or trace only)
45b
________
Sugar (Negative only)
47
________
HGB (Male: 13.5 or higher; Female: 12.0 or higher)
48
________
Blood Type
49
________
HIV (Negative only)
53 - 55
________
Height / Weight -- (If over max weight include tape test)
57
________
Pulse (Not over 99)
58a - c
________
Blood Pressure (MAX’s 140 / 90) (MIN’s 90 / 60), If high or low, will need a 5 day BP Check
59
________
Vivid Red / Green Pass (Required of SM when he fails color test in item # 66
61
________
Far Vision (Must Correct to 20/20 in both eyes)
62
________
Refraction (Required if vision does not correct to 20/20 in each eye with spectacle or contacts, OR had Lasik/PRK, OR if
uncorrected vision is worse than 20/70 in either eye; In between + or - 8 diopters max)
63
________
Near vision (Must correct to 20/20 in both eyes)
66
________
Color Vision (If SM fails PIP or falant test, must be able to pass Vivid Red / Green test, item # 59)
71a
________
Hearing - 500 - 2000hz - Average less than 30db per ear, not one range above 35db
3000hz - not more than 45db, 4000hz - not more than 55db
72b
________
Valsalva (Should be SAT OR +)
73
________
In the Notes Section: No Fear Statement, Hemmocult / Occult Blood, CHOL, LDL, HDL, TRI, Sickle Cell, RPR, EKG must be
signed by the PHYSICIAN, / Chest X-Ray (NML or NEG) only
74a
________
Qualified / Not Qualified (Must state SF / SFAS Training )
74b
________
Physical Profile and Category (MIN 111221)
81a, 82a, 8 ________
Doctor (MD, DO or MC)
83a
________
Dentist (DC or DDS) signature
Block #
DD Form 2807-1 pages 1-3, Report of Medical History
1 - 6b
________
Examinee information, legible and current
6c
________
Purpose of exam ( SF / SFAS / SFQC)
8
________
Current Medications
9
________
Current Allergies
10 - 28
________
Completely filled out, All Yes answers must be explained in Item 29, page 2, 2807-1
29
________
All Yes answers will be fully explained by examinee
30
________
All Yes answers by the examinee will be fully explained by PA or DR
30b - c
________
Doctor or Physician Assistant signature and date
All Lab results should be annotated on DD 2808 – Retain copy of lab printout in Residual file but do not scan in with physical
Chest X-ray – Should be annotated on DD 2808 as Normal - Retain copy of lab printout in Residual file but do not scan in with physical
EKG / ECG – Should be annotated on DD 2808 as Normal - Retain copy of lab printout in Residual file and
scanned in with physical
Physical QC’d BY: _______________________________Physical QC’d BY: _________________________________
RECRUITER
CENTER COMMANDER
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