Form Cg-719k - Medical Evaluation Report Page 8
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9Page 8 of 9 of CG-719K Rev. 01-09
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If the verifying medical practitioner is unable to conduct the practical demonstration, the applicant should be referred to a
competent evaluator of physical ability. The Coast Guard recognizes that all medical practitioners may not have the
equipment necessary to test all of the tasks as listed. Equivalent alternate testing methodologies may be used. For
further information,
see enclosure (2) of NVIC 4-08.
►
If the applicant is unable to perform any of the following functions, the examining practitioner should provide information
on the degree or the severity of the applicant's inability to meet the standards. The results of any practical demonstration
I
or attendant physical evaluation should be recorded in the Section
X .
List of tasks considered necessary for performing ordinary and emergency response shipboard functions:
Shipboard Tasks,
function, event or
Related Physical Ability:
The examiner should be satisfied that the applicant:
condition:
Routine Movement on
slippery, uneven, and
Maintain Balance (equilibrium).
Has no disturbance in sense of balance.
unstable surfaces.
Routine access
Climb up and down vertical ladders and
Is able, without assistance, to climb up and down vertical
between levels.
stairways.
ladders and stairways.
Routine movement
Is able without assistance, to step over a door sill or
Step over high door sills and coamings,
between spaces and
coaming of 24 inches (61 centimeters) in height. Able to
and move through restricted accesses.
compartments.
move through a restricted opening of 24 inches.
Is able, without assistance, to open and close watertight
Open and close
Manipulate mechanical devices using
doors that may weigh up to 55 pounds (25 kilograms).
watertight doors, hand
manual and digital dexterity, and
Should be able to move hands/arms to open and close
cranking systems,
strength.
valve wheels in vertical and horizontal directions; rotate
open/close valve.
wrists to turn handles. Reach above shoulder height.
Is able, without assistance, to lift at least a 40 pound
Handle ship’s stores.
Lift, pull, push, and carry a load.
(18.1 kilogram) load off the ground, and to carry, push or
pull the same load.
Crouch (lowering height by bending
knees); kneel (placing knees on ground);
General vessel
and stoop (lowering height by bending at
Is able, without assistance, to grasp, lift and manipulate
maintenance.
the waist). Use hand tools such as
various common shipboard tools.
spanners, valve wrenches, hammers,
screwdrivers, pliers.
Emergency response
Crawl (the ability to move the body with
Is able, without assistance, to crouch, keel and crawl,
procedures, including
hands and knees); feel (the ability to
and to distinguish differences in texture and temperature
escape from smoke-
handle or touch to examine or determine
by feel.
filled spaces.
differences in texture and temperature).
Is able, without assistance, to intermittently stand on feet
Stand a routine watch.
Stand a routine watch.
for up to four hours with minimal rest periods.
React to visual alarms
Fulfills the eyesight standards for the merchant mariner
and instructions,
Distinguish an object or shape at a
credential(s) applied for. See footnote 1 of this table &
emergency response
certain distance.
enclosure (5) of NVIC 4-08.
procedures.
React to audible alarms
Fulfills the hearing capacity standards for the merchant
and instructions,
Hear a specified decibel (dB) sound at a
mariner credential(s) applied for.
emergency response
specified frequency.
procedures.
Make verbal reports or
call attention to
Describe immediate surroundings and
Is capable of normal conversation.
suspicious or
activities, and pronounce words clearly.
emergency conditions.
Is able, without assistance, to pull an uncharged 1.5 inch
Participate in
Be able to carry and handle fire hoses
diameter, 50’ fire hose with nozzle to full extension, and
firefighting activities.
and fire extinguishers.
to lift a charged 1.5 inch diameter fire hose to fire fighting
position.
Has the agility, strength and range of motion to put on a
Abandon ship.
Use survival equipment.
personal flotation device and exposure suit without
assistance from another individual.
Applicant Name: _______________________________________
Date of Birth:____________________________
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