Form Cg-719k - Mershant Mariner Physical Examination Report
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4Department of Transportation
OMB-2115-0514
U.S. Coast Guard
Merchant Mariner Physical Examination Report
Page 1
CG-719K (Rev 1/02)
Instructions
If you are applying for:
1. ORIGINAL LICENSE AND/OR QUALIFIED RATING DOCUMENT (i.e., First Rating of Able Seaman,
Qualified Member of the Engine Department, and Tankerman) – Submit this report, completed by your
physician.
2. RENEWAL OF LICENSE AND/OR QUALIFIED RATING DOCUMENT – You may:
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Submit this report, completed by your physician; or
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Submit a certification by a physician in accordance with Title 46, CFR, 10.209(d) or 12.02-27(d).
3. RAISE-IN-GRADE (LICENSES) – You may:
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Submit this report, completed by your physician; or
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Submit a certification by a physician in accordance with Title 46, CFR, 10.207(e).
Instructions for Licensed Physician / Physician Assistant / Nurse Practitioner
The U. S. Coast Guard requires a physical examination / certification be completed to ensure that all holders of Licenses and Merchant
Mariner Documents are physically fit and free of debilitating illness and injury. Physicians completing the examination should ensure that
mariners:
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Are of sound health.
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Have no physical limitations that would hinder or prevent performance of duties.
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Are physically and mentally able to stay alert for 4 to 6-hour shifts.
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Are free from any medical conditions that pose a risk of sudden incapacitation, which would affect operating, or working on
vessels.
Below is a partial list of physical demands for performing the duties of a merchant mariner in most segments of the maritime industry:
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Working in cramped spaces on rolling vessels.
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Maintaining balance on a moving deck.
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Rapidly donning an exposure suit.
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Stepping over doorsills of 24 inches in height.
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Opening and closing watertight doors that may weigh up to 56 pounds.
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Pulling heavy objects, up to 50 lbs. in weight, distances of up to 400 feet.
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Climbing steep stairs or vertical ladders without assistance.
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Participating in firefighting and lifesaving efforts, including wearing a self-contained breathing apparatus (SCBA), and
lifting/controlling fully charged fire hoses.
1.
Detailed guidelines on potentially disqualifying medical conditions are contained in Navigation and Vessel Inspection Circular
(NVIC) 02-98. Physicians should be familiar with the guidelines contained within this document. NVIC 02-98 may be obtained
from
index
or by calling the nearest USCG Regional Examination Center.
2.
Examples of physical impairment or medical conditions that could lead to disqualification include impaired vision, color vision or
hearing; poorly controlled diabetes; multiple or recent myocardial infarctions; psychiatric disorders; and convulsive disorders. In
short, any condition that poses an inordinate risk of sudden incapacitation or debilitating complication, and any condition requiring
medication that impairs judgment or reaction time are potentially disqualifying and will require a detailed evaluation.
3.
Engineer Officer, Radio Officer, Offshore Installation Manager, Barge Supervisor, Ballast Control Operator, QMED and
Tankerman applicants need only to have the ability to distinguish the colors red, green, blue and yellow. The physician should
indicate in Section IV the method used to determine the applicant’s ability to distinguish these colors.
4.
This applicant should present photo identification before the physical examination/certification.
Previous Editions Obsolete
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