Nasa Competition License Physical Examination Instructions
ADVERTISEMENT
1
2
3NATIONAL AUTO SPORT ASSOCIATION
P.O. Box 2366
Napa Valley, CA 94558
(510) 232-6272
(510) 277-0657 FAX
Memorandum to Examining Physician:
NASA
The three pages of this form are collectively referred to as the “Physical Examination.”
You are being asked to examine this applicant for the purpose of obtaining an
Competition
automobile racing license. This form concentrates on the organ system and disease
processes that may jeopardize the applicant or others while attending a competitive
License
racing event. If you deem that the applicant may be in questionable condition, the
Physical
matter may be turned over to the NASA Medical Director for review.
Page One (this page) - instructions for completing the Physical Examination form,
Examination
and should be read carefully by both the examining physician and the applicant.
Page Two of the Physical Examinat ion form is to be completed by the applicant.
Instructions
Page Three of the Physical Examination form is to be completed by a Physician.
A. The functional suggested requirements of a driver in a competition automobile are:
1.
Ability to rapidly operate acceleration, braking, and steering mechanisms / systems.
2.
Vision: distant vision correctable to 20/40 each eye, ability to distinguish basic colors, and peripheral vision to
70 degrees in the horizontal median for each eye.
3.
Should have minimal chance of sudden incapacitation from any disease process.
4.
Ability for rapid mental activity, problem solving, and decision-making.
B. The environment this applicant may operate in is:
1. Temperature extremes from 0 degrees (F) to 120 degrees (F) for long periods of time.
2. Smoke, fumes, vapor, caustic chemicals, and dust.
3. Loud noise and vibration.
4. Increased potential for exposure to fire.
Special Cases:
In a case where consults are needed, the consultant should be made aware of the information in Section A
and Section B of this memorandum.
Requirement of All Applicants *
All applicants must submit a completed APPLICANT’S MEDICAL HISTORY and PHYSICIAN’S EXAM. Similar
forms from other recognized organization and agencies may be acceptable, however the applicant will be held
accountable to the rules, laws, and other parameters, as set forth by the issuing organization or agency.
Renewals:
Applicants that are less than 40 years old must renew their Physical Examination every five years.
Applicants that are at least 40 years old must renew their Physical Examination every three years.
Applicants that are at least 50 years old must renew their Physical Examination every two years.
Applicants that are at least 70 years old must renew their Physical Examination every 12 months.
Note to the examining physician: Please note the “Renewals” section of this document (above).
Consideration should be given to the length of time between examinations, unless otherwise specified with
highlighted notation in the comment section found on the PHYSICIAN’S EXAMINATION page of this
document.
Exceptions:
*
Medical Waivers may be granted in certain circumstances with the approval of the proper authorities, as listed
on the Application for a Medical Wavier form. Drivers that have been granted a Medical Waiver may be
subject to special requirements as the NASA Medical Director sees fit. Temporary Medical Waivers may be
granted to the participants of other recognized organizations that are participating in a specific event as a
“guest group,” or events that are co-hosted or co-sanctioned at the discretion of the NASA Regional Director.
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Business