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f PLAINTIFFS EXHIBIT UC-P-206
PHYSICAL STANDARDS
Fork Truck Operators
The following minimum physical standards are recommended for fork truck operators.
1. Sufficient use of hands and legs to manipulate controls.
2. Full rotation of neck in all directions.
3. Corrected vision of 20/40 in each eye.
4. Peripheral vision 140 minimum. 5. Adequate depth perception, minimum of two correct, on
Ortho sight screener or demonstration of safe operation by five years experience without visually related incident.
6. No condition or disease associated with loss of consciousness or vertigo attacks such as: seizure disorder, uncontrolled Meniere's syndrome, uncontrolled cardiac or hypertension problems.
7. Mental or emotional disorders which are not adequately control led.
DHG:mm 7/2/82
/fj /V'x
David H. Glenn, M.D. Medical Director
S. 0. P. PHYSICAL STANDARDS Heavy Equipment Operators
Medical Division
The following minimum physical standards are recommended for heavy equipment operators.
1. Sufficient use of hands and legs to manipulate controls.
2. Coordination, agility and strength required to climb in and out of cranes and other heavy equipment safely.
3. Full rotation of neck in all directions.
4. Corrected vision of 20/40 in each eye.
5. Peripheral vision 140 minimum.
6. Adequate depth perception, minimum of two correct, on Ortho sight screener or demonstration of safe operation by five years experience without visually related incident.
7. No condition or disease associated with loss of consciousness or vertigo attacks such as: seizure disorder, uncontrolled Meniere's Syndrome, uncontrolled cardiac or hypertensive problems.
8. Mental or emotional disorders which are not adequately controlled.
DHG:mm 7/2/82
L'S.pARTMtNT ot TRANSPORTATION
^,
MERCHANT MARINE PERSONNEL PHYSICAL EXAMINATION
U 6. COAST GUARD pr-719K (Rev. 3-67)___
(Instructions on reverse)
PORT
Medical Officer In Charge, U. S. Public Health Service
Please examine the below-named applicant as Indicated. The minimum physical standards are listed on the reverse
cf this form. If the applicant ia found physically competent this form should be bo marked and returned to him. If he la found not physically competent, this form, showing the reasons for the incompetent finding should tie returned,
not to the applicant, but to the Officer in Charge, Marine Inspection.
NAMt
OAT* or BIRTH
PLACE or MIRTH
ENDORSEMENT APPLIED PORI fChccJt)'
ABLE SEAMAN
I I T AHK1WAM
QUALIFIED MEMBER Of THE ENGINE DEPARTMENT
STEWARDS DEPARTMENT (Food Handw)
HEIGHT
WEIGHT
COLOR ETCS
COLOR HAIR
SIGNATURE OP APPlWant fjn pftftc* of ofiicmr iawulnj Ioib\)
EXAMINATION REQUESTED
VISUAL ACUITY. COLOR SENSE. HEARING AMO GENERAL PHYSICAL
I--I TO DETERMINE IP PREE TROM COMMUNICABLE
CONDITION ID1------------------------------------------------------------------------------------------------------------------------------------- DISEASE >
DAT* ISSUED
ISSUED BY
PORT
SI O MATURE
Officer In Charge, Marine Inspection
0) EXAMINATION -U. S. PUBLIC HEALTH SERVICE
I HEREBY CERTIFY that I have this day examined the above described applicant and make the following findings: (Additional comments on findings may be entered under remarks)
COLOR SENSE I 1 NORMAL (uA 1 1 NOT NORMAL >SJ" TEST GIVEN
RIGHT
*0/
VISION
LEFT
SO/
CORRECTED TOl CORRECTED TOl
*0/ *0/
10 NORMAL V) C w RIGHT
wv
SV
AUDITORY CANALS [0 DISCHARGE
HEARING
/ft
LEPT
wv
/Yf it
'
/* /tr
HEART
LUNOS
OTHER MAJOR DEFECTS
REMARCK" S
V
3I
req., reverse
NOTE
Considering the above findings and the requirements of applicable U. S. Coast Guard regulations, the applicant is I--| competent [0 incompetent for endorsement applied for:
| | ABLE SEAMAN
3 TANKERMAN
DATE
SIGNATURE OP APPLICANT (In pr*ncf o/NkIuJ CUic.t)
PORT
0 QUALIFIED MEMBER OP ENGINE DEP ARTI1IMT
signature or ueoical orncir..um:-8
(2 EXAMINATIOH-U . S. PUBLIC VEAL7H SERVICE
I HEREBY CERTIFY that I have this day examined the above described applicant and find that he is [0 is not free from communicable disease.
REMARKS
DATE
or (MATURE
applicant fin pf***OC#
oiM+dJCJsi Oltivt)
PORT
signature or medical orricER.uspns
PREVIOUS EDITIONS MAY BE USED
FROM: Commanding Officer, USCG, Marine Safety Office, Galveston, Texas TO: Medical Examining Personnel
SUBJ: Merchant Marine Personnel Physical Examination Standards; advisement of:
1. It has been found that some confusion can arise as to vhat standards are to be applied prior to considering an applicant (competent) or (incompetent) to perform his or her required duties. To assist you in making this determination below are listed extracts from Title 46 Code of Federal Regulations 10.02-5 (e), Part 12, Part 187 and 310.6(a)(3) for your guidance:
(a) No examination is required for Ordinary Seaman, or Wiper. However,
for Stewards Department (FH) (Food Handler) (46 CFR 12.25-20), the applicant
must be free from communicable disease.
"'
(b) 46 CFR 10.02-5(e)(2) states that epilepsy, insanity, senility, acute venereal disease or neurosyphitis, badly..impaired-hearing.-or other.-defects that would .render the applicant incompetent-to-perform their ordinary duties at .sea are causes for certification as incompetent.
(c) ABLE SEAMAN: Same as for an Original License as Deck Officer (see below).
(d)-QUALIFIED MEMBER ENGINE DEPARTMENT.-(0MED>.: ..Same as for an Original-License
as Engineer (see below).
,
...
.
***-: (e) TANKERMAN: Same as for an Original License as Engineer, "EXCEPT the color-vision test'will-be as for-a deck officer.
'
(f) DECK LICENSE: (Master, Mate, Pilot, Operator) - .Applicant must have uncorrected vision of at Least 20/100 in-both eyes correctable to at least .20/20 In one eye and 20/40 in the other. Color sense will be tested by PseudoIsochroOatic Plate Test.
(g) ENGINEER*s LICENSE: Applicant must have uncorrected vision of at least * 20/100 in both eyes correctable' to at least 20/30 In one eye and 20/50 in the other. Engineers are only required to distinguish! the colors red, blue, green and yellow.
..........(h) MARITIME SERVICE CADETS: Meet the same standards for Original License as a Merchant Marine .Officer (DECK or. ENGINEER,__respectively).------- -
2. Your cooperation in using thes
will be appreciated.
/R/T. INGRAHAM Captain, U. S. Coast Guard
-Officer In Charge, Marine Inspection '
DO NOT KEYPUNCH
PREPLACEMENT MEDICAL EXAMINATION HISTORY
RACE: White Black Other________ HARITAL STATUS: S M W D Sep. NO. CHILDREN: _ Temp. F. Pulse/Mir
FAMILY HISTORY: Father Living and well Sick Dead _
Mother Living and well SickDead _
Cause of _Death____
Cause of Death
Do you have any relatives ill or who have died with the following: {Include relationship)
Cancer
Heart trouble
Diabetes _EpilepsyStrokes Asthma Tuberculosis
f Brothers Living____ Dead I Sisters Living _____Dead
Nervousness
PERSONAL HISTORY: (Include dates) Injuries .
Illnesses ;._______________________________________________ _
Operations ________________________________________________________________________________
Hospital or sanitarium admissions Heaviest weight lbs. 19___________________ Weight gain/loss within last year? lbs. Reason______________________________ _______
Work absence due to illness or injury during last 3 years? Reason Female Applicants: Menstruation: RegularPain # Days Date last period began
Female disorders Details
Number of pregnancies Number of miscarriages or abortions Have you had or do you now have the following: (Number the "yes" answers and include details and dates under "Explanation"
Allergies Hay fever Hives Asthma Ear trouble Fainting Dizziness Headache Eye trouble Stomach trouble
Poor appetite Chest pain Shortness of breath Chronic cough Last chest x-ray date Blood spitting Heart trouble Last EKG date High blood pressure Swelling of feet
Kidney trouble Bladder trouble Backache Back injury Rheumatism Gout 8roken bones Knee injuries Nervous breakdown Fits or convulsions
Paralysis Diabetes Tuberculosis Jaundice Skin disease Rupture Auto accidents
-----
Explanation:
VICE HISTORY: Branch
t Years
Type Discharqe
Date Discharged
OCCUPATIONAL HISTORY:
Is this your first job? Yes ----------------------------------------------------- -
No
. (If answer is "No," complete MRMS-5, OCCUPATIONAL HISTORY QUESTIONNAIRE.)
I hereby declare that my answers to the preceding medical questionnaire are complete and true to the best of my knowledge.
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