Instruction Guide to the Merchant Mariner Physical Examination

For the latest information on STCW and Licensing, visit our web site at http://www.uscg.mil/nmc.

The National Maritime Center is an ISO 9001:2000 Compliant Organization.

October 30, 2009

Instruction Guide to the

Merchant Mariner Physical Examination Report

(CG-719K & K/E)

Background: The Coast Guard is releasing a new version of the Merchant Mariner Credential Medical

Evaluation Report (CG-719 K) and the Merchant Mariner Evaluation of Fitness for Entry Level Ratings

(CG-719 K/E) forms to facilitate obtaining objective medical information which will enable the Coast

Guard to make a more accurate assessment of mariner fitness for duty with the overall goal of reducing

risk to maritime and public safety.

The revised CG 719K and 719K/E forms more clearly align the Merchant Mariner Credentialing process

with the guidelines set forth by Navigation and Vessel Inspection Circular 04-08 (NVIC), MEDICAL

AND PHYSICAL EVALUATION GUIDELINES FOR MERCHANT MARINER CREDENTIALS.

This NVIC provides guidance for evaluating the physical and medical conditions of applicants for

merchant mariner credentials. The new CG 719K and 719K/E forms are designed to be used primarily in

conjunction with Enclosure (3) of the NVIC. Enclosure (3) contains a non-exhaustive list of medical

conditions subject to further review and supplemental medical data that should be submitted for such

medical review. The use of NVIC 04-08 will serve to facilitate obtaining objective medical evidence of

an applicant’s physical condition as it relates to the ability to safely perform their Merchant Mariner

duties. Without this supporting documentation, the medical evaluation process is delayed due to the need

to solicit additional medical information. To prevent delays in processing credential applications,

mariners and physicians are highly encouraged to use NVIC 04-08 in conjunction with the new physical

examination forms. If these forms are properly completed and the additional relevant medical

documentation indicated by NVIC 04-08 encl (3) is provided, even those mariner applicants with

significant medical conditions should expect to see reduced processing times for their applications.

General instructions are provided through out the form in order to assist both the examiner and the

mariner in providing the correct information.

Which form to use? The CG-719 K/E should be used only by mariners seeking an entry level credential.

This form is limited to applicants for the following rating endorsements: Ordinary Seaman, Wiper, or

Steward’s Department (food handler). The CG-719K should be used for all other endorsement

applications.

Mariner physical exams completed on or after January 1, 2010 must be on the new CG719K or K/E (Rev

(01/09). Physicals completed and signed on previous versions of the form prior to January 1, 2010 will

continue to be accepted provided they are dated within one year of the application.

Sincerely,

David C. Stalfort

Captain, U. S. Coast Guard

Encl: (1) 719K/E Instructions

(2) 719K Instructions

Commanding Office

United States Coast Guard

National Maritime Center

100 Forbes Drive

Martinsburg, WV 25404

Phone: (304) 433-3400

Fax: (304) 433-3409

E-mail: iasknmc

usc

.mil

For the latest information on STCW and Licensing, visit our web site at http://www.uscg.mil/nmc.

The National Maritime Center is an ISO 9001:2000 Compliant Organization.

719K/E Instructions

Section I and II should be filled in entirely. The examiner should fill in weight and body mass index.

The BMI calculation is discussed on the Centers for Disease Control and Prevention website and may be

calculated based on height and weight. A useful link to an adult BMI calculator can be found at:

http://www.cdc.gov/nccdphp/dnpa/bmi/adult_BMI/about_adult_BMI.htm

Section III Physical Ability Certification must be completed:

1. Credential applicants should be physically able to perform assigned shipboard functions and meet the

physical demands that would reasonably arise during an emergency response. As used in this context,

an “emergency response” refers to emergency evolutions such as abandon ship and firefighting, and

the basic procedures to be followed by each mariner.

2. If the examining medical practitioner doubts the applicant’s ability to meet the guidelines contained

within this table, and for all applicants with a Body Mass Index (BMI) of 40.0 or higher, the

practitioner should require that the applicant demonstrate the ability to meet the guidelines. This does

not mean, for example, that the applicant must actually don an exposure suit, pull an uncharged 1.5

inch diameter 50’ fire hose with nozzle to full extension, or lift a charged 1.5 inch diameter fire hose

to fire fighting position. Rather, the medical practitioner may utilize alternative measures to satisfy

himself or herself that the applicant possesses the ability to meet the guidelines in the third column. A

description of the methods utilized by the medical practitioner should be reported on the CG-719K/E

as appropriate. All demonstrations of ability should be performed by the applicant without assistance.

Any prosthesis normally worn by the applicant and other aid devices such as prescription glasses may

be used by the applicant in all practical demonstrations except when the use of such would prevent the

proper wearing of mandated personal protective equipment (PPE).

The examiner must check the box certifying whether the mariner does or does not have the physical

strength, agility, and flexibility to perform the listed tasks. The examiner should check the “Competent”

box if the applicant is able to complete all Physical Ability tests satisfactorily, or there are no physical

impairments that would preclude such completion.

The examiner should check the “Not Competent” box if any one of the listed items was not completed

satisfactorily. If the applicant is unable to perform any of the following functions, the examiner should

provide information on the degree or the severity of the applicant's inability to meet the standards.

The examiner should check “Needing Further Review” in the event that the Physical Ability cannot be

assessed (e.g. equipment or opportunity to complete equivalent tasks not available).

The examiner must provide their name, office address, License Number, telephone numbers, and

signature with date.

Section IV: The applicant must sign and date Section IV

For the latest information on STCW and Licensing, visit our web site at http://www.uscg.mil/nmc.

The National Maritime Center is an ISO 9001:2000 Compliant Organization.

719K Instructions

Pages 1- 2: Provide general instructions for both the applicant and the medical practitioner completing

this form. The applicant must print their name and date of birth on the bottom of each page

of the CG

719K.

Page 3:

Section I – Applicant Information: The applicant must complete Section I entirely, including their

signature. An Alien Registration Number may be entered in lieu of a Social Security Number. It is

recommended that mariners provide good telephone contact information (home, work, cell) as our

medical evaluators may be able to resolve simple issues over the phone.

Section II - Release: Completion of Section II is voluntary. Mariners may be able to avoid potential

delays in the medical evaluation process by authorizing their verifying medical practitioner to release or

discuss pertinent information directly with the Coast Guard Mariners wishing to authorize release need to

print their name, sign and date this section.

Page 4

Section III - Medications: The applicant must either check “NONE” if not taking any medications or

provide the names of the medications, dosage, and the reason the medication has been prescribed for

medications used within 30 days prior to the date of the 719K, or medications used for a period of 30 or

more days within the last 90 days prior to the date of the 719K. The (VMP) should review the list of

medications for accuracy. See the example below.

For the latest information on STCW and Licensing, visit our web site at http://www.uscg.mil/nmc.

The National Maritime Center is an ISO 9001:2000 Compliant Organization.

Page 4 - 5

Section IV - Certification of Medical Conditions:

The applicant must check all the medical conditions/diagnoses that apply. See the example below. The

VMP should elaborate on the medical conditions checked by providing comments on 1) the identified

condition, 2) list any limitations caused by the condition, 3) is the condition controlled, 4) approximate

date of diagnosis, 5) prognosis, and 6) any additional information about the condition. Conditions of

concern are those with the potential to cause sudden incapacitation, or have the potential to deteriorate

significantly over the next 5 years. In general, medical conditions qualify for a waiver when the

conditions are sufficiently controlled to mitigate risk to maritime and public safety. In order to determine

whether or not a medical condition is controlled, objective documentation is required as outlined in NVIC

04-08 encl (3). For example, it is not sufficient to only indicate “CAD with MI and CABG in 2004,

stable” Supporting objective medical documents would include a recent cardiology evaluation, recent

report of GXT (Bruce protocol to at least 8.0 METS), a recent echocardiogram report to assess LVEF and

perhaps the coronary catheterization and operative reports from 2004. Recent reports should be no more

than 12 months old.

Not every condition listed on the 719K will be specifically referenced in the NVIC. Some conditions are

more descriptive, rather than diagnostic. In these cases, an evaluation of the underlying cause of the

condition should be obtained from a relevant specialist. For example, fainting spells or loss of

consciousness (72) may require a cardiology, neurology or endocrine evaluation based upon the etiology

of the symptoms. Any other condition not specifically referenced in the NVIC, the examiner should

obtain an evaluation from the relevant medical specialist.

For the latest information on STCW and Licensing, visit our web site at http://www.uscg.mil/nmc.

The National Maritime Center is an ISO 9001:2000 Compliant Organization.

For the latest information on STCW and Licensing, visit our web site at http://www.uscg.mil/nmc.

The National Maritime Center is an ISO 9001:2000 Compliant Organization.

Page 6

Section V(a) - Visual Acuity:

The VMP must complete the mariner’s Visual Acuity. If any block is marked “Abnormal”, information

should accompany the CG 719K to explain. For applicants using corrective lenses, the VMP must

include both uncorrected and corrected distant vision testing. Current deck standards require an applicant

to have correctable vision to at least 20/40 in one eye and uncorrected vision of at least 20/200 in the same

eye. Current engineering, radio operator, tankerman and MODU standards require an applicant to have

correctable vision of at least 20/50 in one eye and uncorrected vision of at least 20/200 in the same eye.

See NVIC 04-08 encl (5) for further guidance.

Section V(b) - Color vision:

Current regulations require all applicants to submit the results of color vision testing.

The color vision test performed should be selected from the list provided, and the 719K must be checked

normal or abnormal. If any block is checked “Abnormal”, information must accompany the CG 719K to

explain. Any alternative test must be approved by the USCG prior to sending the examination report.

The use of unapproved alternative testing will likely cause delays in the medical evaluation process. The

use of color sensing lenses is prohibited. See NVIC 04-08 encl (5) for further guidance.

Section VI: - Hearing:

It is not necessary to submit an audiogram for an applicant with normal hearing.

If hearing is abnormal, the applicant must submit the results of audiogram testing to include functional

speech discrimination at 55dB. The frequency responses for each ear are averaged to determine the

measure of an applicant’s hearing ability. Current regulations have changed the hearing standard from

30dB average at 500 Hz, 1000Hz, 2000Hz and 3000Hz to 20dB in each ear. See NVIC 04-08 encl (5) for

further guidance.

Pages 7 and 8

Section VII (a) - Physical information

The VMP should complete all items. The BMI calculation is discussed on the Centers for Disease Control

and Prevention website and may be calculated based on height and weight. A useful link to an adult BMI

calculator can be found at:

http://www.cdc.gov/nccdphp/dnpa/bmi/adult_BMI/about_adult_BMI.htm

Section VII (b) - Physical Exam

This section is to be completed by the VMP only. See the example below. The Verifying Medical

Practitioner must make numbered comments about any “abnormal” findings and provide comments and

descriptions of any physical impairments and associated limitations. Significant negative findings should

be noted as well.

For the latest information on STCW and Licensing, visit our web site at http://www.uscg.mil/nmc.

The National Maritime Center is an ISO 9001:2000 Compliant Organization.

Section VIII - Demonstration of Physical Ability (to be completed by the VMP):

1. Credential applicants should be physically able to perform assigned shipboard functions and meet the

physical demands that would reasonably arise during an emergency response. As used in this context,

an “emergency response” refers to emergency evolutions such as abandon ship and firefighting, and

the basic procedures to be followed by each mariner.

2. If the examining medical practitioner doubts the applicant’s ability to meet the guidelines contained

within this table, and for all applicants with a Body Mass Index (BMI) of 40.0 or higher, the

practitioner should require that the applicant demonstrate the ability to meet the guidelines. This does

not mean, for example, that the applicant must actually don an exposure suit, pull an uncharged 1.5

inch diameter 50’ fire hose with nozzle to full extension, or lift a charged 1.5 inch diameter fire hose

to fire fighting position. Rather, the medical practitioner may utilize alternative measures to satisfy

himself or herself that the applicant possesses the ability to meet the guidelines in the third column. A

description of the methods utilized by the medical practitioner should be reported on the CG-719K

section IX as appropriate. All demonstrations of ability should be performed by the applicant without

assistance. Any prosthesis normally worn by the applicant and other aid devices such as prescription

glasses may be used by the applicant in all practical demonstrations except when the use of such

would prevent the proper wearing of mandated personal protective equipment (PPE).

Page 9

Section IX - Verifying Medical Practitioner Recommendation:

The VMP must check the box certifying whether the mariner does or does not have the physical strength,

agility, and flexibility to perform the listed tasks. See the example below. The examiner should check the

“Competent” box if the applicant is able to complete all Physical Ability tests satisfactorily, or there are

no physical impairments that would preclude such completion.

For the latest information on STCW and Licensing, visit our web site at http://www.uscg.mil/nmc

The examiner should check the “Not Competent” box if any one of the listed items was not completed

satisfactorily. If the applicant is unable to perform any of the following functions, the examiner should

provide information on the degree or the severity of the applicant's inability to meet the standards.

The examiner should check “Needing Further Review” in the event that the Physical Ability cannot be

assessed (e.g. equipment or opportunity to complete equivalent tasks not available).

The results of any practical demonstration should be recorded in the comment space provided, along with

any other comments relevant to this physical examination report.

Verifying Medical Practitioner: The VMP completes this section to include their name, address, phone

number, and state license number.

ilton T. Marine

The National Maritime Center is an ISO 9001:2000 Compliant Organization.