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Certificate of Physical Qualification for Mine Rescue Work U.S. Department of Labor Mine Safety and Health Administration OMB Number 12190078 and 12190144, Approval expires 12/31/2016 30 CFR 49.7

How to fill out certificate of physical qualification

How to fill out a certificate of physical qualification:

1. Start by filling out the personal information section, including your full name, date of birth, and contact information.
2. Next, provide details about your medical history, including any pre-existing conditions, surgeries, or allergies.
3. Fill out the section regarding your current medications, indicating the name, dosage, and frequency of each medication.
4. If applicable, provide information about any physical limitations or disabilities that may affect your ability to perform certain tasks or activities.
5. Indicate whether you have any chronic illnesses or conditions that require ongoing medical treatment.
6. If you have any visual, hearing, or auditory impairments, make sure to include this information in the relevant section.
7. Provide details about your immunization history, including dates and types of vaccines received.
8. If you have recently undergone any medical tests or screenings, specify the type of test and its results.
9. Finally, sign and date the certificate to authenticate the information provided.

Who needs a certificate of physical qualification?

1. Individuals applying for certain job positions that require physical fitness or the ability to perform specific duties, such as police officers, firefighters, or professional athletes.
2. Students participating in competitive sports or physical activities at school or college level.
3. Certain individuals involved in activities that pose a higher risk to their health, such as scuba diving, aviation, or extreme sports.
4. Individuals seeking to obtain specific licenses or certifications that involve physical abilities, such as driving commercial vehicles or operating heavy machinery.

For pdfFiller’s FAQs

What is certificate of physical qualification?

The certificate of physical qualification is a document that verifies an individual's health and fitness to perform certain tasks or duties.

Who is required to file certificate of physical qualification?

Certain professions or positions may require individuals to file a certificate of physical qualification, such as pilots, commercial vehicle drivers, or military personnel.

How to fill out certificate of physical qualification?

To fill out a certificate of physical qualification, individuals typically need to visit a healthcare provider for a physical examination and then have the provider complete the necessary paperwork.

What is the purpose of certificate of physical qualification?

The purpose of the certificate of physical qualification is to ensure that individuals are physically capable of performing specific tasks or duties without endangering themselves or others.

What information must be reported on certificate of physical qualification?

The certificate of physical qualification typically includes information about the individual's medical history, current health status, and any restrictions or limitations based on the examination results.

How do I make changes in certificate of physical qualification?

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