NOAA Health Form

Emergency Contact Information Form

·         NOAA Health Services Questionnaire form with instructions

The following are the medical requirements for the upcoming CLIVAR/CO2 Repeat
Hydrography Cruise:

         NOAA Health Services Questionnaire (signed and dated)
         Emergency Contact Information
         TB skin test
         Yellow Fever immunization

The date and results of the TB test should be included in the NOAA Health
Services Questionnaire. The NOAA Health Services Questionnaire form,
along with a copy of the TB test result must be sent to NOAA Health Services.
This information can be faxed or emailed. The NOAA Health Services fax number
is 757-441-3760. The email address is moa.health.services@noaa.gov. Put the
name of the cruise on the fax cover sheet or in the subject line of the email.
This form must reach NOAA Health Services no later than 4 weeks prior to the
beginning of the cruise. Please notify Betty Huss (Betty.Huss@noaa.gov) when
the medical information has been sent.

Before and during the cruise, no vaccinations or antimalarial drugs will be provided
by the ship to the A10 cruise participants.

The Emergency Contact Information form must be completed by all cruise
participants. The completed form must be emailed to Betty Huss
(Betty.Huss@noaa.gov) at least one month prior to the beginning of the cruise.

·         Emergency Contact Information Form

  Last updated July 11, 2011