• NOAA Health Services Questionnaire form with instructions
• NOAA Form 57-10-2 Tuberculosis Screening Document
The following are the medical requirements for the upcoming A13.5 2022 GO-SHIP/CO2 Repeat Hydrography Cruise:
NOAA Health Services Questionnaire (signed and dated)
Emergency Contact Information
TB skin test
Proof of Vaccination
The date and results of the TB test should be included in the NOAA Health
Services Questionnaire. The NOAA Health Services Questionnaire form,
a copy of the TB test result and proof of COVID-19 vaccination 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 (GO-SHIP A13.5 2022 Cruise) on the fax cover sheet or in the
the subject line of the email. This form must reach NOAA Health Services no later than
four weeks prior to the beginning of the cruise. Please notify Betty Huss
(Betty.Huss@noaa.gov) when the medical information has been sent.
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
This web page last updated October 12, 2021