NOAA Health Forms

The following are the medical requirements for the A16N 2023 GO-SHIP/CO2 Repeat Hydrography Cruise:

         NOAA Health Services Questionnaire form (signed and dated)
         Annual Tuberculosis Screening Document (signed and dated)
         Proof of COVID-19 Vaccination and Booster

Annual Tuberculosis Screening Document - Personnel sailing aboard NOAA ships are no longer required
to get a TB test. Instead, the Annual Tuberculosis Screening Document must be completed. Please fill in the
heading and Section A of the Tuberculosis Screening form and sign at the top of page two. A doctor's
signature is not required. The NOAA Marine Operations Office of Health Services will review the form and
then, based on your answers, let you know if you need a TB test.

The NOAA Health Services Questionnaire, the NOAA Annual Tuberculosis Screening Document, and proof of
COVID-19 vaccination and booster must be sent to NOAA Health Services:
Put the name of the cruise (GO-SHIP A16N 2023 Cruise) in the subject line of the email. These forms should
be sent to Health Services no later than four weeks prior to the beginning of the cruise. Please notify Betty Huss
( when the medical information has been sent.

        NOAA Health Services Questionnaire form with instructions

        NOAA Form 57-10-02 OMAO Annual Tuberculosis Screening Document

Emergency Contact Information Form

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

        Emergency Contact Information Form

This web page last updated January 29, 2023