NOAA Cruise Forms

All cruise participants going to sea on a NOAA vessel such as the FSV Shimada or FSV Lasker must submit the completed Questionnaire and have a recent (within the last 12 months) TB test.

NOAA Office of Medical Services: NOAA Health Services Medical Questionnaire (PDF) – New form posted January 2014

• Information:
  • NOAA Health Services Questionnaire (NHSQ) Decision Memorandum (Information) : NOAA Link to Form 57-10-01 PDF
  • Tuberculosis Policy (Information): NOAA Link to Form 57-10-02
• Forms:
  • Medical Questionnaire & Instructions (NOAA Form 57-10-01) : .org PDF Link
  • Tuberculosis Screening Document (NOAA Form 57-10-02) : .org PDF Link

Send the completed form to:

MOP.Health-Services@noaa.gov and CC travis.hill@noaa.gov

Forms may be faxed to the number listed below

Regional Director of Health Services
NOAA MOC-Pacific
1801 Fairview Avenue East
Seattle, WA 98102
Voice: 206-553-8704
FAX: 206-553-1112
E-mail: mop.health-services@noaa.gov