Canada Oil and Gas Diving Regulations (SOR/88-600)

Full Document:

Regulations are current to 2012-05-14

SCHEDULE VII

(Paragraph 53(b))

DIVER’S MEDICAL EXAMINATION RECORD — PART I

All abnormal findings shall be recorded on the diver’s medical examination record.

Family name: First name(s): Birth date: __________ Sex: M/F

Ht: cm Wt: kgIdentifying features: __________

General appearance: __________

HEENT: Normal? Yes/NoURTI: Normal? Yes/NoTeeth & gums normal? Yes/NoAny dentures? Yes/NoNeck normal? Yes/No

Sinuses normal? Yes/NoDental X-rays normal? Yes/No/Not done*Normal colour vision? Yes/No

	Nasal airway	EAM	Eardrums	Eustacian tube	Audiometry
Rt. normal?	Yes/No	Yes/No	Yes/No	Yes/No	Yes/No
Lt. normal?	Yes/No	Yes/No	Yes/No	Yes/No	Yes/No

Vision: Distant	Dist. with glasses	Near	Near with glasses	Normal visual fields?	Normal fundi?
Right __________	__________	__________	__________	Yes/No __________	Yes/No __________
Left __________	__________	__________	__________	Yes/No __________	Yes/No __________
Both __________	__________	__________	__________	Yes/No __________	Yes/No __________

SKIN: Rash? Yes/NoInfection? Yes/NoParasites? Yes/NoLymph glands normal? Yes/NoSkinfold thickness: Lt. biceps: mm Lt. triceps: mm Lt. subscapular: mm Lt. sacroiliac: mm Breasts normal? Yes/No

RESP: Any chest scars or deformity? Yes/NoChest auscultation normal? Yes/NoAny adventitious sounds? Yes/NoCurrent chest X-ray normal? Yes/NoFVC: FEV₁/FVC%%.

CARDIOVASCULAR: BP: / Pulse: / min. Varicose veins? Yes/NoPeripheral pulses and circulation normal? Yes/NoNormal apex beat? Yes/NoNormal heart sounds? Yes/NoMurmurs present? Yes/NoECG normal? Yes/NoExercise tolerance test (eg. Ruffier test) normal? Yes/NoStress ECG normal? Yes/No/Not done.+

ABDOMEN: Organomegaly? Yes/NoMasses present? Yes/NoHerniae present? Yes/NoGenitourinary system normal? Yes/NoRectal normal? Yes/No

MUSCULO-SKELETAL: Joint X-rays:*

	Shoulders	Hip	Knees	Spine normal? Yes/No
Rt. normal?	Yes/No	Yes/No	Yes/No	Limbs & joints normal? Yes/No
Lt. normal?	Yes/No	Yes/No	Yes/No

CNS: Power & tone of limbs normal? Yes/NoNormal sensation to pinprick? Yes/No

Cranial nerves normal?		Reflexes BJ TJ SJ KJ AJ Abdo. Plantar Clonus
1.	Yes/No	7.	Yes/No	Right
2.	Yes/No	8.	Yes/No	Left
3.	Yes/No	9.	Yes/No	Cerebellar function normal? Yes/NoVestibular function normal? Yes/No
4.	Yes/No	10.	Yes/No	Rombergism present? Yes/NoNystagmus present? Yes/No
5.	Yes/No	11.	Yes/No	EEG normal? Yes/No/Not DoneElectronystagmograms normal? Yes/No/Not Done
6.	Yes/No	12.	Yes/No

LAB. INVESTIGATIONS: Hb: g/dLHCT: Sickle cell trait absent? Yes/No* (initial medical examination)

Blood group: BUN: * Creatinine: * Other

Urine PH: Urine free of:albumin? Yes/Nosugar? Yes/Noprotein? Yes/Noblood? Yes/No

Comment on any abnormalities detected:

Is the candidate free from physical defect and disease?		Yes/No
Has the candidate the physique for prolonged exertion?		Yes/No
Is the candidate fit for work in all climates if inoculations are up-to-date?		Yes/No
Is the candidate permanently unfit to dive?		Yes/No
Is the candidate temporarily unfit to dive?	Yes/No	Date for next examination: __________
Is the candidate fit to dive with restrictions?	Yes/No	Specify: __________
* At the discretion of the examining doctor
+ Mandatory for divers over 35 years of age
Name and address of examining doctor: __________
Signed: Date: Place: __________

DIVER’S MEDICAL EXAMINATION RECORD — PART II

To be completed by the diver in ballpoint pen. Circle correct answer. If in doubt, ask the advice of the examining doctor.

(a)
Family name: First name(s): Birth date: __________

S.I.N.: Provincial Health No.: __________

(b)
Have you had a commercial diver’s medical examination before? Yes/NoIf yes, when? Where? __________

When did you first work under pressure? __________

Other X-ray examinations: Give details of vaccinations: __________

(d)
Have you ever had any of the following medical problems?

1. Skin bends? Yes/No 2. Limb bends? Yes/No 3. Spinal or cerebral bends? Yes/No 4. Pulmonary decompression sickness? Yes/No 5. Vestibular bends? Yes/No 6. Pulmonary barotrauma (ruptured lung)? Yes/No 7. Arterial gas embolism? Yes/No 8. Problems with compression? Yes/No 9. Dysbaric osteonecrosis (bone necrosis)? Yes/No

Give details of any positive (yes) answers, including date and number of times the problem has occurred: __________

__________

(e) Do you have, or have you ever had or been treated for, any of the following medical conditions?

1.	Asthma	Yes/No	19.	Head injury or concussion	Yes/No
2.	Hay fever or allergies	Yes/No	20.	Stroke or paralysis	Yes/No
3.	Allergy to drugs/medications	Yes/No	21.	Severe headache or migraine	Yes/No
4.	Pneumothorax (collapsed lung)	Yes/No	22.	Nervous breakdown or mental illnesses	Yes/No
5.	Pneumonia or pleurisy	Yes/No	23.	Eye disorders	Yes/No
6.	Bronchitis or other lung diseases	Yes/No	24.	Stomach/duodenal/peptic ulcer	Yes/No
7.	Tuberculosis	Yes/No	25.	Gall bladder disorder	Yes/No
8.	Sinus trouble	Yes/No	26.	Diarrhea or bowel disease	Yes/No
9.	Ear disease	Yes/No	27.	Jaundice or hepatitis	Yes/No
10.	Rheumatic fever	Yes/No	28.	Venereal disease	Yes/No
11.	Heart disease or murmur	Yes/No	29.	Toothache, dental problems	Yes/No
12.	Chest pain or palpitations	Yes/No	30.	Bone/joint disease or injury	Yes/No
13.	Varicose veins	Yes/No	31.	Back injury or chronic back pain	Yes/No
14.	Bleeding tendency	Yes/No	32.	Other serious illness or injury	Yes/No
15.	Skin diseases	Yes/No	33.	Females: gynaecological disease or pregnancy	Yes/No
16.	Diabetes	Yes/No	34.	Motion sickness	Yes/No
17.	Tropical diseases	Yes/No
18.	Fits, blackouts or epilepsy	Yes/No

Give details of any positive (Yes) answers, including dates: __________

__________

(f)
Give date and place of any hospital admissions or operations: __________

__________

(g)
Have you been under medical treatment during the past year? Yes/NoIf yes, for what? __________

__________

(h)
Are you taking, or have you ever taken any medicines or drugs? Yes/NoIf yes, specify: __________

__________

(i)
How much do you smoke? /day How much do you drink? /week Have you ever suffered from any health problems related to mind-altering, “street” or addictive drugs? Yes/NoIf yes, give details: __________

__________

I (name), , of (address) , declare that all of the above information is true to the best of my knowledge and I give my permission for this information to be communicated to other doctors concerned with my welfare.

Signed: Date: Place: __________

Doctor’s remarks: __________

__________

Diver’s logbook inspected? Yes/NoSigned: __________ M.D.

If “no”, state reason: Dated: __________

Headings
Sections/Schedules

SCHEDULE VII

(Paragraph 53(b))

DIVER’S MEDICAL EXAMINATION RECORD — PART I

DIVER’S MEDICAL EXAMINATION RECORD — PART II

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