Physical examination verification

Revised 11/03/2015 OMB Control No. 0648-0318 Expiration Date: 11/30/15

OBSERVER REGISTRATION INFORMATION REQUIRED FROM OBSERVER PROVIDER

U .S. Dept. of Commerce/NOAA National Marine Fisheries Service Observer Program Office 7600 Sand Point Way NE Seattle, WA 98115-0070 (206) 526-4066 fax

An observer provider must provide all of the following information to the Observer Program Office

by electronic transmission (email), fax, or other method specified by NMFS within the specified timeframes.

submitted to:

NMFS Observer Program Office

7600 Sand Point Way NE

Seattle, WA 98115–0070

or fax 206–526–4066.

Observer Training and Briefing Registration Materials

Submittal Deadline: Observer training and briefing registration materials must be submitted to the Observer Program Office at least 5 business days prior to the beginning of a scheduled observer certification training or briefing session.

Observer training registration

Date of requested training;

A list of observer candidates. The list must include each candidate’s full name (i.e., first, middle, and last names), date of birth, and gender

A copy of each candidate’s academic transcripts and resume

A statement signed by the candidate under penalty of perjury that discloses any criminal convictions of

the candidate.

Observer briefing registration

Date and type of requested briefing session and briefing location; and

List of observers to attend the briefing session.

Each observer’s full name (first, middle, and last names) must be included.

Projected observer assignments

Prior to the observer or observer candidate’s completion of the training or briefing session, the observer provider must submit to the Observer Program Office a statement of projected observer assignments that includes

the observer’s name

vessel, shoreside processor, or stationary floating processor assignment

gear type

vessel/processor code

port of embarkation

target species

area of fishing

Physician’s statement.

A signed and dated statement from a licensed physician that he or she has physically examined an observer or observer candidate. The statement must confirm that, based on the physical examination, the observer or observer candidate does not have any health problems or conditions that would jeopardize their individual safety or the safety of others while the observer or observer candidate is deployed, or prevent the observer or observer candidate from performing his or her duties satisfactorily. The statement must declare that, prior to the examination, the physician read the NMFS-prepared pamphlet provided to the candidate by the observer provider and was made aware of the duties of the observer as well as the dangerous, remote, and rigorous nature of the work.

Deadline: The physician’s statement must be submitted to the Observer Program Office prior to certification of an observer. The physical exam must have occurred during the 12 months prior to the observer’s or observer candidate’s deployment. The physician’s statement will expire 12 months after the physical exam occurred. A new physical exam must be performed, and accompanying statement submitted, prior to any deployment occurring after the expiration of the statement.

Observer deployment/logistics report.

Deadline: must be submitted by Wednesday, 4:30 p.m., Pacific local time, of each week

with regard to each observer deployed by the observer provider during that week. The deployment/logistics

report must include

the observer’s name,

cruise number,

current vessel, shoreside processor, or stationary floating processor assignment

vessel/processor code,

embarkation date,

estimated or actual disembarkation dates.

The report must include the location of any observer employed by the observer provider who is not assigned to a vessel, shoreside processor, or stationary floating processor.

Observer debriefing registration.

Deadline: The observer provider must contact the Observer Program within 5 business days after the completion of an observer’s deployment to schedule a date, time, and location for debriefing.

Observer debriefing registration information must be provided at the time the debriefing is scheduled and must include

the observer’s name

cruise number

vessel, or shoreside or stationary floating processor assignment name(s) and code(s)

requested debriefing date

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