Form NF 57-03-39 NF 57-03-39 Initial Swim Test

OMB Control Number: 0648-XXXX
Expiration Date: XX/XX/20XX

NOAA Form 57-03-39
(03-17)

U.S. DEPARTMENT OF COMMERCE
NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION

SWIM TEST EVALUATION
FIRST NAME

DIVING CANDIDATE LAST NAME

MIDDLE INITIIAL

DATE OF TEST

INSTRUCTIONS: Rate the diving candidate's performance of the NOAA swim test as per the NOAA Standards
and Safety Manual. Watermanship of the diving candidate, which shows a noticeable degree of confidence,
must be verified prior to arrival at the NOAA Diving Center (NDC) for upcoming training or as part of review
for certification requirements. Personnel attending training are required to successfully perform this test
during the first day of pool work.

Watermanship Criteria
1. UNINTERRUPTED SURFACE SWIM - The diving candidate must swim a distance of 550 yards (500 meters)
without stopping, using the front crawl, side stroke, or breast stroke in less than 15 minutes.

Time (mm:ss) required to complete the 550 yard swim:
2. UNDERWATER SWIM - The diving candidate must swim a distance of 25 yards (22 meters) without
surfacing and without the use of fins.

25 yard underwater swim completed successfully:
3. THIRTY (30) MINUTE FLOAT - The diving candidate must tread water for 30 minutes without the use of any
flotation aids.

30 minute float completed successfully:
All skills must be successfully demonstrated during a single pool session. It is suggested that the underwater
swim be completed first, followed by the uninterrupted surface swim and then the 30 minute float. A 10-15
minute rest period is recommended between each element.
The diving candidate's swimming ability is:

Poor

Satisfactory

UNIT DIVING SUPERVISOR / DIVEMASTER NAME

ORGANIZATION / DIVE UNIT

UNIT DIVING SUPERVISOR / DIVEMASTER SIGNATURE

TELEPHONE NUMBER

Excellent

DATE

Return the evaluation to NDC upon completion of the test or include this form with certification packet.
Submit forms via Email to [email protected]
NOAA Diving Center, 7600 Sand Point Way N.E., Seattle, WA, 98115
FAX: (206) 526-6506 Phone: (206) 526-6196
Reset Form

PRA Public Burden Statement
A Federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for
failure to comply with an information collection subject to the requirements of the Paperwork Reduction Act of 1995 unless the
information collection has a currently valid OMB Control Number. The approved OMB Control Number for this information collection
is 0648-XXXX. Without this approval, we could not conduct this information collection. Public reporting for this information collection
is estimated to be approximately 1 hour per response, including the time for reviewing instructions, searching existing data sources,
gathering and maintaining the data needed, and completing and reviewing the information collection. All responses to this information
collection are required to obtain benefits. Send comments regarding this burden estimate or any other aspect of this information
collection, including suggestions for reducing this burden to the NOAA Diving Center Executive Officer, NOAA Diving Program, 7600
Sand Point Way NE, Building 8, Seattle, WA 98115, 206-526-6460.
Privacy Act Statement
Authority: The collection of this information is authorized under 29 CFR 1910, Subpart T, Commercial Diving Operations. Additional
authorities include 29 U.S.C. 653, 655, 657; 40 U.S.C. 333; 33 U.S.C. 941; Secretary of Labor's Order No. 8-76 (41 FR 25059), 9-83 (48 FR
35736), 1-90 (55 FR 9033), 6-96 (62 FR 111), 3-2000 (65 FR 50017), 5-2002 (67 FR 65008), 5-2007 (72 FR 31160), or 4-2010 (75 FR
55355) as applicable, and 29 CFR 1911.
Purpose: NOAA is collecting this information to assess an individual’s medical fitness to dive, proficiency, and further training.
Information will also be used to ensure diving equipment is safe and well maintained and that all policies are being adhered to for safety
reasons. Aggregate data is used for annual reports and other leadership documents.
Routine Uses: NOAA will use this information in the determination of an individual’s medical fitness to dive. Disclosure of this
information is permitted under the Privacy Act of 1974 (5 U.S.C. Section 552a) to be shared among Department staff for work-related
purposes. Disclosure of this information is also subject to all of the published routine uses as identified in the Privacy Act System of
Records Notice NOAA-10, NOAA Diving Program.
Disclosure: Furnishing this information is voluntary. However, the failure to provide complete and accurate information will exclude
the individual from NOAA’s Diving Program.