NF 57-03-39 Initial Swim Test

OMB Control Number: 0648-XXXX
Expiration Date: XX/XX/20XX
NOAA Form 57-03-39
(12-23)

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

INITIAL SWIM TEST EVALUATION
DIVING CANDIDATE LAST NAME

FIRST NAME

MIDDLE INITIAL DATE OF TEST

INSTRUCTIONS

The Unit Diving Supervisor (UDS), or UDS designee should proctor the candidate’s NOAA Diver initial swim test as per the NOAA
Diving Standards and Safety Manual (NDSSM). Personnel attending the NOAA Diving Center training course are also required to
successfully perform this test during the first day of the course, or they will be sent home.
All skills must be successfully demonstrated during a single pool session. It is suggested that the underwater be completed first,
followed by the uninterrupted surface swim, and then the 30 minute water tread. A 10-15 minute rest period is recommended
between each element.

WATERMANSHIP CRITERIA
UNDERWATER SWIM

The candidate must swim a distance of 25 yards (22 meters) underwater without surfacing and without the use of fins.
Was the 25 yard underwater swim completed successfully? Yes

No

UNINTERRUPTED SURFACE SWIM

Time (mm:ss) required to complete the 550 yard swim:

:

THIRTY (30) MINUTE TREAD

Was the 30 minute water tread completed successfully? Yes

No

Is the candidate’s swimming ability satisfactory, according to the requirements in the NDSSM? Yes

No

PROCTOR RATING
PROCTOR COMMENTS (OPTIONAL)

AUTHORIZATION

I certify that the candidate named above has satisfactorily demonstrated all the watermanship skills above in a single pool session
as required by the NOAA Diving Program.

PROCTOR NAME

ORGANIZATION / DIVING UNIT

PROCTOR SIGNATURE

TELEPHONE NUMBER

DATE

SUBMISSION

Please proctor the test, fill out the form, and then submit this completed form via email to [email protected].

Clear 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 10 minutes 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.