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# DLA Official Forms

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| Form Number:  DLA0012                                                                                                                                                                                         |
|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Form Title:  Physical Fitness Inquiry for MHE Operators                                                                                                                                                       |
| Form Version:  Apr 2013                                                                                                                                                                                       |
| Status:  Active                                                                                                                                                                                               |
| Functional Area:  Installation Management                                                                                                                                                                     |
| Opr:  DM                                                                                                                                                                                                      |
| Safeguards:  FOUO, PAS                                                                                                                                                                                        |
| Electronic:  Yes                                                                                                                                                                                              |
| Form Link:  Documents/FormsSite/forms/DL0012.pdf                                                                                                                                                              |
| Type:  Primary                                                                                                                                                                                                |
| Prescribed:  DTM 14-016                                                                                                                                                                                       |
| Description:  Used to document the health self-assessment of Material Handling Equipment operators.                                                                                                           |
| Records Retention:  162.40 Employee Medical Folder (EMF)guidance that § 293.503 Implementing instructions. Agencies must issue written internal instructions describing how their EMFS is to be implemented.  |
| Form Audience:                                                                                                                                                                                                |

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