Rhode Island Code of Regulations › Title 250 - Department of Environmental Management › Chapter 80 - Law Enforcement › Subchapter 00 - N/A › Part 9 - Rhode Island State Pilotage Commission Rules and Regulations › Section 250-RICR-80-00-9.17 - Rhode Island Pilot Commission Medical Form

Current through June 14, 2024
Rhode Island Pilotage Notice to all Rhode Island
Supplemental Medical Form
Commission Licensed Pilots
This form must be supplied to your physician at the time
					 of:
Required annual Returning to duty after an The prescribing
					 or change of
physical injury or illness dosages of any
					 medications
Name of Pilot:
List of medications / include both prescription and
					 Non-prescription including dosages:
Dosage: Dosage:
Dosage: Dosage:
Dosage: Dosage:
Duties and responsibilities of a Rhode Island State
					 licensed pilot and the physical requirements necessary to perform those duties:
					 In addition to the customary tasks performed by mariners:
A pilot's duties include but are not limited to:
Safe navigation* of a vessel of up to one thousand one
					 hundred feet (1100') in length through narrow channels during all hours of the
					 day or night in any weather condition.
Safely moor and/or anchor those same vessels.
A pilot's responsibilities include but are not limited
					 to:
Protecting the port (its people, property and environment)
					 from the hazards and cargo aboard the vessel under his or her keeping while
					 transiting the waters of the State.
Determining if the proposed vessel transit is safe
					 considering such factors as vessel
characteristics, weather, current, draft, etc.
The ability to bring to the safest possible conclusion any
					 contingencies that may arise.
Physician requirement necessary to perform pilotage duties
					 include but are not limited to:
Transferring between the pilot vessel and the transiting
					 vessel in all weather conditions. This may include jumping from a moving pilot
					 boat onto a Pilot Ladder (rope and wood ladder hanging down the side of a
					 vessel) and climbing a height of up to ten (10) meters and then a stair climb
					 of as much as ten (10) stories.
Eyesight and hearing up to standards to perform the above
					 duties.
On call and available for duty twenty-four (24) hours a day
					 seven (7) days a week.
Unavailability of professional medical intervention during
					 most of the time on board vessels.
Long periods of stress and concentration periodically
					 interspersed with short periods of extreme stress.
*Navigation - to steer, direct, manage, or sail a vessel by
					 determining the vessel's position, piloting, directing the vessel along a
					 desired trackline, keeping account of the vessel's progress through the water,
					 ordering or executing changes in course, rudder position or speed, maintain a
					 lookout.
I have read and understand the above information concerning
					 the duties of a pilot and have taken this into consideration during my
					 evaluation of said pilot. I hereby certify that the pilot has, in my opinion,
					 the ability to competently perform his or her duties and that the pilot's use
					 of medications listed above will not adversely interfere with his or her
					 ability to perform those duties.
Signature of Physician: Date:
Print Name of Physician:
Address: City: State: Zip: