This confidential form is completed by physicians who need to determine a diver’s fitness to be certified.

The form is comprised of two parts: the examination portion to be retained for the physician’s records only, and the certificate to be shared with WorkSafeBC and the diver.

Please note the form’s functionality will not work properly if the form is opened in an internet browser such as Microsoft Edge or Google Chrome.

You will need to complete the form using Adobe Acrobat Reader.

To complete and submit the form digitally:

1. Click the Download PDF button. The form will be copied to the Downloads folder on your computer hard drive.
2. Open the form in Acrobat by going to your Downloads folder and right-clicking on the PDF file. Select Open with > Adobe Acrobat Reader.
3. View instructions for completing and sending the certificate portion only to WorkSafeBC.