Form Of 345 PDF Details

The OF 345 form, known formally as the Physical Fitness Inquiry for Motor Vehicle Operators, serves a vital function in ensuring that federal employees tasked with operating government-owned or leased motor vehicles are physically fit to perform their duties safely and effectively. Originating from the Office of Personnel Management under the guidance of FPM Chapter 930 (EF-V1)(PerForm Pro), this thorough document requires applicants to reveal any medical conditions that might impair their driving capabilities, ranging from poor vision and hearing to more serious health issues like diabetes or cardiovascular problems. The form also inquires about the use of corrective devices such as glasses or hearing aids during driving, underscoring the importance of sensory accuracy in safely operating a vehicle. Beyond serving as a basic health questionnaire, the OF 345 is instrumental in the decision-making process regarding the issuance or renewal of permissions for federal employees to drive government vehicles. The requirement for employees to disclose their physical fitness truthfully is pivotal, with an emphasis on the accuracy of provided information, given its potential implications for public safety and operational integrity. Additionally, the form features a privacy act statement, explaining the legal framework and authority under which the information is solicited, highlighting the mandatory nature of disclosure for those employees whose roles involve driving, and outlining the consequences of non-compliance, including the potential for disqualification from operating government vehicles or more severe disciplinary actions. This meticulous approach underlines the government's commitment to ensuring that only those of adequate physical health and reliability are entrusted with the operation of its vehicles.

QuestionAnswer
Form NameForm Of 345
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesNSN, of 345, 345, OPM

Form Preview Example

OF 345

PHYSICAL FITNESS INQUIRY FOR MOTOR VEHICLE OPERATORS

(11/85)

Office of Personnel Management

FPM Chapter 930 (EF-V1)(PerForm Pro)

1.Name (Last, First, Middle)

2.Date of Birth (Month, Day, Year)

3. Title of Position

4.Home Address (Number, Street or RFD, City, State and Zip Code)

5. Employing Agency

6.Have you ever had or have you now: (Place check at left of each item.)

YES

NO

 

YES

NO

 

 

 

Poor vision in one or both eyes

 

 

Arthritis, rheumatism, swollen or painful joints

 

 

Eye disease

 

 

Loss of hand, arm, foot, or leg

 

 

Poor hearing in one or both ears

 

 

Deformity of hand, arm, foot, or leg

 

 

Diabetes

 

 

Nervous or mental trouble of any kind

 

 

Palpitation, chest pain, or shortness or breath

 

 

Blackouts or epilepsy

 

 

Dizziness or fainting spells

 

 

Sugar or albumin in urine

 

 

Frequent or severe headaches

 

 

Excessive drinking habit (Alcohol)

 

 

High or low blood pressure

 

 

Other serious defects or diseases

 

 

Drug or narcotic habit

 

 

 

7. If your answer is "Yes" to one or more of the above questions, explain fully in this space, indicating date of original condition and current status:

8.(A) Do you wear glasses (or contact lenses) while driving?

(B)Do you wear a hearing aid?

YES

YES

NO

NO

PRIVACY ACT STATEMENT

 

Solicitation of this information is authorized by 40 U.S.C. 491 and 5

Based on the information provided, employees may be referred for a

CFR Part 930 Subpart A, which require OPM to regulate Federal

medical examination before being granted an initial authorization or a

employees use of Government-owned or -leased motor vehicles. It is

renewal. The disclosure of this information is mandatory when an

used to ascertain the physical fitness of Federal employees, whose

employee's job requires driving a Federal motor vehicle and is

jobs require authorization to drive Government-owned or -leased

voluntary otherwise.

However, failure to complete when requested

vehicles. It is also used in the renewal of authorizations for all such

may result in you not being permitted to operate a Government

employees.

vehicle.

 

Certification: I certify that my answers to the above are full and true,

9. Signature

10. Date Signed

and I understand that a willfully false statement or dishonest answer

 

(Month, Day, Year)

 

 

may be grounds for cancellation of my eligibility or my dismissal from

 

 

the service and is punishable by law.

 

 

REVIEW AND CERTIFICATION BY DESIGNATED OFFICIAL

I certify that I have reviewed this physical fitness injury form and other available information regarding the physical condition of the applicant, and that I have made the following determination:

1. There is no information on this form or otherwise available to indicate that the applicant should be referred for physical examination.

2. On the basis of items checked on this form or other information, this applicant must be referred for physical examination before authorized to operate a Government-owned or -leased motor vehicle or current authorization is renewed.

3. Items checked on this form or otherwise available do not warrant referral for medical examination because of the following facts:

Signature of Designated Official

Date Signed

(Month, Day, Year)

50345-101

Reset

NSN: 7540-00-634-4000

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Within the field Solicitation of this information, Based on the information provided, Certification I certify that my, Signature, Date Signed Month Day Year, REVIEW AND CERTIFICATION BY, I certify that I have reviewed, There is no information on this, Items checked on this form or, Signature of Designated Official, Date Signed Month Day Year, and NSN enter the information the platform asks you to do.

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