SELF ASSESSMENT CHECKLIST
SELF ASSESSMENT CHECKLIST
FOR TRAVEL ON NPS VESSELS TO THE CHANNEL ISLANDS

Traveling on boats, transferring between vessel and dock, and working on the islands can be physically and mentally challenging. You should be comfortable with most of the following activities before committing to a trip on NPS vessels. Please check off all the statements below that apply to you.

Be honest in evaluating yourself. We are not looking for a perfect score, but we would like to know a little about your strengths and weaknesses. In this way we can better provide the proper level of assistance and increase the safety of your trip.
Email address *
Answer Yes or No to each question *
YES
NO
I have traveled on boats.
I can shift my weight quickly to maintain my balance on the deck of a boat.
I can step confidently across a two-foot span over open water to a ladder or platform.
I can climb up a 10-foot vertical ladder and hold on for up to two minutes.
I can twist my body, turn my head and look over my shoulder.
I can climb 157 stairs (Anacapa).
I have good depth perception.
I can hear verbal instructions in spite of background noise; such as a boat engine.
I am not afraid of heights; from a secure platform, I can look straight down 20 feet without fear.
I never or almost never get seasick.
I do not have a medical condition that is likely to cause a problem on the boat.
Is there anything we should know about you that will help us make your trip a safe one? If there are any changes in your condition on the day of travel please bring it to our attention. *
Your answer
I have viewed the boat transportation videos and have read the Boat Transportation Guide. I have honestly evaluated myself. *
First Name *
Your answer
Last Name *
Your answer
Affiliation to Park *
Select "Other" and type your affiliation
Supervisor/ Park Point of Contact *
Please include the CHIS point of contact EMAIL address only
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of DEPARTMENT OF THE INTERIOR. Report Abuse