Post-Dive Air Travel Safety Questionnaire Form
Complete this form to review recent dive activity, current symptoms, and upcoming flight plans before air travel after diving.
Diver Identification and Trip Context
Full Name
*
First Name
Middle Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Dive Trip / Location Name or Destination
*
Date and Time of Last Dive
*
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Total Number of Dives During the Trip
*
Dive Exposure Details
Dive type
*
Recreational
Repetitive
Deep
Drift
Altitude
Other
Maximum depth reached
*
Dive duration (minutes)
*
Surface interval before the last dive (hours)
*
Multiple dives in the last 24 hours?
*
Yes
No
Not sure
Any ascent rate issues or omitted safety stop?
*
Yes
No
Not sure
Additional dive-profile notes
Current Symptoms and Physical Readiness
Which of these symptoms are you currently experiencing?
*
Ear pain or pressure
Sinus congestion
Headache
Dizziness
Nausea
Unusual fatigue
Shortness of breath
Joint pain
Tingling or numbness
Coughing
Chest discomfort
Other discomfort
Did any symptoms worsen after surfacing or during the trip home?
*
Yes
No
Not sure
How do you feel about your readiness to travel by air today?
*
Feel fine
Mild concerns
Need medical advice before flying
Please describe any symptoms or discomfort in more detail
Are you experiencing any shortness of breath or chest discomfort right now?
*
No
Yes, mild
Yes, moderate or severe
Do you feel mentally and physically able to complete air travel safely?
*
Yes
Unsure
No
Air Travel Plans and Acknowledgement
Planned Flight Date and Time
*
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Total Hours Between Last Dive and Planned Departure
*
Additional Altitude Exposure Planned Before Flying
Mountain drive
High-elevation stop
No additional altitude exposure
Other
Final Destination Altitude (feet), if known
Submit Questionnaire
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