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The OF 345 form serves a crucial role in ensuring the safety and well-being of both Federal employees and the general public by evaluating the physical fitness of individuals who operate government-owned or leased vehicles. It collects essential personal information, such as your name, date of birth, position title, and contact details, providing a comprehensive overview of the applicant's identity and employment. The form poses a series of questions aimed at uncovering any potential health issues, including vision and hearing impairments, chronic diseases, and mental health conditions, each requiring a simple yes or no response. If any conditions are disclosed, the applicant is prompted to provide further details, enhancing transparency in the evaluation process. Additionally, the OF 345 includes a privacy statement that emphasizes the mandatory nature of this information collection, underpinning its importance in determining driving authorizations. After completing the form, a designated official reviews the provided information to ascertain whether a medical examination is necessary. This careful procedure helps maintain high standards for those entrusted with the responsibility of operating government vehicles, reinforcing the commitment to safety on the roads.

Of 345 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

Form Characteristics

Fact Name Description
Form Purpose The OF 345 form is designed to assess the physical fitness of individuals who operate government-owned or leased vehicles.
Governing Laws This form is governed under 40 U.S.C. 491 and FPM Chapter 930, which outline the required regulations for federal medical examinations.
Personal Information Required Applicants must provide their name, date of birth, title of position, home address, and the employing agency.
Health Conditions The form includes a checklist for various health conditions, such as poor vision, arthritis, or diabetes.
Explanation Section If any health condition is marked "Yes", the applicant is required to provide details about the condition.
Vision and Hearing Aids The form asks whether the applicant uses glasses, contact lenses, or hearing aids while driving.
Privacy Statement There is a privacy statement indicating that providing this information is mandatory for job-related driving tasks.
Consequences of False Information Giving false or dishonest answers can lead to cancellation of eligibility or dismissal, as highlighted in the certification statement.
Designated Official Review Before granting authorization, a designated official must review the form and indicate whether the applicant needs a physical examination.
Signature Requirement Both the applicant and the designated official must sign and date the form to confirm the accuracy of the information provided.

Guidelines on Utilizing Of 345

Filling out the OF 345 form is an important step for individuals whose jobs require driving government-owned or leased vehicles. This form gathers essential information about your physical fitness and health history. Completing it accurately and honestly is crucial, as it may affect your eligibility to operate these vehicles.

  1. Begin with your name. Write your last name, first name, and middle name in the designated space.
  2. Provide your date of birth. Write it in the appropriate format: Month, Day, Year.
  3. Indicate your job title in the space provided.
  4. Fill out your home address, including the number, street or rural route, city, state, and zip code.
  5. List your employing agency in the section labeled for it.
  6. Answer the questions about your medical history. For each item, place a checkmark in the "YES" or "NO" box as applicable.
  7. If you answered "YES" to any medical issue, provide an explanation in the designated area. Include the date of the original condition and its current status.
  8. Answer question 8(A) about wearing glasses or contact lenses while driving. Check "YES" or "NO".
  9. Complete question 8(B) regarding the use of a hearing aid while driving by again checking "YES" or "NO".
  10. Sign and date the form. The signature should indicate your understanding of the consequences of providing false information.
  11. Your designated official will review the form and sign it, providing their determination about your fitness for operating a government vehicle.

Make sure to double-check your responses before submitting the form to ensure all information is accurate and complete. This diligence helps ensure a smoother process in maintaining your driving authorization.

What You Should Know About This Form

What is the OF 345 form used for?

The OF 345 form, known as the Physical Fitness Inquiry for Motor Vehicle Operators, serves to evaluate the physical fitness of federal employees whose job responsibilities require them to drive government-owned or -leased vehicles. This form collects vital health and medical history information to ensure that drivers can operate vehicles safely and effectively.

Who is required to complete the OF 345 form?

Employees who are seeking authorization to drive government vehicles or who are renewing their existing authorization must complete the OF 345 form. The requirement applies to all federal employees whose job roles necessitate the use of these vehicles.

What kind of information is requested on the OF 345 form?

The OF 345 form requests personal information, including the employee's name, date of birth, job title, home address, and agency. Additionally, it asks about past and current medical conditions that may affect driving abilities, such as vision problems, hearing difficulties, and other serious health issues.

What should I do if I answer "Yes" to any health questions?

If any health-related questions are answered with a "Yes," you are required to provide detailed explanations in the space provided on the form. This should include the nature of the condition, the date it originated, and the current status. This information is crucial for the assessment of your fitness to drive.

Is my information on the OF 345 form confidential?

Yes, the information collected on the OF 345 form is protected under the Privacy Act. It is intended solely for the purpose of evaluating your ability to drive government vehicles. However, keep in mind that providing false information can have serious consequences, including job dismissal.

What happens if I do not complete the OF 345 form?

If you fail to complete the OF 345 form when required, you may lose your eligibility to operate a government vehicle. This could significantly impact your job duties, especially if driving is a key aspect of your role.

What is the role of the designated official in the process?

The designated official reviews your completed OF 345 form along with other health-related information. After the review, they will determine whether you require a further physical examination based on your health disclosures. Their assessment ensures that only qualified individuals are authorized to drive government vehicles.

What are the consequences of providing false information on the OF 345 form?

Providing willfully false statements or dishonest answers on the OF 345 form can lead to serious repercussions. This may result in cancellation of your driving eligibility, disciplinary action, or even dismissal from federal service. Additionally, such actions may be punishable by law.

What do I need to sign the OF 345 form?

To complete the OF 345 form, you must provide your signature and the date. This serves as a certification that all your provided information is accurate and true. By signing, you acknowledge your understanding of the potential consequences of misrepresentation.

Common mistakes

Filling out the OF 345 form can be straightforward, yet many individuals encounter common pitfalls that may lead to incomplete or inaccurate submissions. One common mistake is failing to provide complete and accurate personal information in the initial section of the form. The first four items, which include the applicant's name, date of birth, position title, and home address, must be filled out clearly and without errors. Omissions or inaccuracies in this section can cause delays and complications in processing the form.

Another frequent error arises during the health screening portion of the form. Applicants often overlook the significance of marking 'Yes' or 'No' adequately next to their health conditions. Each box requires a thoughtful assessment of personal health history. Neglecting to check any relevant boxes, even those that may seem minor, can lead to misunderstandings about an individual's fitness for duty. It is crucial to take the time to reflect on one’s health and be transparent with this information.

Moreover, individuals sometimes misinterpret the instructions regarding conditions requiring further explanation. If a person answers 'Yes' to any of the health questions, they must provide a full explanation in the designated area. This is not merely a formality but a vital part of the review process. Providing vague or incomplete explanations could raise red flags during the review, potentially leading to a referral for unnecessary medical examinations.

Finally, a significant mistake involves the certification section at the end of the form. Applicants often fail to sign or date the form properly. Both a signature and a date are essential as they certify the accuracy of the information provided. Without these, the application may be void. It is important to remember that a willfully false statement may result in serious consequences, including ineligibility or dismissal, highlighting the necessity of diligence and honesty throughout the process.

Documents used along the form

The OF 345 form is essential for assessing the physical fitness of individuals who operate government vehicles. Along with this form, various other documents may also be required to complete the evaluation process. Here is a list of related forms and documents frequently used in conjunction with the OF 345.

  • OF 306 - Declaration for Federal Employment: This form gathers essential information about an individual’s background, including personal and employment history, and is often required for federal job applications.
  • DD Form 2807-1 - Report of Medical History: This form documents an individual’s medical history, detailing past and current medical conditions. It is crucial in assessing fitness for duty.
  • DD Form 2808 - Report of Medical Examination: This form is used to record the results of a medical examination. It provides a comprehensive overview of the individual's physical condition.
  • SF 78 - Statement of Health Condition: This document is related to the health of an individual seeking a job. It highlights any ongoing health issues that may impact job performance.
  • OF 378 - National Agency Check and Inquiry (NACI): This form is a security clearance document that examines an individual's background for any security risks before employment.
  • SF 85 - Questionnaire for Non-Sensitive Positions: This form collects personal information for individuals applying for non-sensitive government positions, focusing on character and fitness for the role.
  • Medical Examination Report (MER): This report summarizes the findings of a medical evaluation conducted by a healthcare professional and determines an individual’s ability to perform job duties.
  • Drug Test Consent Form: This document is often required to obtain an individual's consent for drug testing, ensuring compliance with federal regulations on substance use.
  • OF 294 - Federal Medical Examination Program Consent Form: Used to obtain consent from employees for a physical examination related to their employment, it ensures they understand the examination's purpose and procedures.

These documents work together to ensure that individuals fit the criteria necessary for operating government vehicles safely. Completing these forms accurately and thoroughly helps support the health and safety of all employees in transportation roles.

Similar forms

  • OF 306 - Declaration for Federal Employment: Similar to the OF 345, this form collects personal information such as name, date of birth, and employment history to assess eligibility for federal employment, ensuring candidates meet specific criteria.

  • SF 85 - Questionnaire for Non-Sensitive Positions: This document is used to gather information on an applicant's background, focusing on issues that affect a person's suitability for federal positions, akin to the OF 345's focus on physical fitness for driving.

  • SF 86 - Questionnaire for National Security Positions: Like the OF 345, this form dives into personal health and psychological well-being, although it is targeted more towards positions requiring security clearance, addressing concerns about an individual’s reliability.

  • OF 447 - Request for Employment Information: This form requests details about an individual's driving history and employment records. Similar to the OF 345, it evaluates eligibility to operate vehicles for government purposes.

  • DOT Medical Examination Form (MCSA-5876): This document is crucial for commercial drivers and assesses medical fitness, reflecting the OF 345's goal of ensuring drivers meet health standards for safe vehicle operation.

  • Department of Defense (DoD) Physical Examination Board (PEB) Forms: Used to evaluate physical conditions in a military context, these forms are similar in purpose to the OF 345, but focused on overall service fitness rather than just driving.

  • VA Form 21-2680 - Examination for Housebound Status or Permanent Need for Regular Aid and Attendance: This form examines physical limitations and health status, paralleling the OF 345 in assessing an individual's ability to perform necessary tasks safely.

  • SF 75 - Request for Preliminary Employment Data: This form gathers preliminary personal data from candidates, similar to the OF 345, but with a broader scope beyond just physical fitness for vehicle operation.

  • CA-2 - Federal Employee’s Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation: This document requires employees to disclose health status owing to work-related injuries, akin to the health disclosures found in the OF 345.

  • Form I-9 - Employment Eligibility Verification: While focused on eligibility to work in the U.S., it also requires disclosure of personal information, similar to basic data collection in the OF 345.

Dos and Don'ts

When filling out the OF 345 form, it is important to carefully consider your responses. Here is a list of things you should and shouldn’t do:

  • Do ensure your name is written clearly and accurately.
  • Do provide your complete address, including the correct zip code.
  • Do answer all medical questions honestly, especially those regarding your health history.
  • Do check your work for any mistakes or omissions before submitting the form.
  • Don’t skip any questions, as all information is crucial for your assessment.
  • Don’t provide vague answers; be specific, especially when documenting medical conditions.
  • Don’t falsify any information, since this may lead to severe consequences.

Misconceptions

  • Misconception 1: The OF 345 form is only for new employees.
  • This form is essential for both new hires and current employees who need to renew their authorization to operate government vehicles. It ensures ongoing compliance with physical fitness standards.

  • Misconception 2: Completing the OF 345 form is optional.
  • Filling out the OF 345 is mandatory for employees whose job requires driving government vehicles. Failing to submit the form may prevent you from operating those vehicles.

  • Misconception 3: The information on the form is not confidential.
  • The form contains sensitive personal information. Under the Privacy Act, the disclosure of this information is highly regulated, and it is used solely for the purpose of assessing fitness to drive government-owned or -leased vehicles.

  • Misconception 4: Only physical disabilities are considered on the OF 345 form.
  • The form addresses both physical and mental health conditions. Issues such as nervous problems or excessive drinking habits can also impact an individual’s ability to drive safely.

  • Misconception 5: Medical referrals are automatic if any symptoms are checked "Yes."
  • A "Yes" response does not automatically result in a medical referral. The designated official will review the information and make a determination based on all factors before deciding on a referral.

  • Misconception 6: The OF 345 form is only relevant for specific job titles.
  • This form applies broadly to many federal positions that include driving as part of the job description, regardless of job title.

  • Misconception 7: If I wear corrective lenses, I cannot pass the fitness inquiry.
  • Wearing glasses or contact lenses does not disqualify you. In fact, the form specifically asks about corrective lenses, indicating that accommodations can be made to support your ability to meet safety standards.

  • Misconception 8: Providing false information on the form is a minor issue.
  • Submitting false information is a serious matter. It can lead to the cancellation of your driving eligibility and potential disciplinary actions, including dismissal. Honesty is paramount.

  • Misconception 9: The OF 345 form is only reviewed by the employee’s supervisor.
  • The form is reviewed by a designated official, who has the responsibility to assess the information thoroughly. This ensures an objective evaluation of an employee’s physical fitness regarding safe driving.

Key takeaways

Filling out the OF 345 form is an essential step for federal employees seeking to operate government vehicles. Understanding its requirements can help ensure a smooth process. Here are key takeaways to consider:

  • Accurate personal information is crucial. Include your full name and date of birth correctly.
  • Make sure to provide your job title and home address, as this helps in identifying your eligibility.
  • List your employing agency. This information connects you to your specific workplace requirements.
  • Health questions cover various conditions. Read each question carefully and answer honestly.
  • If you answer "Yes" to any health condition, explain it thoroughly in the provided space.
  • Indicate whether you wear glasses or contact lenses while driving. This information is important for safety.
  • Be aware that there are consequences for false statements. Understand the importance of honesty in your responses.
  • Your signature and date certify that the information you've provided is accurate and complete.
  • A designated official will review your form. They will determine if a physical examination is necessary.
  • Failure to complete the form accurately may affect your ability to operate government vehicles.

By being mindful of these points, you can effectively navigate the requirements of the OF 345 form.