Fit To Train Form

Spontaneous pneumothorax (collapsed lung)*
YesNo

Traumatic pneumothorax*
YesNo

Asthma*
YesNo

Reactive Airways Disease*
YesNo

COPD (chronic obstructive pulmonary disease)*
YesNo

Emphysema*
YesNo

Sarcoidosis*
YesNo

Tuberculosis*
YesNo

Pulmonary Fibrosis*
YesNo

Cystic Fibrosis*
YesNo

Lung Bullae or Cysts*
YesNo

Chest or ‘open-heart’ surgery or Cysts*
YesNo

Any other chest or lung disease*
YesNo

Lung problems related to vigorous physical activity and/or immersion in water (including but not limited to non-immersion pulmonary oedema)?*
YesNo

Are you currently using (or have you had to use in the past) inhalers/puffers for asthma, COPD or chest infections?*
YesNo

Are you currently using any medications for a persisting ear nose or throat condition (do not include common cold or hay fever)*
YesNo

Have you been advised to avoid swimming/immersion of your ears in water?*
YesNo

Have you been advised to avoid diving because of any problem related to your ears, nose, sinuses or throat?*
YesNo

Brief details of 'yes' answer(s):