BLU3 FITNESS TO DIVE EVALUATION
Participant’s Name: Date of Birth:
Surface Supplied Air (referred to as SSA such as BLU3 equipment) diving with BLU3 Nemo and Nomad
products is fun and exciting but can be a strenuous and demanding activity. As with any underwater activity
using life support equipment pumping compressed air to a diver below the surface, there are inherent risks
that may cause serious illness, injury and death. SSA divers need to be in good health to dive. If you have
any questions about your medical, mental or physical fitness to dive, you should consult a physician to
assess your individual risks factors.
This evaluation is to help you determine if you should be examined by a physician prior to diving. If you
have any doubt about your fitness to dive, then you must obtain approval to dive from a physician. Failure
to obtain a physician’s approval to dive may significantly increase your risk of illness, injury or death. You
are solely responsible for honestly evaluating your fitness to dive and you are ultimately responsible for
your safety and wellbeing when swimming and diving.
Answer each question about your past and present medical history in the corresponding [NO] or [YES] box.
If you are not sure of the correct answer, then answer “YES”. A “YES” response indicates an increased risk
factor that must be evaluated by a physician. If any of these conditions apply to you, then you must obtain
approval to dive from a physician before SSA diving with BLU3 Nemo and Nomad products.
1. Are you currently being treated or under the care of a medical professional for
a medical, mental or physical condition? [NO] [YES]
2. Do you take a prescription medication (not including birth control)? [NO] [YES]
Do you have or have you ever been treated for:
3. A heart, circulatory, blood, blood pressure, or bleeding abnormality? [NO] [YES]
4. A stroke, seizure, head injury, loss of consciousness, migraines, behavioral or
neurologic condition? [NO] [YES]
5. An ear, sinus, mouth, throat or lung disorder – including asthma? [NO] [YES]
6. Diabetes, severe allergies, obesity, stomach or intestinal disorders? [NO] [YES]
7. Musculoskeletal, strength, stamina or mobility disorders? [NO] [YES]
8. Any type of medical implant that could be affected by immersion in water
or change in ambient pressure? [NO] [YES]
9. A pacemaker or medical implant that may be affected by magnets? [NO] [YES]
(BLU3 Nemo and Nomad have strong magnets and therefore must not be used by
persons with pacemakers or medical implants that may be affected by magnets.)
If you answered YES to any of these conditions, then you must be evaluated by a physician to approve
your fitness to dive. You are responsible to obtain and keep a written document from the physician stating
you are fit to dive. Documents for your physician to fill out are available at http://diveblu3.com/fitness-to-
dive-evaluation.
Additionally, if you are under the influence of alcohol or recreational drugs, unable to swim, prone to
panic attacks, unable to exercise good judgment or you are unable to be responsible for your own safety
and wellbeing, then you have a significant increase to risks of illness, injury and death while in the water
and you should unconditionally refrain from swimming or diving.
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