16-02 Annex A - Example Training Limitations Assessment Form
Cadet Administrative and Training Orders (CATOs)
Example – Training Limitations Assessment Form
A. Identification And Medical Status
Cadet Name:
[Insert name]
Corps/Squadron:
[Insert corps/squadron]
The CF 51 of this cadet applicant for the Canadian Forces Cadet Summer Training Program mentions the following medical condition: [insert conditions]
B. Authorization
I authorize the disclosure of information contained in this document to medical authority for the purposes of training programmed selection of this applicant.
[Signature of parents/guardians/
(cadet if over 18)]
[Name (please print)]
[Date]
C. Medical Information
Additional medical information is required to determine the applicant’s medical suitability to undertake training. Please identify the following:
1. Past history of illness, surgery or incapacitating conditions:
[Insert conditions]
2. Past/present treatment and/or medications:
[Insert ast/present treatment and/or medications]
3. Date of last follow-up with his/her physician and current medical status:
[Insert status]
Use the attached task statement to determine the cadet’s physical requirements on his/her course and the conditions under which they will have to perform. Please indicate any factors or task the cadet cannot perform for medical reasons:
[Insert reasons]
[Signature of attending physician]
[Name (please print)]
[Date]
D. Formation Surgeon Review
Include any restrictions imposed due to medical condition:
[Date]
[Base Surgeon Signature]
Note: The department of National Defense is not responsible for any FEES incurred, as a result of this request.