U.S. DOD Form dod-ngb-116
Page 1 of 2
(For use of this Form, see page 2, Proponent Agency is NGB-AVN-OO)
(Check appropriate box)
PRIORITY 1 - INCLUDES:
a. All Class 1, 1A, and 2S Flight Physicals.
b. All Class 2 Flight Physicals for aviators
applying for ARNG aviation service.
c. Class 2 Flight Physicals for requalification of
aviation service. (NOT PERIODICS OR ANNUALS)
PRIORITY 2 - INCLUDES ALL OTHER FLIGHT PHYSICALS
THIS IS AN
ARMY NATIONAL GUARD
FLIGHT PHYSICAL
IF QUALIFIED FOR AVIATION SERVICE
RETURN TO:
(Stamp or type return address)
IF:
(1) Disqualified and waiver recommended.
(2) Disqualified and termination recommended.
(3) Requisition recommended.
RETURN TO:
Chief, National Guard Bureau
Army Aviation Division
ATTN: NGB-AVN-OO
Bldg. E6810
Aberdeen Proving Ground, MD 21019-5420
NGB Form 116, JULY 99 (Adobe v. 4.0)
(Replaces NGB Form 116 dated, JUNE 90 which is obsolete)
Page 2 of 2
GENERAL INSTRUCTIONS FOR USE OF NGB FORM 116
1.
Check the appropriate priority box at the top of the form.
2.
Rubber stamp or print the address to which the physical is to be returned to in
the box provided.
3.
It is the responsibility of the individual requesting the review of the physical, i.e.
Unit, Flight Activity, Facility, Flight Surgeon, etc., to ensure that this form is a
part of the physical packet so that upon completion of the physical i can be
attached as a cover sheet prior to forwarding to USAAMC.
4.
All Class I, and Class II (Class III when appropriate) physicals to be reviewed in
accordance with AR 40-501, will have this form as a cover sheet attached prior
to forwarding to USAAMC. ATTN: HSXY-AER, Ft. Rucker, AL 36362.
NGB Form 116, JULY 99 (Adobe v.. 4.0)