Individuals assigned to an ESCAPE post, where living and working conditions are austere and high-threat, need this two-page acknowledgement in addition to the DS-1843 clearance exam. After a full clearance evaluation, the provider states whether the person can more probably than not live and work in those conditions, using the patient's answers to 42 screening questions on page 2.
The patient answers the 42 yes/no questions on page 2 and signs there. The examining provider completes page 1: the check-one opinion, a reason if the person cannot live or work at the post, stamp or printed name, signature and date.
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Employee Self-Certification and Ability to Perform in Emergencies (ESCAPE) Posts Pre-Deployment Physical Exam Acknowledgement Form
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When the proposed post of assignment is an ESCAPE post. DS-1843 tells examinees to complete a DS-6570 if their post is an ESCAPE post, and the DS-6570 is submitted with the medical clearance exam. It does not replace DS-1843; the provider first performs the full clearance evaluation.
Extreme heat, high elevation, dust and air pollution, sleep deprivation, emotional stress and circadian disruption. The person may need to respond to duck-and-cover alarms, navigate a smoke-filled building, climb stairs and board helicopters in PPE, ride in off-road or military transport, and lift luggage into a helicopter.