DRAFT
Merchant Shipping Notice No. 00 of 2013
No: 70-NT (1)/2008-pt
Date: 11/07/2013
Sub: Medical Fitness Examinations for Seafarers under STCW, 1995 as
amended (2010 amendments) and Maritime Labour Convention [MLC],
2006-regarding.
For the attention of: Seafarers, Approved Training Institutes, Ship Owners,
Ship Managers, DGS – RPS License holders,
Seafarers Unions, DGS
approved Medical Examiners and Examination Centers and Mercantile
Marine Departments, etc.
Introduction 1. The Directorate vide its Merchant Shipping Notice No. 23 of 2010 dated
4th November, 2010 developed procedures to grant approval to Medical
Examiners for the purpose of conducting Pre-sea (new entrant) and
Periodical Medical Examination (existing seafarers).
2.
India being signatory to STCW, 1995 as amended and Maritime Labour
Convention, 2006 has obligations to implement and enforce its
provisions.
In view of this, the Directorate in consultation with the
stakeholders has revised the existing M.S. Medical Examination Rules,
2000.
3. The new draft rules conforms to the relevant provisions of STCW, 1995
as amended in 2010, Maritime Labour Convention 2006 as adopted by
IMO & IMO/ILO/JMS/2011 including all annexes relating to revised
guidelines on the conduct of medical examination.
These draft rules
shall replace the existing M.S. Medical Examination Rules, 2000 after
due promulgation by the Govt. of India.
4. The promulgation of these rules shall be undertaken as per the
requirements stated under Section 458 of the Merchant Shipping Act,
1958 that may take some time.
In the interim, to give affect to the
provisions of STCW, 2010 (amendments) and MLC, 2006 relating to
medical examination of seafarers, this M.S. Notice is being issued which
supersedes M.S. Notice No. 23 of 2010. This M.S. Notice primarily
incorporates the salient features of new draft medical examination rules.
1
Applicability:
5. This notice is applicable to the;
5.1
new entrant(s) seeking marine profession;
5.2
seafarers
taking
certificate
of
competency
/
proficiency
examination and seeking relevant endorsements under STCW
Rules as amended for the purpose of statutory safe manning and
other matters incidental to this.
5.3.
Seafarers being employed on board ships.
Procedure for the approval of medical examiners:
6.
Medical examiners seeking approval shall6.1.
send an application duly completed in the prescribed format as
per Schedule I by post/speed post to the Directorate General of
Shipping, Mumbai;
6.2.
be a licensed physician and holding at least MBBS degree
recognized
by
the
Medical
Council
of
the
Central/State
Government and his/her age not to exceed 65 years from the date
of submission of application;
6.3.
be experienced in conducting medical fitness examination of
seafarer.
6.4.
have the requisite medical facilities and equipments to carry out
medical fitness examination, which are conveniently situated for
easy access by seafarers, and enabling all the requirements of
medical fitness examination to be met and conducted with respect
for confidentiality, modesty and cleanliness at the declared
premises within the municipal limits of the city. Such declaration
shall be made in the check list as prescribed in schedule III;
6.5.
be familiar with the relevant sections of the Maritime Labor
Convention 2006 adopted by ILO such as Regulation 1.2- Medical
Certificate, Regulation 3.1- Accommodation and recreational
facilities and Regulation 4.1 – Medical care on board ship and
ashore;
6.6.
be familiar with the relevant sections of the STCW Convention and
the Codes such as Regulation I/9 Medical standards, section AI/9-Medical standards, section B-I/9-Medical examination and
2
Certification and Resolution 8- Development of guidelines to
implement international standards of medical fitness for seafarers;
6.7.
be familiar with the latest edition of the International Maritime
Guide for ships or an equivalent medical guide for use on ships;
possess adequate knowledge of living and working conditions on
board a merchant ships or vessels, or other description of vessels
use in navigation and the job demands on seafarers in so far as
they relate to the effect of health problems on fitness for work.
6.8.
this knowledge may be gained either through special instructions
suo-motu or courses relating to occupational/maritime medicines
conducted by the medical professional bodies in India or otherwise
duly approved by the medical professional bodies in India or
through adequate shipboard service onboard sea going ships in
the capacity of medical doctor or as supernumerary or serving as
medical doctor in any shipping company or being associated with
the approved Medical examiner of the DG Shipping for adequate
period ( preferably at least 6 months ) whichever is practical and
convenient to him
6.9.
submit along with the application an affidavit confirming the,
means used in acquiring the understanding of knowledge of ship
board activities, in the prescribed form as in Schedule I-A;
6.10. be well conversant with at least Hindi or English language;
6.11. states that he/she enjoys full professional independence in
exercising their medical judgment when undertaking medical
examination procedures; and
6.12. submit all supporting documents duly notarized or attested by the
Gazette officer or self attested.
6.13. the Medical practitioner shall be personally interviewed by the
duly designated officer of the Directorate General of Shipping.
The duly designated officer may carry out the inspection of his /
her premises to verify the facilities at the Diagnostic Laboratory or
other premises.
6.14. upon receipt of satisfactory compliance report along with the
applicable documentary evidences confirming the compliance and
fulfilment
3
of
administrative
procedures
and
clear
recommendations to approve, the Directorate General of Shipping
shall approve the Medical practitioner.
The Medical Practitioner
thereafter shall be issued with letter of approval in the prescribed
format as
specified in Schedule-II . This approval shall be valid
for empanelled Medical examiners for till the validity of his current
registration or maximum period of 5 years.
6.15.
the empanelled Medical examiners, the approval to these may be
extended for further till the validity of his current registration or
maximum period of 5 years may renew their empanelment within
6 months of date of coming into force of these rules.
6.16. such medical examiners who attains age of 65 years, may apply
for the extension to the Approving Authority in the prescribed
format as specified in Schedule I.
The Directorate General of
Shipping may in such cases extend the letter of approval for a
period of maximum 5 years up to a maximum age of 75 years as
prescribed
in
schedule
II.
No
further extension
shall
be
considered for medical examiners above 75 years of age.
6.17.
all approved Medical examiners shall be placed on the panel of
the DGS. Their names along with contact details shall be
disseminated through the DGS website as soon as possible.
6.18. all approved Medical examiners, who are on the panel of the DGS
shall submit 6 monthly returns in the prescribed format as
specified in Schedule VIII in electronic form and followed by hard
copies. Changes in the status of the approved Medical examiner in
terms of his/her medical fitness, place of business, number of
facilities and sub contracting of related services if undertaken or
any other reasons shall be communicated by the Medical
examiner to the Directorate General of Shipping within 30 days of
such schedule through normal postal service.
Types of Medical Examination7.
The approved Medical examiner as per the request of the
company, approved training institute, new entrant, seafarer or person as
case may be shall conduct the following types of medical examination
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7.1.
a pre sea medical examination-this examination provides an
opportunity to prevent entry of unsuitable new entrant to the
seafaring profession for health reasons apparent at that time.
This examination shall therefore be more stringent in nature than
the periodic medical examination.
7.2.
a periodic medical examination -this examination provides an
opportunity to ensure that seafarer or person remains fit for sea
service by identifying medical conditions which may have develop
since the seafarer entered the profession. It shall be more flexible
than the pre sea examination, yet not so flexible as to permit unfit
seafarer to work at sea or resume ship board duty or undergo
certificate of competency and related examinations and obtain
applicable endorsements.
Frequency of medical examination:
8.
Medical Examinations are normally performed every two years. Where
there is a health condition that requires more frequent surveillance, they
may be performed at shorter intervals. It is important to recognize that
the requirement for more frequent medical examinations may limit the
ability of a seafarer to obtain employment and lead to additional costs for
the seafarer or their employer. If medical examinations are at intervals of
less than two years, they may solely concern the condition under
surveillance and, in this case, any reissued medical certificate shall not
be valid for more than two years from the previous full examination;
9.
Any medical examination at the request of employer or training
institute or the seafarer shall be conducted in accordance with
this notice.
A medical certificate shall be issued by the approved
medical examiner to the seafarer who meets all requirements with
regard to medical fitness as prescribed under the provision of M.S.
Act, 1958 as amended, MLC, 2006 as amended and STCW, 1978
as amended. This medial certificate shall be issued in prescribed
format in schedule-VII only on the basis of compliance with
statutory standards irrespective of compliance with any additional
employer or insurer requirements.
5
10.
Seafarer medical examinations may also provide an opportunity to take
measures to correct or mitigate medical conditions which could adversely
affect the health of seafarers and shall include measures of a preventive
character. Tests necessary to evaluate the occupational exposure at work
on board ship may, when appropriate, be performed at the same time as
the periodic examinations.
Conduct of Medical Examination by the Approved Medical examiner:
11. The approved Medical examiner and the associated laboratory shall conduct
the physical, mental tests as per the relevant provisions of these rules and shall
use prudence and professional medical judgments and experience.
Medical Fitness Standards- Verification:
12.
The medical examiner in assessing the medical fitness of seafarers
including new entrant shall take into account the physical capability
requirement, fitness criteria for medication use, medication that can impair
routine and emergency duties and medication that can have serious adverse
consequences for the user while at sea including medications that require
limitations of period at sea because of surveillance requirements. In doing so
the medical examiner shall taken into account the guidelines specified in
ILO/IMO publication “Guidelines on the medical examination of seafarersILO/IMO/JMS/2011/12. The medical examiner shall pay special attention to
the following as far as the examination and issuance certification of seafarers;
12.1. Appendix A- Vision standards - STCW Code table A-I/9: Minimum inservice eyesight standards for seafarers
12.2. Appendix B- Hearing standards – testing as per the prescribed procedure
and criteria
12.3. Appendix C- Physical capability requirements - Table B-I/9. Assessment
of minimum entry level and in-service physical abilities for seafarers.
12.4. Appendix D-Fitness criteria for medication use as prescribed.
12.5. Appendix E- Fitness criteria for common medical conditions as
prescribed -
6
Validity of Medical Examination Certificate:
13.
Unless a shorter period is required by reasons of the specific
duties/functions to be performed by the new entrant, seafarers and
persons concerned, the validity of the medical certificate shall be as
follows:
13.1. the medical certificate shall be valid for a maximum period of 2
years and colour vision certificate for maximum period of 6 years.
However, frequent test that may include eye sight test & other
applicable tests as is deemed necessary by the Approved Medical
examiner may be carried out;
13.2. unless the new entrant, seafarer or person is under age of 18, in
which case the maximum period of validity shall be 1 year.
However, frequent test that may include eye sight test & other
applicable tests as is deemed necessary by the Approved Medical
examiner; and
13.3. every seafarer signing off from the ship on medical grounds for
whatsoever reasons shall be subjected to fresh periodic medical
examination even if, the existing medical certificate held by
him/her is valid.;
13.4. every seafarer shall be subjected to physical examination which
may inter-alia include examination of organ or organ systems such as;
13.4.1.
head, eyes, ears, nose, mouth, throat, neck, chest,
abdomen, skin and limbs etc.
13.4.2.
vital signs - blood pressure, pulse rate and body
temperature etc;
13.4.3.
vital
Systems-
respiratory,
cardiovascular,
nervous,
gastrointestinal and genitourinary etc;
13.4.4.
general appearance- posture, expression, restlessness,
speech, behaviour and sweating including weight and
height etc; and
13.4.5.
if deemed necessary clinical tests based on the declaration
made by the seafarer before the approved medical examiner
or requested by the company as the case may be.
7
13.4.6.
the medical certificate for new entrant, seafarers or
persons shall as a minimum be provided in English.
13.5. The medical examiner shall assess the physical and mental
condition of the applicant and conduct the relevant clinical test as
prescribed in schedule-V. The medical examiner may as per his
professional medical judgment in addition carry-out additional
test taking into account the medical declaration made by the
seafarers as prescribed in schedule -VI and other factors as deem
fit for the specific case.
13.6. The seafarer shall not suppress medical information and declare
correct and proper medical information to the medical examiner to
the best of his knowledge and belief.
In case of any wrongful
Act or misrepresentation/suppression of material fact(s) of
information or infringement the concerned seafarer shall be
fully responsible/liable for the consequences/ damages /
penalties as per the provisions or the applicable laws.
Appeal Procedures
14.
Any applicant whose case has been rejected by the Directorate General
of Shipping for the approval to perform the functions of Medical Examiner or
extension of approval, suspension or withdrawal or a ship-owner not accepting
the decision of approve medical examiner or seafarer having grievance against
approved medical examiners or ship-owner may lodge an appeal within three
months from the date of issue of such decision. Such appeal shall be made to
the Director General of Shipping & accompanied by a copy of the order
appealed against in writing including contents of any rejection;
14.2. on receipt of the appeal the Director General of Shipping shall
examine the case and may give the applicant a reasonable
opportunity of being heard before disposing the case.
14.3. an appeal shall be disposed within a period of sixty days from the
date of filing of the appeal;
14.4. the Director General of Shipping may confirm, modify or reverse
the order, appealed against.
15.
8
Compliance and Enforcements :
15.1. All concerned in order to give affect to the provision of MLC, 2006
and STCW, 2010 in respect of medical examination of seafarers
are advised to comply with this notice and insure that the medical
certificate prepared and issued which is based on medical
examination seafarers declaration. The medical certificate for the
new entrant and existing seafarers before they embarked on board
your ships are issued which conforms to the provisions of STCW,
2010, MLC, 2006 and IMO/ILO/JMS/2011 revised guidelines of
conduct of medical examination.
15.2. As regards, the trainees or seafarers already in employment of
ship-owners or ship manager or RPS license holders and serving
on board Indian Flag Ships, the medical certificate issued under
the existing Medical Examination Rules, 2000 shall remain valid
wherever the Indian ship is.
In the event of expiry of such
certificates at sea, it shall remain valid till arrival of next port of
call or where the facility of medical examination is available.
15.3. The ship-owners, ship managers and RPS license holder of the
Directorate as the case may be shall advise their empanelled
medical examiners who are approve by D.G. Shipping to be guided
by this notice.
15.4. All concerned in order to avert any intervention by the Port State
Control Authorities or Flag State Control Authorities or delegated
authorities of the flag state to voluntarily comply with this
requirement from the date of issuance of this notice.
15.5. MLC,
2006,
is
entering
into
force
internationally
w.e.f.
20/08/2013 and therefore it is essential that all concerned shall
comply with the provisions of this notice strictly. However, ship
owners or managers or RPS license holders may issue medical
certificate or voluntary basis prior to this.
15.6. This notice shall comes w.e.f. ............ and may be reviewed if
deemed necessary at periodical interval.
15.7. These issues with the approval of Director General of Shipping.
(Capt. Deepak Kapoor)
9
List of Annexes –
Deputy Nautical Advisor -cumSr. Deputy Director General DDG (Tech)
Schedule I- Application for Approval and Extension of Approval
Schedule II- Affidavit format
Schedule III- Letter of Approval/Extension of Approval to the Medical examiner
Schedule IV- Check List for Approval /Extension of Approval to the Medical
Examiner
Schedule V - Minimum Test for the conduct of medical examination
Schedule VI – Medical Examination of Seafarer (Examinee’s Declaration).
Schedule VII- Medical Certificate to Seafarer
Schedule VIII – Half Yearly Returns
10
Schedule I
Application for Approval and extension of Approval
Photograph
(size)e
3.5
3.5
To
Directorate General of Shipping
Date
_________________
Jahaz Bhavan,
Place
________________
Walchand Hirachand Marg,
Ballard Estate,
Mumbai-400 001.
[Kind Attn: Approving Authority (Nautical Adviser to the Government of
India) ].
[Subject:- Approval / Extension of approval to Medical examiner -regarding.]
Sir,
I, Dr.
__________________________________ wish to apply for the
approval of Medical examiner / extension of approval to conduct medical
examination.
11
A copy of my Bio-data along with other relevant documents
pertaining to academic and professional qualification, experience, previous
letter of approval, proof of age, check list duly notarized or certified and filled in
are enclosed. I declare to extend all co-operation to the authorized official of the
Competent Authority in course of interview and inspection of premises before
the approval or thereafter.
You are therefore, requested to issue a letter of approval /
extension of approval to enable me to perform the function of Medical examiner
for the purpose of medical examination.
Yours faithfully,
(Dr._____________________)
Name:__________________
Medical Council of India Registration No.__________
Date of issue: __________________
(delete as applicable)
Enclosures:
1.
Copy of Medical Council of India Registration Certificate.
2.
Copy of bio-data with supporting documents including an affidavit
3.
Copy of check list duly filled in with relevant information.
4.
Copy of proof of age.
5.
Copy of previous letter of approval, if applicable. [Note:- A copy of above
mentioned documents shall be duly notarized or certified by Gazette
officer or self attested]
6.
A proof for medical fitness by Government department in case of
extension.
7.
A proof for filing periodical returns in case of extension.
8.
A proof stating no pending complaints or legal proceedings for new
applicant and existing cases.
9.
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Two passport size photograph (3.5 x 4.5 cm)
Schedule II
AFFIDAVIT
I, Dr. ______________, Regn. No. ______, (State/Centre) Medical Council,
aged ____ years, Indian Resident, having my clinic at ______________, do hereby
on solemn affirmation as under:
1.
I am fully conversant with the applicable Indian Maritime Laws, the
entire process of examination the seafarers and good understanding in the
following areas:
(i)
have adequate knowledge of living and working conditions on
board sea going merchant ships of various types gained
through
special
instructions
or
attended
occupational/Maritime medicine/health related courses or
other means as prescribed by the council or association or self
efforts.
(ii)
Medical publication “The International Medical guide for ships
or an equivalent national medical guide for use on ships.
(iii)
Standard of Training, Certification and Watchkeeping 1995 as
amended REG I/9-Medical Examination.
(iv)
Maritime Labour Convention 2006- Medical Examination of
Seafarers.
(v)
International
Labour
Organization/World
Health
Organization/D.2/1997,
as
amended-Guidelines
for
conducting pre-sea and periodic medical fitness examination of
seafarers.
(vi)
Relevant provisions of Merchant Shipping Act, 1958, section 98
etc.
(vii)
Merchant Shipping (Medical Examination) Rules 2000, as
amended and DGS/M.S. Notices of Medical Examination and
Sight test issued from time to time as available on DGS
website.
(viii)
Procedure to deal with appeal cases etc.
I state that the contents of this affidavit are true and correct to my knowledge.
Solemnly affirmed in _______ on dd/mm/yyyy
(place)
13
Before me
Attested
Schedule III
Letter of Approval / Extension of Approval
(No.DGS/Medical/_______)
Reference No. --------To,
Dr
[Sub: Letter of Approval / extension of approval to Dr.
Registration No. --- ]
-----------------------------------------------------------------------------------------------Sir,
In response to your application No.__________
dated
and
subsequently fulfilling the laid down criteria for the approval /extension of
approval], the Competent Authority is pleased to accord approval or extend
approval
to you as Medical examiner in accordance with Section 98 (4) of
Merchant Shipping Act, 1958. [You are therefore permitted to conduct medical
examination in accordance with the relevant provisions of Merchant Shipping
Act, 1958, Rules framed their under and other laws applicable, including any
notification issued by Competent Authority from time to time.
Your name along with contact details given by you in the application /
check list shall be displayed on the DGS Website at the earliest. This approval
shall remain valid for --- years till ----------- subject to the compliance with the
following conditions.
1.
2.
3.
The Nautical Advisor to the Government of India has the right to suspend or
withdraw this letter of approval / extension or report to the concerned
14
authorities after giving an opportunity to you to defend. However, you have the
right to appeal to the Competent Authority against such decision.
Yours faithfully,
(Authorized Official of Competent Authority)
(delete as applicable)
Cc:
1. All Principals Officers, MMD
Schedule IV
CHECK LIST FOR APPROVAL/EXTENTION OF APPROVAL TO MEDICAL
EXAMINER
(To be duly filled in by the applicant)
PART A
Name of the applicantDate of birthName & address of clinic at which medical examination to be conducted –
PART B
Educational qualification with certified copies as attachmentProfessional qualification with certified copies as attachment (at least M.B.B.S.)IMC registration numberDetails of experience including experience on ships or in lieu adequate
knowledge on living and working condition on board merchant ships
Details of qualified support staff having adequate experience in providing
medical services to the seafarersDetails of other doctors, managerial, Para-medical and clerical staff including
consultantsDetails of the clinic(numbers) and laboratory facilities(numbers) – adequate area
to accommodate medicals officer, staff, record room, waiting area for seafarers
& list of medical examination facilities at the clinic –
15
List of clients giving evidence of integrity, goodwill and understanding of
seafaring profession -
Names of inspecting team
1.
2.
3.
Remarks of the Inspecting TeamRecommendations of the Inspecting team-
Date
16
Official Seal
Place
Schedule V
Minimum Test for the conduct of medical examination
1. Periodic Medical Examination (Sea Service & Certification purposes)
(A) Mandatory Examination and Tests (Sea Service)
Physical Examination: Weight, Height, Temperatures, Blood Pressure, pulse rate, Sight,
Hearing , Oral Health ,general appearance and systemic examination of whole body.
Blood Tests :BI CBC
BI ESR
RBS / FBS
SGOT
SGPT
SGGT
S Creatinine & Urea
S Cholesterol
S Triglycerides
Blood group & Rh factor( tested only once, need not be repeated)
Test for Hepatitis B (HbsAg) and C
VDRL
HIV I& II
X-ray chest
Urinalysis
ECG
17
Drug
&
Alcohol
Screening
–
Morphine,
Barbiturates,
Marijuana,
Cocaine,
Amphetamines, Alcohol
Audiometric
Stool R/E & Widal for food handlers
Ultrasound (USG) of the Abdomen & Pelvis
(B) Optional Tests-
Psychometric evaluation on case to case basis
Stress test
2D echo Doppler study (for heart patient)
Glycosylated (Hb1Ac)
Spirometry
3. Mandatory Examination and Tests (Certification of Competency and other
endorsements) subject to the candidate not having medical certificate.
(i) Physical Examination: Weight, Height, pulse rate, Temperatures, Blood Pressure,
Sight, Hearing ,Oral Health ,general appearance and systemic examination of whole
body.
(ii)Blood Tests :BI CBC
BI ESR
RBS / FBS
SGOT
SGPT
SGGT
S Creatinine
S Cholesterol
18
S Triglycerides
Blood group & Rh factor
Test for Hepatitis B (HbsAg) and C
BI VDRL
HIV I& II
(iii)X-ray chest (PA)
(iv)ECG
(v) Urine analysis
4. Pre-sea Medical Examination(New Entrant)-
(A) Mandatory Examination and Tests
Physical Examination: Weight, Height, Temperatures, pulse rate, Blood Pressure, Sight
,Hearing , Oral Health , general appearance & systemic examination of the whole body .
Blood Tests :BI CBC
BI ESR
SGOT
SGPT
SGGT
S Creatinine
S Cholesterol
S Triglycerides
Blood group & Rh factor CL
Test for Hepatitis B (HbsAg) and C
BI VDRL
HIV I& II
X-ray chest (PA)
19
Urinalysis
Drug
&
Alcohol
Screening
–
Morphine,
Barbiturates,
Marijuana,
Cocaine,
Amphetamines, Alcohol
Audiometric
Psychometric test conducted by any qualified psychiatrist / psychologist
Ultrasound (USG) of the Abdomen & Pelvis
(B) Optional TestsGlycosylated (Hb1Ac)
RBS/FBS(Blood test)
ECG
Stress Test if deem necessary
2D echo Doppler study Psychometric evaluation on case to case basis
5. Vaccination under WHO or other country’s regulations as applicable-
(i) Vaccination at the time of Pre-sea and Periodic test:- Seafarers shall be vaccinated
according to the requirements indicated in the
WHO
publication,
International
Travel & Health; vaccination requirement and health advise updated periodically.
(ii) Yellow fever is now only decease for which vaccination is statutory requirement in
some countries and for which an International certificate of vaccination is required.
Responsibility to provide immunization shall rest with the training institute and the
employer of the seafarer as the case may be.
Yellow Fever –
At a WHO designated Yellow Fever Centre only. Booster once every 10 years for
seafarer and new entrant.
Hepatitis B & C –
A primary course of three doses to be completed during the training period.
20
Booster may be given once every 20 years. In cases of doubtful immunity, test for Anti
HBS antibody titre shall be conducted to assess the suitability of administration of the
vaccine.
c) Typhoid vaccination - during training & to be repeated once every three years.
A primary course of two doses.
d) Tetanus Toxoid –
Most of the pre-sea trainees would have received their tetanus prophylaxis during their
childhood immunization. However, tetanus toxoid injection shall be given at the time of
entry to the pre-sea training programme. A booster injection every 5 years.
e) Hepatitis A Vaccination.
f) Vaccination against any other epidemic or pandemic disease at that period of time.
(ii) Vaccination at the time of Periodic Medical Examination:
Note :-
The DG approved Medical examiner shall check the immunization record of new entrant
or the seafarers as the case may be, at the time of pre-sea or periodic medical examination
and arrange for re-vaccination if and when deemed necessary. These records shall be
retained with the seafarers and to be verified periodically.
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Schedule –VI
MEDICAL EXAMINATION OF SEAFARERS
Examinee's Declaration
PS: 1. The seafarer shall not suppress medical information and declare
correct and proper medical information to the medical examiner to
the best of his knowledge and belief.
2. In case of any wrongful Act or misrepresentation/suppression of
material fact(s) of information or infringement the concerned
seafarer shall be fully responsible/liable for the consequences/
damages / penalties as per the provisions or the applicable laws.
1.
2.
Name (last, first, middle): _____________________________________________
Date of birth (day/month/year):
.. /.. /….
3.
Sex:
4.
Home address: _______________________________________________________
5.
Method of confirmation of identity, e.g. Passport No./Seafarer’s book No.
__ Male __ Female
or other relevant identity document No.: _____
6.
Department (deck/engine/radio/food handling/other): _____
7.
Routine and emergency duties (if known): _____
8.
Type of ship (e.g. container, tanker, passenger): _____
9.
Trade area (e.g. coastal, tropical, worldwide): _____
10.
Examinee’s personal declaration
(Assistance should be offered by medical staff)
11.
22
Have you ever had any of the following conditions?
Condition
23
Yes

Eye/vision problem

High blood pressure

Heart/vascular disease

Heart surgery

Varicose veins/piles

Asthma/bronchitis

Blood disorder

Diabetes

Thyroid problem

Digestive disorder

Kidney problem

Skin problem

Allergies

Infectious/contagious diseases

Hernia

Genital disorder

Pregnancy

Sleep problem

Do you smoke, use alcohol or drugs?

Operation/surgery

Epilepsy/seizure

Dizziness/fainting

Loss of consciousness

Psychiatric problems

Depression

Attempted suicide

Loss of memory

Balance problem

Severe headaches

Ear (hearing, tinnitus)/nose/throat problem

Restricted mobility

Back or joint problem
No

Amputation

Fractures/dislocations
If you answered “yes” to any of the above questions, please give details:
12. Additional questions
 Have you ever been signed off as sick or repatriated from
Yes
No
a ship?

Have you ever been hospitalized?

Have you ever been declared unfit for sea duty?

Has your medical certificate even been restricted or revoked?

Are you aware that you have any medical problems,
diseases or illnesses?

Do you feel healthy and fit to perform the duties of your
designated position/occupation?

Are you allergic to any medication?
Comments:
13. Additional questions

Yes
No
Are you taking any non-prescription or prescription
medications?
If yes, please list the medications taken, and the purpose(s) and dosage(s):
I hereby certify that the personal declaration above is a true statement to the
best of my knowledge.
Signature of examinee: _______________________Date (day/month/year): ../../….
Witnessed by (signature): ___________ Name (typed or printed): _________________
24
I hereby authorize the release of all my previous medical records from any
health
professionals,
health
institutions
and
public
authorities
to
Dr ______________________ (the approved medical practitioner).
Signature of examinee: _______________________ Date (day/month/year): ../../….
Witnessed by (signature): ___________ Name (typed or printed): _________________
Date and contact details for previous medical examination (if known): _________
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------14.
MEDICAL EXAMINATION

Sight
Use of glasses or contact lenses: Yes/No (if yes, specify which type and for
what purpose)
___________________________________________________________________________

Visual acuity
___________________________________________________________________________
Unaided
Right eye
Left eye
Binocular
Aided
Right eye Left eye Binocular
___________________________________________________________________________
Distant
Near
___________________________________________________________________________
 Visual fields
__________________________________________________________________________
Normal
Defective
________________________________________________________________________
Right eye
Left eye
___________________________________________________________________________
 Colour vision
fective

Hearing
___________________________________________________________________________
Pure tone and audiometry (threshold values in dB)
___________________________________________________________________________
500 HZ
1 000 HZ
2 000 HZ
3 000 HZ
25
______________________________________________________________________________
Right ear
Left ear
______________________________________________________________________________
 Speech and whisper test (metres)
______________________________________________________________________________
Normal
Whisper
______________________________________________________________________________
Right ear
Left ear
______________________________________________________________________________
15.
Clinical findings
Height: _____ (cm) Weight: _____ (kg)
Pulse rate: _____/(minute) Rhythm: _____
Blood pressure: Systolic: _____ (mm Hg) Diastolic: _____ (mm Hg)
Urinalysis: Glucose: _____ Protein: _____ Blood: _____
______________________________________________________________________________
Normal
Abnormal
______________________________________________________________________________
Head
Sinuses, nose, throat
Mouth/teeth
Ears (general)
Tympanic membrane
Eyes
Ophthalmoscopy
Pupils
Eye movement
Lungs and chest
Breast examination
Heart
Skin
Varicose veins
Vascular (inc. pedal pulses)
Abdomen and viscera
Hernia
Anus (not rectal exam)
26
G-U system
Upper and lower extremities
Spine (C/S, T/S and L/S)
Neurologic (full/brief)
Psychiatric
General appearance
16.
Chest X-ray
Results:
17.
Other diagnostic test(s) and result(s):
Test:
Result:
Medical practitioner’s comments and assessment of fitness, with reasons
for any limitations:
18.
Assessment of fitness for service at sea
On the basis of the examinee’s personal declaration, my clinical
examination and the diagnostic test results recorded above, I declare the
examinee medically:
-out
Not fit for look-out
Other services
(training/examination)
Deck service Engine service
Catering service
Other services
Fit
Unfit
Without restrictions
Visual aid requ
Describe restrictions (e.g., specific position, type of ship, trade area & others as
applicable):
Medical certificate’s date of expiration (day/month/year): ______/______/______
Date medical certificate issued (day/month/year):
______/______/______
Number of medical certificate: ________________________________________________
Signature of approved medical examiner: _____________________________________
Approved Medical examiner information (name, license number, approval
number, address):
27
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Schedule VII
MEDICAL CERTIFICATE FOR PRE-SE-TRAINING- CERTIFICATE OF
COMPETENCY / PERIODIC MEDICAL EXAMINATION – SERVICE AT SEA
As per medical standards of MLC 2006, as amended STCW 2010, as amended
and section 98 of the Indian Merchant Shipping Act, 1958 and medical
examination rules on medical examination framed there under
APPROVED MEDICAL EXAMINER NAME AND ADDRESS
Last/Family Name
First Name
Position applied for
ID (Passport/Discharge book) No:
Photo
Date of Birth
Company Name
Sex
Nationality
Vessel Name
I have evaluated the above-named seafarer/ new entrant after establishing his
identity as per the documents mentioned above. On the basis of the
seafarer’s/ new entrant personal declaration, my clinical examination, the
diagnostic test results obtained, and in consideration of the essential
requirements of the position applied for, my opinion is -
28
(a)
(b)
(c)
that the hearing meets the required STCW standards section A-I/9:Yes / No
Unaided hearing is satisfactory
Yes / No
(d)
Visual acuity meets the required STCW Code standards section A-I/9
Yes / No
Color Vision meets the required STCW Code standards section A-I/9
Yes / No
(testing only required every 6 years unless considered necessary )
(e)
Date of last color vision test ( Day/Month/Year)
……………………..
(a) Fit for look out duty
Yes / No
(b) No. limitation or restrictions on fitness
Yes / No
(if no “ specify limitations or restrictions
(c) Is the seafarer free from any medical condition likely to be aggravated
by Service at sea or to render the seafarer unfit for such service or to
endanger the health of other persons on board :
(d) Date of examination:
(Day/Month/Year) ……………………………
(e) Expiry date of certificate: (Day/Month/Year)
(f)
Yes / No
………………………
this seafarer is UNFIT FOR DUTY**/FIT FOR DUTY with / without
restrictions*as mentioned below,
* This Medical Certificate is issued with following restrictions
** Reasons for being unfit
Approved Medical Examiner Signature::_______________________
Official Stamp
(Registration No. &
DGS approval no.)
Approved Medical Examiner Name Printed:___________________________
29
Date :
Valid till:
Approving Authority of Medical Examiner: Directorate General of
Shipping, Govt. of India.
I acknowledge, that I have been advised of the content of the medical certificate & of the right to a review in accordance with
paragraph (6) of section A-I/9 of STCW Code.
Seafarers/ New Entrant Signature:
Schedule VIII
S
Half Yearly Returns Format
SUMMARY OF MEDICAL EXAMINATION CONDUCTED FOR THE PERIOD
Seafarers
signature with
Date
:- __________________________
FROM
-----------TO
----------
Sr.
No
.
Name of
the
seafarer
Date of
Birth/Ran
k
Male
/
Femal
e
CD
C
No.
Pre sea /
Periodic or
additional
examinatio
n
Signature of the Medical examiner:Name of the Medical examiner:Registration No. :DGS approval number:-
30
******
Name of
shipping
Company
/training
institute
Unfit /
Temporar
y
Permane
nt
If unfit
reason(s
) for
unfitnes
s
If
referred
to
Authorit
y