Table of Contents

1 Interpretation

2 Purpose and application

3 Review of decisions

4 Penal provisions

5 Requirement to be medically fit

6 Evidence of medical fitness

7 Certificate of Medical Fitness

8 Aids to vision or hearing

Appendix 1 Medical certificate evidencing fitness for work in a sea-going vessel

Appendix 2 Guidelines for the medical examination of seafarers and coastal pilots

Appendix 3 Job task analyses

Appendix 4 Forms

Appendix 5 Guidance in screening for colour vision

Previous issues
Issue 1, Order No 6 of 1983
Issue 2, Order No 5 of 1985
Issue 3, Order No 5 of 1988
Issue 4, Order No 1 of 1993
—Amended by Order No 4 of 1993

1   Interpretation

1.1  In this Part, unless the contrary intention appears, the following definitions apply:

AMSA means the Australian Maritime Safety Authority;

applicant means a person who applies for a Certificate of Medical Fitness under 7.1;

Certificate of Medical Fitness means a Certificate of Medical Fitness issued in accordance with this Part;

coastal pilot means a person who is performing, or intends to perform, the duties of a licensed pilot for the purposes of Part VIIA of the Great Barrier Reef Marine Park Act 1975;

holder, in relation to a certificate, means the person identified as holder by that certificate;

Manager means the Manager, Ship Operations and Qualifications, in AMSA, or in respect of any particular function, a suitably qualified person appointed by the Manager, Ship Operations and Qualifications, to carry out that function;

seafarer means a person serving or intending to serve on a ship to which Part II of the Navigation Act applies and includes a master, officer or seaman but does not include a pilot, a person who is not a member of the crew of the ship, a supernumerary, or special personnel as defined in section 283 of the Navigation Act;

sea-going vessel, for the purposes of the ILO Convention, means:

(a) a trading ship on an overseas or interstate voyage; or

(b) a trading ship of 500 tons gross tonnage or more on a voyage:

  (i) that is not an overseas or interstate voyage; and

 (ii) in the course of which it is not at all times capable, at normal operating speed, of returning to its port of departure in 6 hours or less or reaching its intended next port of call in 6 hours or less;

seaman includes a person engaged on a ship in a trainee capacity, other than a sail trainee as defined in Marine Orders, Part 52;

STCW Code means the Code referred to in the STCW Convention;

STCW Convention means the International Convention on Standards of Training, Certification and Watchkeeping for Seafarers, 1978, as amended;

the ILO Convention means the Medical Examination (Seafarers) Convention 1946 adopted by the General Conference of the International Labour Organization on 29 June 1946; and

valid, in relation to a certificate, means a certificate that is current and that has not been cancelled.

1.2  In this Part:

(a) headings and sub-headings are part of the Part;

(b) each Appendix is part of the Part;

(c) a note included in the text and printed in italics is not part of the Part.

2   Purpose and application

2.1  Purpose

This Part:

(a) for the purposes of subsection 15(2) of the Navigation Act 1912, prescribes matters relating to the health of persons performing, or intending to perform, the duties of a qualified master, officer or seaman;

(b) for the purposes of section 124 of the Navigation Act 1912, makes provision for and in relation to the medical examination of, and the issue of certificates to, masters and seamen and persons proposing to engage in employment as masters or seamen; and

(c) for the purposes of section 134 of the Navigation Act 1912, makes provision for and in relation to giving effect to the ILO Convention.

(e) for the purposes of section 186C of the Navigation Act 1912, makes provision for and in relation to the health of pilots;

(f) gives effect to regulation I/9 annexed to the STCW Convention and section B-I/9 of the STCW Code.

2.2  Application

This Part applies to:

(a) a person employed, or proposing to engage in employment, on a ship to which section 124 of the Navigation Act applies;

(b) a person performing, or intending to perform, the duties of a coastal pilot;

(c) a person employed, or proposing to engage in employment, on a sea-going vessel registered in Australia:

  (i) that is not a ship to which section 124 of the Navigation Act applies; and

 (ii) in respect of which a law of a State or of the Northern Territory does not give effect to the ILO Convention; and

(d) an applicant for the issue or revalidation of certificates under Marine Orders, Part 3.

3   Review of decisions

3.1  Reviewable decisions

Application may be made to the Administrative Appeals Tribunal for review of a decision by the Manager:

(a) requiring a person to obtain a new Certificate of Medical Fitness under 7.5.2 or 7.5.3;

(b) refusing to accept a certificate as equivalent under 7.10.3.

3.2  Statement to accompany notices

If a person making a decision referred to in 3.1 gives to a person whose interests are affected by the decision notice in writing of the decision, the notice must:

(a) include a statement to the effect that, if the person is dissatisfied with the decision, application may, subject to the Administrative Appeals Tribunal Act 1975, be made to the Administrative Appeals Tribunal for review of the decision; and

(b) except where subsection 28(4) of that Act applies, also include a statement to the effect that the person may request a statement under section 28 of that Act.

3.3  Validity of decisions

Failure to comply with 3.2 in relation to a decision does not affect the validity of that decision.

4   Penal provisions

Provisions 5.1, 5.2, 5.3, 7.8, 7.9 and 8 are penal provisions.

5   Requirement to be medically fit

5.1  A person must not perform duties as a seafarer, or be taken into employment to perform duties as a seafarer, on a ship to which section 124 of the Navigation Act applies unless that person is medically fit to perform those duties.

5.2  A person must not perform the duties of a coastal pilot unless that person is medically fit to perform those duties.

5.3  A person must not be employed on a sea-going vessel registered in Australia:

(a) that is not a ship to which section 124 of the Navigation Act applies; and

(b) in respect of which a law of a State or of the Northern Territory does not give effect to the ILO Convention;

unless that person is medically fit for that employment.

6   Evidence of medical fitness

6.1  A person is medically fit for the purposes of 5.1 or 5.2 if that person:

(a) has a valid Certificate of Medical Fitness; and

(b) there is no evidence that his or her medical condition has altered since the previous medical examination to an extent that would make him or her unfit for the duties to be performed.

6.2  A person is medically fit for the purposes of 5.3 if that person:

(a) has a valid:

  (i) Certificate of Medical Fitness; or

 (ii) certificate issued by a qualified medical practitioner in accordance with Appendix 1; and

(b) there is no evidence that his or her medical condition has altered since the previous medical examination to an extent that would make him or her unfit for the duties to be performed.

7  Certificate of Medical Fitness

7.1  Application for Certificate of Medical Fitness

A person requiring a Certificate of Medical Fitness must apply to a Medical Inspector of Seamen.

Note: Under s.123 of the Navigation Act, Medical Inspectors of Seamen are appointed by AMSA. No person will be appointed unless he or she is registered as a medical practitioner in a State or Territory of Australia.  Preference is given to a person who either has a Fellowship of the Australasian Faculty of Occupational Medicine (AFOM), or is a trainee of AFOM and works under the direct supervision of a Fellow.  The names of Medical Inspectors of Seamen may be obtained from any AMSA office.

7.2  Medical examination etc

A Medical Inspector of Seamen is to conduct such examinations, tests and interviews and make such enquires in relation to an applicant as appear appropriate to determine whether the applicant is medically fit to perform the intended duties as a seafarer or as a coastal pilot on a ship.

7.3  Determination of fitness

7.3.1  In determining if an applicant is medically fit, a Medical Inspector of Seamen must, in addition to applying normal medical fitness considerations, have regard to the Guidelines for the Medical Examination of Seafarers, set out in Appendix 2 and the job task analyses set out in Appendix 3.

Note: Where an employer has additional fitness requirements for particular duties or voyages (such as for the handling of specific cargoes or voyages to the Antarctic), the employer should advise the Medical Inspector of Seamen of those requirements and request a supplementary report against them.

7.3.2  If a person has been declared unfit for duty at sea, that person or his or her employer may apply for further examination by an independent panel of medical practitioners, of whom one must be an occupational physician and one a specialist physician/surgeon from the appropriate specialty.

Note: The seafarer may bring further evidence of fitness for duty at sea, including medical reports from treating medical practitioners, for consideration by the independent panel.

7.4  Issue of Certificate of Medical Fitness

7.4.1  If a Medical Inspector of Seamen:

(a) is satisfied as to the identity of an applicant;

(b) is able to attest to the true state of the applicant’s health; and

(c) determines that the applicant is medically fit to perform the proposed duties,

he or she is to issue to the applicant a Certificate of Medical Fitness in accordance with Form 1 in Appendix 4.

7.4.2  If a Medical Inspector of Seamen:

(a) is satisfied as to the identity of an applicant;

(b) is able to attest to the true state of the applicant’s health; and

(c) determines that the applicant is medically fit to perform duties other than those proposed,

he or she may issue to the applicant a Certificate of Medical Fitness in accordance with Form 1 in Appendix 4, endorsed to indicate the duty or duties for which the applicant is medically fit.

7.5 Further examination

7.5.1  A person who is refused a Certificate of Medical Fitness may make a second application.

7.5.2  A seafarer who is the holder of a valid Certificate of Medical Fitness may at any time be required by the owner or master of a ship, or by the Manager, to obtain a new certificate where as a result of illness, injury or other cause it is believed the seafarer may no longer meet the standards specified in this Part.

7.5.3  A coastal pilot who is the holder of a valid certificate of medical fitness may at any time be required by the Manager to obtain a new certificate where as a result of illness, injury or other cause it is believed the coastal pilot may no longer meet the standards specified in this Part.

7.6  Period of validity of Certificate of Medical Fitness

7.6.1  Except as provided in 7.6.2, 7.6.3, 7.6.5 and 7.6.6, and subject to 7.7, a Certificate of Medical Fitness is valid from the date of issue for a period of 2 years.

7.6.2  Subject to 7.7, a Certificate of Medical Fitness in respect of a person who on the date of issue was:

(a) less than 17 years of age; or

(b) 54 years of age or more,

is valid from the date of issue for a period of one year.

7.6.3  An expired Certificate of Medical Fitness may be extended by the Manager for a period of 3 months from the date of its expiry if the holder is to be employed on a ship and;

(b) the holder is unable to be issued with a new Certificate of Medical Fitness in accordance with this Part prior to the ship being taken to sea; and

(c) the expired Certificate of Medical Fitness has not already been extended by virtue of this provision.

7.6.4  A Certificate of Medical Fitness extended under 7.6.3 is not valid for use by a coastal pilot.

7.6.5  If the period of validity of a Certificate of Medical Fitness expires during the course of a voyage, the Certificate of Medical Fitness continues to be valid until the end of that voyage, except for use by a coastal pilot.

7.6.6  A Certificate of Medical Fitness may be issued for less than the full period if the Medical Inspector of Seamen considers it appropriate.

Note: An example might be where a Medical Inspector of Seamen considers that a person, although fit at the time of the examination, needs to be re-examined to determine the continued efficacy of treatment for a condition.

7.7  Cancellation

A Certificate of Medical Fitness is deemed to be cancelled when the person to whom it is issued:

(a) is issued with a later Certificate of Medical Fitness; or

(b) is required in accordance with 7.5.2 or 7.5.3 to obtain a further Certificate of Medical Fitness.

7.8  Production of Certificate of Medical Fitness

A person required by Marine Orders to be the holder of a valid Certificate of Medical Fitness must not fail, except with reasonable excuse, to produce the certificate on demand to the owner or master of a ship on which the person serves or intends to serve, or to a surveyor.

7.9  Delivery of cancelled Certificate of Medical Fitness

A person whose Certificate of Medical Fitness is deemed to be cancelled under 7.7 must deliver the Certificate of Medical Fitness to the Manager on demand.

7.10  Issue of certificate for purposes of STCW Convention

7.10.1  If a Medical Inspector of Seamen determines that a person who, at the time of the examination does not qualify for the issue of a Certificate of Medical Fitness, meets the standards in Appendix 2 relating to eyesight, colour vision and hearing, the Medical Inspector of Seamen may issue that person with a certificate in accordance with Form 2 in Appendix 4 for the purposes of issue or revalidation of a certificate under Marine Orders, Part 3.

7.10.2  A certificate issued under 7.10.1 is valid from the date of issue for a period of 5 years.

7.10.3  A certificate accepted by the Manager as being equivalent to a certificate issued under 7.10.1 is deemed to be valid for the period specified in the certificate or for 5 years, whichever is the less.

8   Aids to vision or hearing

A seafarer or coastal pilot whose Certificate of Medical Fitness indicates that an aid to vision or hearing was used for the purpose of being found fit must at all times when on duty on a ship use such aid or aids and, in the case of an aid to vision, keep a spare aid to vision available.

Appendix 1

Medical certificate evidencing fitness
for work in a sea-going vessel

1. A medical certificate in respect of a person may only be issued by a duly qualified medical practitioner who, being satisfied after conducting such examinations, tests and interviews and making such enquires in relation to the person as appear appropriate, is satisfied that the person is medically fit to serve on a ship.

2. In deciding on fitness for service, the medical practitioner is, in addition to normal medical fitness considerations, to have regard to the age of the person and the nature of the duties to be performed.

3. A medical certificate is to attest:

(a) that the hearing and sight of the person and, in the case of a person to be employed in the deck department, colour vision, are all satisfactory;

(b) that the person is not suffering from any disease likely to be aggravated by, or to render the person unfit for, service at sea or likely to endanger the health of other persons on board.

4. A medical certificate is to remain in force for a period not exceeding 2 years from the date on which it was granted.

5. Colour vision needs to be examined only every 6 years.

6. If the period of validity of a medical certificate expires in the course of a voyage, the certificate is to continue in force until the end of that voyage.

7. A person who has been refused a medical certificate is entitled to a second examination by a medical practitioner who is independent of any shipowner or of any organisation of shipowners or seafarers.

8. A person who is the holder of a valid medical certificate  may at any time be required by the owner or master of a ship to obtain a new certificate where as a result of illness, injury or other cause it is believed the person may no longer meet appropriate minimum standards.

* * * * *

Appendix 2

Guidelines for the medical examination
of seafarers and coastal pilots

Contents

How to use these guidelines

Part A  Seafaring and medical fitness

1. Introduction

- Why is fitness important?

- The work environment of seafarers

2. Procedures

- Frequency of health assessment

- What information goes to the employer, AMSA and the seafarer?

- Health assessment outcomes

 Right of appeal and medical panels

3. Forms

Part B  Medical standards

1. Overview

2. Obesity

- Body morphology

3. Eyes/vision

- visual acuity

- colour vision

- Table 1:  Seafarers’ visual standard

4. Hearing, ear, nose and throat

- Hearing standard

- Table 2:  Minimum standards of Hearing for Deck and Engine Departments

- The conduct of the conversation test

- Other ear, nose and throat conditions

5. Cardiovascular

- Ischaemic heart disease

- Arrhythmia/pacemaker

- Valvular heart disease

- Cardiomyopathy

- Aneurysms

- Hypertension

- Congenital heart disease

- Peripheral circulation

- Pulmonary circulation

6. Respiratory

- Pneumothorax

- Asthma

- Reduced lung function

- Tuberculosis

- Chest X-rays

7. Gastrointestinal

- Teeth and gums

- Peptic ulcer

- Liver and pancreas

- Gall bladder disease

- Hernia

- Colostomies

- Enteric diseases

8. Genitourinary

9. Neurological system

- Epilepsy

- Migraine

- Stroke

- Transient ischaemic attacks (TIAs)

- Neuromuscular Disorders including Multiple Sclerosis, Parkinsonism

10. Psychiatric conditions

11. Prescribed medication, drugs and alcohol

- Prescribed drugs

- Table 3:  Classes of drugs with potential to affect an individual’s skills to operate ships, boats, plant and equipment, including cranes

- Illegal drugs

- Alcohol

12. Musculoskeletal

13. Diabetes and endocrine

- Diabetes mellitus

- Thyroid disease

- Adrenal disease

14. Skin disorders

- Infections

- Dermatoses

15. Haemopoietic

16. Infectious diseases

17. Neoplasms

How to use these guidelines

These guidelines should be read in full, at least once, at the time of issue.

When a seafarer presents for a medical:

Part A  Seafaring and Medical Fitness

1  Introduction

Marine Orders, Part 9 (Medical Fitness of Seafarers) is administered by the Australian Maritime Safety Authority.  Part 9 makes provision for the issue of Certificates of Medical Fitness for duty at sea of seafarers (masters, mates, engineers and integrated ratings) and gives effect to Article 3 of ILO convention 73.

These guidelines have been compiled for the use of Medical Inspectors who are assessing an individual’s fitness to work at sea.  The medical fitness standards have been developed in relation to the basic job task analyses in Appendix 3.  An employing company may have more stringent guidelines developed by its own occupational physician.  Such guidelines will depend on the nature of the jobs and any specific equipment operated.  Where such guidelines exist, they should be followed.

While the final judgement on whether or not an applicant is fit to work in a particular job at sea rests with the Medical Inspector, these guidelines draw attention to those conditions that have the potential to present a high level of risk in some circumstances.

1.1  Why is fitness important?

1.1.1  Employers have a duty of care to provide a safe work environment and protect the health, safety and welfare of employees.  Employees similarly have a duty of care for their own safety and that of the people they work with and the community.  Medical assessment of fitness is one aspect of meeting this duty of care.

1.1.2  The primary objectives of a medical assessment of fitness for duty at sea are:

1.1.3  Medical conditions may impinge on work in the following areas:

(a) the condition may limit, reduce or prevent an individual from performing the job effectively eg loss of mobility and dexterity making engine room work and other maintenance tasks difficult;

(b) the condition may be made worse by the job eg an asthmatic exposed to allergens on a grain ship;

(c) the condition may make it unsafe for the person to do the job eg liability to sudden loss of consciousness whilst transferring from a smaller vessel to a larger vessel by climbing a rope ladder;

(d) the condition is likely to make it unsafe both for the individual and other crew eg a ships crane operator liable to sudden loss of consciousness; catering crew with infectious hepatitis or gastro-enteritis;

(e) the condition is likely to make it unsafe for other shipping eg a master or mate who is at risk of sudden loss of consciousness due to a cardiac arrhythmia;

(f) the condition, if it worsens, is one which will require emergency evacuation for medical treatment eg gastric ulcer haemorrhage.

1.2  The work environment of seafarers

1.2.1  Medical Inspectors should bear in mind the aspects of seafaring life, listed below, when assessing fitness for duty at sea.

1.2.2  As ships often operate far offshore or in inaccessible areas, it is often difficult to replace seafarers who become injured or ill.  Many ships have only the minimal number of persons on board necessary to operate the ship; thus the incapacitation of even one seafarer may place a substantial additional burden on his or her shipmates.

1.2.3  Ships’ officers generally receive basic first-aid and other medical training, and ships are usually equipped with basic medical supplies.  Nevertheless, it is often quite difficult to transport sick or injured seafarers ashore where they can be treated by qualified physicians.  In some geographical areas, the closest medical care ashore may be well below the standard of the seafarer’s home country.  It is therefore inadvisable and often unsafe to allow persons with certain medical conditions to become seafarers or to return to seagoing employment.

1.2.4  Seafarers live close to each other at sea, often for long periods.  Contagious diseases therefore may be a serious threat, endangering not only the health of other seafarers but also the safety of the ship and, where carried, passengers.  It is particularly important that seafarers concerned with the preparation of food do not suffer from conditions which may be transmitted to others through their work.

1.2.5  Seafarers should be medically fit to perform their normal duties correctly and to be able to respond to emergency situations (eg fighting fires, lowering lifeboats, assisting passengers).

1.2.6  Seafarers should be able to adjust to the often violent motions of the ship, to be able to live and work in sometimes cramped spaces, to be able to climb ladders, to lift heavy weights and to be able to withstand exposure to harsh weather conditions on deck or excessive heat in the machinery spaces.  They should not suffer from conditions which are exacerbated by air travel.

1.2.7  Seafarers should be able to live and work closely with the same people for weeks and perhaps months on end and under occasionally stressful conditions.  They should be capable of dealing effectively with isolation from family and friends and, in some cases, from persons of their own cultural background.

1.2.8  Shipping operations and shipboard duties vary substantially.  For a fuller understanding of physical demands of particular categories of work on board ship, the Medical Inspector should consult the employer.

2  Procedures

2.1  Frequency of health assessments

2.1.1  All seafarers and coastal pilots should be assessed as to medical fitness for duties at sea:

 less than 18 years of age:  annually

 18 - 54 years of age:  two-yearly

 55 years of age and over:  annually with resting ECG (stress ECG, if in safety critical job and clinically indicated)

 if there is a change in the medical condition of the employee

 after prolonged sickness absence of 3 months or more due to injury or illness.

2.2  What information goes to the employer, AMSA and the seafarer?

Confidentiality

2.2.1  The employer, AMSA and the applicant/seafarer will receive a copy of the Certificate of Medical Fitness.

2.2.2  The Medical Inspector (or successor) should keep all the medical examination forms, including results of investigations in a confidential file, for a period of at least 30 years.  This information is not to be released to any person, agency or employer without a signed consent form or as required by law.

2.3  Health assessment outcomes

2.3.1  An applicant or seafarer is either fit for the intended duties at sea or unfit.

2.3.2  Those declared unfit may be temporarily or permanently unfit or may be fit for duties other than the intended duties.

2.3.3  If temporarily unfit, the Medical Inspector should specify a minimum period after which the assessment can be reviewed.

3  Forms

The form of the Certificate of Medical Fitness is prescribed as Form 1 in Appendix 3 to Marine Orders, Part 9.  Other forms that may be found useful are attached to these guidelines.

Part B  Medical Standards

1  Overview

1.1  This section provides information and guidance on medical conditions which may affect individuals in the safe performance of their duties at sea.

1.2   The medical standards attempt to be specific and give examples of tasks/jobs which may be affected.  The standards cannot cover every clinical situation and the Medical Inspector should exercise judgement in relation to the key objective - maintaining safety.  For example, could the condition cause sudden loss of control of a ship, or sudden loss of consciousness when working at heights, or interfere with the performance of emergency duties?

1.3  Medical Inspectors should make a comprehensive medical assessment of overall health in the knowledge that errors or omissions of a critical task in some jobs can lead to serious consequences in terms of human health and life, environmental impact and/or major property loss.

1.4  The critical time needed for treatment/access to appropriate land-based care is also a consideration when determining fitness.

1.5  Medical Inspectors of Seafarers should consider what medical conditions could increase the probability of poor performance of critical tasks, and the probability and severity of the consequences when determining “Is this applicant medically fit for duty at sea?”.

2.  Obesity

Body morphology

2.1  As obesity can hamper evacuation procedures, persons with a body mass index of more than 30 kg/m2 should be able to demonstrate that they can climb ladders and fit through hatches.  An Occupational Physician or an Occupational Therapist may need to conduct a functional assessment on board ship.

2.2  A body mass index of more than 35 kg/m2 presents a high risk.  Applicants in this category may need to undertake weight reduction and be reassessed.  It should be noted that sleep apnoea is more common in those with morbid obesity, as are diabetes and hypertension.

3.  Eyes / vision

Visual acuity

3.1  Far vision is required for:

(a) watchkeeping duties; and

(b) control of ships, ships’ small craft and cranes.

3.2  Near vision is required to read charts, weather maps, computer screens, monitors and instructions.

3.3  Night and depth vision are required for watchkeeping and control of the ship; (depth vision is especially important for operating cranes at close distances).

Colour vision

3.4  Good colour vision is required for bridge watchkeeping duties to distinguish red and green port and starboard channel markers, navigation beacons and ships’ navigation lights.  The ability to identify red, green and white navigation lights is an essential part of the job for masters, deck officers and seamen required to carry out lookout duties.

3.5  Impaired colour vision presents a risk to engineers who may be required to distinguish the colours of electrical wiring in order to make proper electrical connections.  As such, it presents a risk depending on the degree of impairment that may affect a person’s ability to perform his duties.  However, engineers and ratings may provide evidence from a relevant employer that, within the last two years, impaired colour vision, if present, has not been found to affect their work.

3.6  When testing colour vision, coloured lenses should not be worn by the seafarer.

Note: The wearing of contact lenses or spectacles with chromagen lenses with red filters will increase the contrast of greens, yellows & browns, thus enabling a colour deficient seafarer to pass the Ishihara test.  Unfortunately, these lenses are not sufficient to enable safe watchkeeping duties at sea..

3.7  Information regarding colour vision impairment must be provided on the medical certificate to assist the employer to make an appropriate decision regarding engagement or continued employment.

Note: Guidance on appropriate screening for colour vision is contained in Appendix 5.

Table 1:  Visual standards

Table 1:  Visual standards (continued)

3.8  Any eye disease or defect which affects vision needs to be corrected.

3.9  A history of glaucoma or uveitis needs ophthalmological assessment.

3.10  The vision standards listed in Table 1 are those that are internationally accepted as appropriate.

4.  Hearing, ear, nose and throat conditions

Hearing standard

4.1  Hearing is required for communication by radio, by telephone or person to person and therefore the critical frequencies are in the speech range 500 to 2,000 Hz.  Hearing loss should be checked throughout the range of 500 to 3,000 Hz using a pure tone audio meter.

4.2  The speech must be reasonably clear and free of stutter and hesitation sufficient to use radios and communicate on deck.  Those using cranes must be able to hear whistle signals where these are used.

Table 2:  Minimum Standards of Hearing for Deck and Engine Departments

4.3  If hearing loss is 40dB or more at the frequencies specified in Table 2, ability to use a radio will need to be demonstrated.  In this circumstance the applicant must pass a conversation test.

The conduct of the conversation test

4.4  The following is a recommended procedure for conduct of a conversation test.

4.5 The test should be conducted in a quiet room with a stable background noise level. Hearing aids should be worn if normally used at work or if retesting following their fitting.

4.6  The examiner should face the subject and address him/her from a distance of 3 metres for normal speech.

4.7  The subject’s eyes should be closed  or covered to prevent lip reading.

4.8  A normal conversational vocal volume should be used.

4.9  The test material should be a mixture of alphabetical letters and numerals in any order, not to exceed a total of three in any one phrase, eg 6Y3, 2N4, S5G, 7BL.

4.10  Ten combinations should be used, each preceded by the carrier phrase “PLEASE SAY”.

4.11  The subject should repeat what was thought to be heard.  If uncertain guessing is encouraged.

4.12  Six or more combinations should be repeated without error to be considered satisfactory.

4.13  Applicants who do not pass this test should be referred for further assessment of functional hearing and speech discrimination by an audiologist.

4.14  A functional hearing loss sufficient to interfere with communication or to impede safety (eg hearing audible warning devices) presents a high risk.

Other ear, nose and throat conditions

4.15  Acute infections require treatment.  Although chronic middle ear disease presents a high risk, recurrent or chronic sinus infection presents less of a risk if the Medical Inspector is satisfied that the seafarer can manage the condition with appropriate medication at sea.

4.16  Vestibular malfunction can occur suddenly and with sufficient severity to make safe operations of vessels and cranes impossible.  It may be accompanied by nystagmus which compounds the disability.  Meniere’s disease therefore presents a high risk.

4.17  Hay fever which responds to therapy (without side effects) presents a lower level of risk.

4.18  Frequently recurring tonsillitis presents a high risk until corrected.

5  Cardiovascular system

5.1  Cardiovascular conditions can cause sudden loss of consciousness putting others at risk or interfere with exercise tolerance as in climbing or working in confined spaces.  Some cardiovascular conditions, if they become acute, can require immediate emergency medical care or medical evacuation, neither of which may be available, particularly in remote locations and/or in bad weather.

5.2  Careful assessment is required to ensure applicants are free of any cardiovascular condition which puts themselves or others at risk.  Seafarers 55 years and over, or those with a history of cardiovascular disease, will require a resting ECG.  A stress ECG may be performed if clinically indicated.

Ischaemic heart disease

5.3  Current angina presents a high risk.  Any occurrence within the previous 3 months of confirmed myocardial infarction, coronary artery bypass grafting, coronary angioplasty or stent presents a high risk.

5.4  A lower risk is presented if the seafarer has had no symptoms of coronary artery disease for more than 3 months and there is good control of risk factors with no medication for angina control necessary.  Review should be by a cardiologist  using results of tests, e.g. angiogram, stress ECG.  Any doubt about medical fitness should be referred to an independent medical panel.

5.5  If the review finds that 3 months or more has elapsed since the last symptom incident, there are no signs of ischaemia on the exercise ECG (less than 2mm ST segment depression) and/or coronary angiography shows a lumen reduction of less than 70% in a major coronary branch and less than 50% in the left main coronary artery, and the ejection fraction is 50% or more, the seafarer could be declared fit for duty at sea but with annual or more frequent cardiological review highly recommended.

Arrhythmia/pacemaker

5.6  A history of recurrent or persistent arrhythmia which may result in syncope or incapacitating symptoms presents a high risk.

5.7  A seafarer who has had surgery (eg for Wolf-Parkinson White syndrome), or successful treatment by medication for at least 3 months, may be declared fit subject to annual cardiological review.

5.8  If the seafarer has had a pacemaker implanted and the Medical Inspector has taken into account the nature of the person’s underlying disease and is satisfied that the pacemaker function has been appropriately tested, the seafarer may be declared fit subject to 6-monthly testing at a pacemaker clinic and cardiological review.  Note that some ships have strong electro-magnetic fields near communications equipment and aerials which may affect pacemaker function.

Valvular heart disease

5.9  A history or evidence of valve disease, associated with symptoms or a history of, embolism, arrhythmia, cardiac enlargement (on chest X‑ray), abnormal ECG, or high blood pressure presents a high risk.

5.10  Taking anticoagulants is acceptable if the dosage has been stable over time and monitoring of the blood is compatible with swings.

5.11  A seafarer may be considered fit for duty at sea if cardiological assessment shows mild or treated valvular disease of no haemodynamic significance, and it is not associated with any symptoms, and any monitoring of the condition can be done at frequencies compatible with swings.

5.12  Equivocal cases should be referred to an independent medical panel.

Cardiomyopathy

5.13  Established cardiomyopathy presents a high risk.

5.14  A heart or heart/lung transplant presents a high risk.

Aneurysms

5.15  A history of an aortic aneurysm, thoracic or abdominal, either before or after surgery presents a high risk.

Hypertension

5.16  Blood pressure (taken whilst seated) of 160/100 or greater (treated or untreated) presents a high risk.

5.17  End organ damage (cardiac, cerebral, retinal or renal) which would impair safe operation of ships, cranes or small craft presents a high risk.

5.18  Any medical condition that requires the use of medication which can result in marked hypotension or impaired alertness which would cause distraction of attention whilst operating a ship, crane, or small craft presents a high risk.

5.19  A certificate of medical fitness for duty to sea may be issued, subject to annual review:

- if the seafarer is treated with anti-hypertensive drug therapy and effective control of hypertension is achieved (ideal blood pressure less than or equal to 140/90 but no greater than 150/95) without appreciable side effects over a four week follow-up period;

- if there is no evidence of target organ damage, associated ischaemic or other forms of heart disease; and

- if other causative risk factors have been treated.

Congenital heart disease

5.20  Congenital heart disease (eg atrial septal defect, small ventricular septal defect) without symptoms and with no haemodynamic significance may be acceptable.

Peripheral circulation

5.21  Current or recent history of deep vein thrombosis with or without embolisation presents a high risk.  Varicose veins associated with ulcers or other complications presents a high risk.

5.22  Intermittent claudication presents a high risk.

Pulmonary circulation

5.23  A history of more than one pulmonary embolus presents a high risk.  A single episode requires careful assessment of the underlying cause and risk of recurrence.

6  Respiratory system

6.1  Disorders of the respiratory system should be considered in the context of the risk of an acute exacerbation requiring emergency medical treatment (eg asthma, pneumothorax) or symptomatic airway disease sufficient to reduce capacity for physical work or ability to wear a respirator.  Ability to wear a respirator may be required in ships carrying cargoes of grain or cement, or oil tankers and ships carrying chemical cargoes.

Pneumothorax

6.2  A history of recurrent pneumothorax presents a high risk.  A single episode without recurrence for a year, or after successful surgical correction is acceptable.

Asthma

6.3  Asthma, chronic obstructive or restrictive airways disease and emphysema affect the ability of an individual to use self-contained breathing apparatus, and to wear respirators.  Persons with asthma or allergy may find working on grain ships affects their respiratory function.

6.4  Asthma requiring oral corticosteroids and/or frequent medication presents a high risk.

6.5  A history of childhood asthma subsequently resolved in adolescence is acceptable.

6.6  Well-controlled asthma on inhaled corticosteroids and intermittent need of bronchodilators may be acceptable. A report from the seafarer’s treating physician may be required.

Note: There are persons with mild asthma whose symptoms are precipitated by obvious causes such as a respiratory tract infection and there are persons who can suddenly develop life-threatening asthma requiring hospitalisation.  The latter have an asthma which is often more difficult to control and an obvious precipitating factor may not be identified for each asthma attack.  This sub-group of asthmatics presents a high risk.

Reduced lung function

6.7  Severe respiratory disorders can interfere with the safe operation of ships and cranes and confined space work through inadequate oxygen and/or increased carbon dioxide to the brain and heart, leading to poor judgement, agitation or drowsiness, reduced concentration and cardiac effects such as right heart failure or arrhythmia.

6.8  For jobs requiring the use of a respirator because of entry into confined spaces or for work on grain and cement ships, an FEV1 below 65%, FVC below 70% and/or FEV1/FVC less than 70% are grounds for concern.  A practical respirator assessment should be requested if wearing respirators is an essential task requirement.

6.9  In some cases of reduced lung function, individuals who get dyspnoea on exertion may find climbing ladders on ships too difficult.  A person who is unable to keep pace

with people of the same age and body build when walking on level ground or who has dyspnoea on one flight of stairs will have difficulty climbing stairs and ladders, climbing over plant and equipment, and walking reasonable distances on board ship.  If in doubt, a practical test should be requested.

Tuberculosis

6.10  Untreated tuberculosis or other serious infection presents a high risk.  Where the applicant has suffered tuberculosis or other serious lung infection, a letter from the treating physician should be obtained to certify that the seafarer is no longer infectious.

Chest X-rays

6.11  A chest X-ray is required at entry i.e. for pre-sea medicals and may be required where there is a history of tuberculosis, or pneumothorax and/or when clinically indicated.  There is no requirement for routine chest X‑rays.

7  Gastrointestinal system

Teeth and gums

7.1  Seafarers must be dentally fit as, other than temporary pain relief, there is no dental treatment aboard ship.  Dental abscesses or severe gingivitis presents a high risk.  Seafarers with impacted wisdom teeth may need dental review.

Peptic ulcer

7.2  Acute peptic ulceration presents a high risk.  However treated peptic ulceration is acceptable provided that the Medical Inspector is satisfied that the risk of recurrence, especially haemorrhage, is minimal.  A letter from the treating physician, together with endoscopy report, may be required.

Liver and pancreas

7.3  A history of recurrent or chronic pancreatitis presents a high risk.  Serious or progressive liver disease such as cirrhosis with complications of oesophageal varices presents a high risk.

Gall bladder disease

7.4  A person with a history of cholelithiasis and/or cholangitis should be carefully evaluated for the risk of recurrence before being accepted as fit for duty at sea.

Hernia

7.5  A hernia presents a high risk unless surgically corrected, with the exception that an applicant who has a small inguinal hernia where there is no risk of strangulation and where there is surgical opinion to state that there is no clinical indication for surgery may be determined as fit for lifting tasks.

7.6  A rectus divarification or large umbilical hernia should be surgically corrected before applicants can be accepted as fit for lifting tasks.

7.7  A diaphragmatic hernia without disabling reflux oesophagitis or other symptoms is acceptable.

Colostomies

7.8  A person with an uncomplicated stoma is acceptable provided that the underlying cause is compatible with work offshore and there are adequate facilities for changing colostomy bags on board ship.

Enteric diseases

7.9  Catering crew should be free of infectious enteric diseases, including hepatitis A.  A faecal specimen will be required.  A positive test should be discussed with an infectious diseases specialist.

7.10  Catering crew and those exposed to sewage (eg engineers maintaining sewage treatment plants) require hepatitis A immunisation on employment.

8  Genitourinary

8.1  Any person who has haematuria and/or protein on urinalysis should be carefully assessed to exclude any condition which may suddenly worsen and require urgent medical attention, eg renal calculi.

8.2  A history of renal calculi requires advice on fluid intake in hot weather.  The presence of untreated renal calculi presents a high risk.

8.3  Urinary incontinence presents a high risk.

8.4  A large untreated hydrocele presents a high risk.  A small symptomless hydrocele is acceptable.

8.5  Prostatism, due to prostatic hypertrophy sufficient to cause urinary symptoms such as frequency or poor stream, presents a high risk until treated due to the risk of acute urinary retention.

8.6  Menstrual dysfunction which can lead to incapacitating pain or haemorrhage, eg severe endometriosis or menorrhagia presents a high risk.

8.7  Pregnancy affects fitness for duties at sea because of:

 the risk of hypotension, especially in hot weather

 the risk of falls due to the change in the centre of gravity

 difficulty climbing because of increased abdominal girth and additional cardiovascular load

 nausea from ‘morning sickness’ which may be exacerbated by sea conditions.

8.8  Antenatal and obstetric care is not available at sea, and a miscarriage could be life-threatening.  Pregnancy therefore presents a high risk except for a woman with a previous uncomplicated pregnancy who is less than 28 weeks into her pregnancy and who works on short coastal runs only.  A report from the treating obstetrician should be obtained.

9  Neurological system

9.1  Sudden loss of consciousness or loss of control of limbs or balance impairs the ability to control a ship, ship’s small craft or a crane, and to work at heights or alone.

Epilepsy

9.2  Epilepsy can be affected by fatigue.  Shift work can therefore exacerbate the condition if a person fails to get adequate sleep.  Confirmed or current epilepsy, with a fit within the previous 2 years, presents a high risk.  For seafarers with well-controlled epilepsy, evidence of treatment and control of epilepsy (eg letter from treating specialist) must be provided for the condition to be acceptable.

Note: Although only about one-third of patients with a first unprovoked seizure will have further seizures within 5 years, about 75% of those with two or three unprovoked seizures have further seizures within 4 years.

9.3  A past history of convulsions after the age of 5 years, with a seizure-free period of at least two years, and not requiring medication, should be carefully assessed.

9.4  A past, single seizure or cluster of seizures due to exceptional and non-repeatable circumstances (eg head injury with complete recovery) may be acceptable.

Migraine

9.5  Acute incapacitating attacks of migraine which may be accompanied by neurological signs such as hemiparesis and visual defects presents a high risk.

9.6  An established history of migraine which does not interfere with capacity to work safely is acceptable.

Stroke

9.7  A history of cerebrovascular accident generally presents a high risk.  However depending on the degree of recovery from the stroke, and provided that problem solving skills and judgement have not been affected, a person may be considered fit for duty at sea after neuropsychometric evaluation and a report from the treating neurologist / rehabilitation physician indicating that a recurrence is unlikely and that there is no residual disability.

Transient ischaemic attacks (TIAs)

9.8  If a cardiac cause for such episodes is found and treated, then any restriction should be based on the prognosis of that condition, and the likelihood of recurrences.

9.9  Where the aetiology of the attacks has been identified, the underlying cause removed, and a six-month period free of attacks has elapsed, the condition may be acceptable.

9.10  In such cases as outlined above, a review by a cardiologist/neurologist will be required.

Neuromuscular Disorders including Multiple Sclerosis, Parkinsonism

9.11  Parkinsonism, multiple sclerosis, or other neuromuscular disorders would preclude being in control of a ship, operating cranes or other equipment and, where the disability is any more than minor muscular weakness, can affect climbing ability on ship’s rope ladders and steel rung ladders.  Because of the progressive nature of most forms of neuromuscular disorder, these conditions generally present a high risk.

9.12  Drug induced Parkinsonism may disappear on cessation of the treatment.  Should this occur, and the underlying case for which the drugs were administered not

be a cause for exclusion in its own right, then the applicant may be considered fit for duty at sea.

10  Psychiatric conditions

10.1  Affective disorders affect judgement, attention and motor activity and the Medical Inspector should consider this in relation to any jobs with responsibility for the safe operation of ships, cranes and equipment, including emergency procedures.  The Medical Inspector should also be aware that ship-board life involves periods of months away from home, family and other support mechanisms, including psychiatric support.

10.2  An acute episode of mental illness (eg schizophrenia, manic depressive or other psychoses) or a chronic mental illness manifested by symptoms which indicate there is the likelihood of relapse such that the sufferer may cause harm to herself or himself or others, the ship or its cargo, presents a high risk .

10.3  A mental disorder requiring psychotropic drug therapy presents a high risk if the side-effects of such medication affect alertness, co-ordination, cause drowsiness or postural hypotension.

10.4  A present or past mental disorder affecting judgement or psychomotor ability presents a high risk.

10.5  Where the mental illness has been controlled and a report obtained from the treating psychiatrist to the effect that a recurrence is unlikely, the person may be considered fit, subject to regular review.

10.6  In all cases, where there is doubt about fitness, a psychiatric consultation should be sought.

11  Prescribed medication, drugs and alcohol

11.1  Some prescription, over-the-counter, or illegal substances have the capability of altering vision, perception, judgement, attention span, motor function and other characteristics important in the safe operation of ships, cranes, lathes, and powered tools.

Prescribed and over-the-counter drugs

11.2  The main issues with these drugs in relation to fitness for duty at sea are:

 can side-effects place the safety of the person or the safety of others at risk?

 does the medication require monitoring?

 is the underlying disease, for which the medication has been prescribed, compatible with working at sea?

 what is the likely effect of several missed doses if seasickness precludes taking or absorbing medication?

11.3  If the medication is for short term administration, the person may be considered as temporarily unfit and re-examined.

11.4  Long term administration of some medications may lead to tolerance of sedative side effects eg antihistamines.  Once this has stabilised, the taking of medications per se is not a bar to operating plant and equipment.  The Medical Inspector should be satisfied that the person does not suffer sedative side effects and is aware of the potentiation effects of alcohol.

11.5  The short or long term use of prescribed psychoactive drugs requires, at a minimum, strong warnings about the potentiation by alcohol.  It is desirable that alternative therapy, with non-psychoactive drugs if possible, is undertaken.  Each case will need to be assessed individually and discussed with the person’s treating practitioner.  More frequent reassessment will be required.

11.6  Persons using anti-histamines should use those with the least sedative side-effects eg astemizole (Hismanal).

11.7  Cytotoxic agents, insulin, immunosuppressants, oral corticosteroids present a high risk.

11.8  Major tranquillisers, narcotics and hypnotics present a high risk.  A previous history of such treatment will require further consideration.

11.9  Prescribed medication must be listed on the health assessment report form.  The applicant must be warned that he or she must have adequate medication to last a swing.

Table 3: Classes of drugs with potential to affect an individual’s skills to operate ships, boats, plant and equipment, including cranes, are:

Illegal drugs

11.10  Illegal drugs such as opiates, cannabis and amphetamines may reduce a person’s ability to safely operate ships, cranes and machinery.  Drug screening is not required for a Certificate of Medical Fitness, although individual employers may initiate drug and alcohol screening as part of company policy eg in the offshore oil industry.  Such policies are beyond the scope of these guidelines and further information, if required, should be sought from the Australasian Faculty of Occupational Medicine and the Centre for Education and Information on Drugs and Alcohol (CEIDA).

11.11  Any use of illegal drugs presents a high risk.

Alcohol

11.12  Alcohol is implicated as a significant factor in work-related accidents.  It is a statutory requirement that all persons, whilst on duty on a commercial vessel, have essentially a zero blood alcohol level.

11.13  Chronic high alcohol intake (60g per day) impairs cognitive function such as the processing and handling of sensory information and reduces the speed and accuracy of response to psychomotor tasks.  This may not become apparent until the person is in an emergency situation.

11.14  A person with a clear history and clinical evidence of chronic alcohol abuse, where there is evidence of end organ damage such as organic brain damage or hepatomegaly, presents a high risk.

11.15  A seafarer who has been diagnosed as suffering from alcoholism should not be considered as fit for duties at sea until a rehabilitation program has been completed and the Medical Inspector is satisfied that the seafarer is fit to return to service on a ship.

Note: The Seafarer’s Assistance Service provides an employees’ assistance program for seafarers with drug related or other problems.  Counselling services available include drug and alcohol rehabilitation services.

12  Musculoskeletal

12.1  Normal mobility, agility and strength in the spine and all limbs are important for tasks involving climbing, lifting and confined space work.

12.2  Ships have steep stairs, rope ladders and vertical steel rung ladders which must be climbed and hatches which must be got through.

12.3  Rough weather will increase the need for reasonable hip, knee and shoulder strength, flexibility and agility in relation to climbing.

12.4  The majority of lifting tasks are 25 kg or below and much use is made of lifting equipment (cranes and hoists, forklifts) both on ships and on shore.  Lifting is harder to control during emergency procedures, when moving chains on deck, or when lifting and carrying in confined spaces.

12.5  The following conditions present a high risk:

 amputation or congenital loss of an upper limb or lower limb if this affects climbing

 amputation or congenital loss of a lower limb if this is required to operate a foot control

 peripheral neuropathy resulting in loss of sensation or proprioception in the extremities as this makes climbing hazardous

 uncorrected knee instability eg locking, giving way

 uncorrected shoulder dislocation/subluxation

 acute inflammation and pain in any joint which interferes with concentration or impairs the range of motion such that disembarking from a boat cannot be performed safely - the person may need to be re-examined at a later date.

12.6  The following conditions also present a high risk because they affect the ability to undertake manual handling, climb and occasionally maintain awkward postures in engine rooms and other confined spaces:

 reduced range of movement or pain when rotating the neck - unable to look behind and/or up when operating plant, including cranes and hoists

 low back pain which affects activities of daily living and/or results in an inability to shovel, climb, maintain sustained and/or repetitive awkward postures

 painful spinal or shoulder movements with or without limitation in range of strength.

12.7  The Medical Inspector should carefully assess a person with a lower limb prosthesis (eg for a below-knee amputation).  An agility test may be required to prove

that rope ladders, steel rung ladders and ships stairs can be climbed, or alternatively evidence of satisfactory work performance at sea.

12.8  A person with a significant loss of range of motion or some loss of muscle power may also require an agility test.

12.9  Where there is any doubt about mobility, the Medical Inspector should ask for a practical test by contacting the referring employer.

13  Diabetes and other endocrine disorders

Diabetes mellitus

13.1  The Medical Inspector should bear in mind the risk to safety if the applicant had a hypoglycaemic attack or developed a ketacidotic coma.  In particular, attention is drawn to watch keeping duties as there may be periods when the Master or Mate is alone on the bridge and responsible for the safety of the ship eg whilst the Integrated Rating or Mate is doing a round of the ship.

Note: Insulin dependent diabetes mellitus is more difficult to manage for a person on rotating shift work.  There is also the problem of administering optimal emergency care at sea to a person in a coma who may require urgent intravenous therapy.

13.2  The following conditions present a high risk:

 insulin dependent diabetes mellitus (IDDM)

 poorly controlled non-insulin dependent diabetes with unsatisfactory glucometer readings and/or recurrent glycosuria.

Note: The International Labour Office (ILO) and the World Health Organization (WHO) have produced Guidelines on conducting pre-sea and periodic medical fitness examinations of seafarers which preclude persons with IDDM serving at sea.

13.3  Seafarers or applicants with a demonstrated responsible attitude to self-management of a diabetic condition and a report from their treating practitioner confirming adequate control of diabetes, lack of complications (ulcers, retinopathy, renal disease) and ability to work shift work without the risk of a hypoglycaemic attack, may be accepted.

13.4  If the person’s diabetes is currently uncontrolled eg due to change in therapy, it may be necessary to consider him or her as temporarily unfit and subject to re-examination in, say, three months.

Thyroid disease

13.5  Fitness for duties at sea will depend on the degree of control of thyroid disease, the absence of complications, especially cardiac, and the requirements for monitoring medication.

Adrenal disease

13.6  Disorders affecting adrenocortical hormone production such as Cushing’s syndrome or Addison’s disease present a high risk unless the underlying cause has been treated and the individual’s adrenal function is sufficient.

14  Skin disorders

Infections

14.1  Contagious skin disease presents a high risk unless the disease has been treated and is no longer contagious.

Dermatoses

14.2  Mild endogenous eczema is acceptable but the Medical Inspector should be satisfied that the condition will not be aggravated by exposure to oils, detergents or other substances at work to a degree sufficient to render the applicant unfit for duty at sea.

14.3  Psoriasis, not associated with polyarthritis, is acceptable.

15  Haemopoietic disease

15.1  Routine blood tests are not required for assessing medical fitness unless clinically indicated, for example there are clinical signs of anaemia, lymphadenopathy, haemarthroses.

15.2  Coagulation disorders such as Factor VIII deficiency present a high risk because it will not usually be possible to treat an acute traumatic haemorrhage at sea with replacement of clotting factors.

15.3  Leukaemias and myeloproliferative diseases present a high risk.

15.4  Chronic lymphatic leukaemia if mild and asymptomatic may be acceptable.

16  Infectious diseases

16.1  Active infectious disease presents a high risk.  Tuberculosis and contagious skin diseases are mentioned in the relevant sections.

16.2  Catering staff must be free of enteric diseases, including hepatitis A. Faecal specimens are required at each examination (see also gastrointestinal section).

16.3  HIV testing is not routinely required and should not be done unless there is a clinical indication.  Whilst a positive HIV test is not a bar to employment, evidence of AIDS (Acquired Immunodeficiency Syndrome) presents a high risk.  Of particular concern are neurological or neuropsychiatric and other complications which would compromise safety.

17  Neoplasms

17.1  Neoplasms of any type have the potential to disqualify an applicant or seafarer from duties at sea because of:

 acute symptoms, eg hemianopia with pituitary tumours

 complications eg pulmonary emboli

 side-effects of treatment/medication, eg immunosuppression, anaemia, nausea.

17.2  Frank malignant disease presents a high risk.  Seafarers should be carefully reassessed after a diagnosis of cancer is confirmed and treatment instituted.  The natural history and prognosis of the neoplasm should be taken into account.  The progress and likelihood of complications of the disease or its treatment must also be carefully evaluated.

ATTACHMENT

Recommended forms

Medical Examination Questionnaire

Please complete this questionnaire prior to attendance, but leave blank the answer to any question you do not understand.  You must bring a suitable means of identification (passport, certificate of competency, driving licence) with you to the examination

PERSONAL HISTORY

All questions must be answered

Have you now or have you previously had any of the following conditions?  Circle ‘YES’ or ‘NO’ in space provided.

Please give details of

A copy of this document is to be forwarded to AMSA.

Appendix 3

Job task analyses

Table 1 Master/Mate/Pilot

Table 2 Chief Engineer/Engineer/ Electrician/Fitter

Table 3 Chief Integrated Rating/Integrated Ratings

Table 4 Chief Cook/Cook/Steward

Table 5 Catering Attendant and Steward

Table 1: Master/Mate

* These duties are not normally required of a pilot

Table 2: Chief Engineer/Engineer/Electrician/Fitter

Table 3: Chief Integrated Rating/Integrated Rating

Table 4: Chief Cook/Cook/Steward

Table 5: Catering Attendant and Steward

Appendix 4

Forms