MEDICAL CHECK LIST ( ILLNESS OR INJURY)

Company Forms and Check Lists ACTION Location of vessel

RADIO ADVICE

Date : 03.04.01 Rev.No : 1 Prep. : MGV App. : CAP Section : 03 Page : 1 of 1

WRITEN REPORT
DOCUMENTS

EVIDENCE

1 2 3 4 5 6 7 8 9

Name of person sick or injured

Nature of illness or cause of injury

Notify Pleiades office

Prepare account of wages

Prepare personal effects inventory with witness

Enter facts in medical and official log books

Prepare deviation statement if necessary If injury due to defective equipment etc. keep parts on board for inspection

10 Witnesses statements 11 Incident or accident report

INSTRUCTIONS :
To be filled in whenever there is illness or injury onboard. Checklist to be kept in the Safety Officer's file and a copy to be forwarded to the office.

C:\FORMS\03_0006.PDF

MT LADON