Seafarers are required to undergo medical examinations to reduce

risks to other crew members and for the safe operation of the ship,
as well as to safeguard their personal health and safety. The Maritime
Labour Convention, 2006, and International Convention on Standards
of Training, Certification and Watchkeeping for Seafarers, 1978, as
amended, therefore require seafarers to hold medical certificates
attesting that they are medically fit to perform the duties they are to
carry out at sea.
These Guidelines will assist medical practitioners, shipowners,
seafarers representatives, seafarers and other relevant persons with
the conduct of medical fitness examinations of serving seafarers and
seafarer candidates. They also will help administrations establish
criteria that will lead to equitable decisions about who can safely and
effectively perform their routine and emergency duties at sea, provided
these are compatible with their individual health-related capabilities.
They have been developed in order to reduce the differences in the
application of medical requirements and examination procedures and
to ensure that the medical certificates which are issued to seafarers
are a valid indicator of their medical fitness for the duties they will
perform.
Ultimately, the aim of the Guidelines is to contribute to health and
safety at sea.

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Guidelines on the medical
examinations of seafarers
Sectoral
Activities
Programme


Guidelines on
the medical examinations
of seafarers
INTERNATIONAL LABOUR OFFICE GENEVA
INTERNATIONAL MARITIME ORGANIZATION
This publication was produced by the Document and Publications Production,
Printing and Distribution Branch (PRODOC) of the ILO.
Graphic and typographic design, layout and composition,
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in an environmentally sustainable and socially responsible manner.
Code: COC-WEI-MUS
ILO Cataloguing in Publication Data
Guidelines on the medical examinations of seafarers / International Labour Ofce, Sectoral Activities
Programme; International Migration Organization. Geneva: ILO, 2013
ILO/IMO/JMS/2011/12
ISBN 978-92-2-127462-9 (print)
ISBN 978-92-2-127463-6 (web pdf)
International Labour Ofce; Sectoral Activities Programme; International Maritime Organization
medical examination / occupational health service / seafarer / merchant marine / sea transport
02.07.4
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3

Preface
The International Labour Organization (ILO) adopted the Medical Examination of
Young Persons (Sea) Convention, 1921 (No. 16), as one of the rst Conventions. This
was followed by the Medical Examination (Seafarers) Convention, 1946 (No. 73). These
instruments have now been consolidated into the Maritime Labour Convention, 2006
(MLC, 2006). The laws of most maritime countries require that all seafarers carry a
valid medical certicate.
The International Maritime Organizations (IMO) International Convention on
Standards of Training, Certication and Watchkeeping for Seafarers (STCW), 1978, as
amended, states that every seafarer holding a certicate issued under the provisions of
the Convention, who is serving at sea, shall also hold a valid medical certicate issued
in accordance with the provisions of Regulation I/9 and of Section A-I/9 of the STCW
Code.
With national tness standards for seafarers varying widely, the set of international
guidelines adopted in 1997 (the Guidelines for Conducting Pre-sea and Periodic Medical
Fitness Examinations for Seafarers) was a rst attempt towards harmonization. The
increasing internationalization of shipping makes such harmonization even more de-
sirable. Medical practitioners performing such examinations should have a clear under-
standing of the special requirements of seafaring life, as their professional judgement is
often critical to the lives of seafarers. All concerned should be able to trust a seafarers
medical certicate as having been issued in accordance with the relevant applicable
international standards.
These Guidelines have been endorsed by the ILO Governing Body and the IMO
Maritime Safety Committee to provide complementary advice to competent authorities,
medical practitioners and all stakeholders of the shipping industry on the application
of the MLC, 2006, and the STCW Convention, 1978, as amended, with regard to safe-
guarding the health of seafarers and promoting safety at sea.
These Guidelines supersede the Guidelines for Conducting Pre-sea and Periodic Medical
Fitness Examinations for Seafarers, which were published by the ILO and the World
Health Organization (WHO) in 1997.
Disseminating these Guidelines and ensuring their implementation should contribute to-
wards harmonizing the standards for medical examinations of seafarers and improving
the quality and efectiveness of the medical care provided to seafarers.
5

Contents
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Part 1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Part 2. Guidance for competent authorities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Part 3. Guidance to persons authorized by competent authorities to conduct
medical examinations and to issue medical certicates . . . . . . . . . . . . . . . . . 17
Appendices
A. Vision standards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
B. Hearing standards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
C. Physical capability requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
D. Fitness criteria for medication use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
E. Fitness criteria for common medical conditions . . . . . . . . . . . . . . . . . . . . . . 31
F. Suggested format for recording medical examinations of seafarers . . . . . . 48
G. Medical certicate for service at sea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
H. Extract from the Maritime Labour Convention, 2006 . . . . . . . . . . . . . . . . . 54
I. Extract from the International Convention on Standards of Training,
Certication and Watchkeeping for Seafarers, 1978, as amended . . . . . . . . 60
J. Extract from the Seafarers Training, Certication
and Watchkeeping Code . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
7

Part 1. Introduction
I. Purpose and scope of the Guidelines
Seafarers are required to undergo medical examinations to reduce risks to other crew
members and for the safe operation of the ship, as well as to safeguard their personal
health and safety.
The MLC, 2006, and the STCW Convention, 1978, as amended, require a seafarer to
hold a medical certicate, detail the information to be recorded and indicate certain
specic aspects of tness that need to be assessed.
These Guidelines apply to seafarers in accordance with the requirements of the MLC,
2006, and the STCW Convention, 1978, as amended. They revise and replace the
Guidelines for Conducting Pre-sea and Periodic Medical Fitness Examinations for
Seafarers, published by the ILO and WHO in 1997.
When implementing and utilizing these Guidelines, it is essential to ensure that:
(i) the fundamental rights, protections, principles, and employment and social
rights outlined in Articles III and IV of the MLC, 2006, are respected;
(ii) from the point of view of safety of life and property at sea and the protection of
the marine environment, seafarers on board ships are qualied and t for their
duties; and
(iii) medical certicates genuinely reect seafarers state of health, in light of the
duties they are to perform, the competent authority shall, after consultation
with the shipowners and seafarers organizations concerned, in giving due con-
sideration to applicable international guidelines referred to in GuidelineB.1.2 of
the MLC, 2006, prescribe the nature of the medical examination and certicate,
as outlined in StandardA.1.2.2 of the MLC, 2006.
These Guidelines are intended to provide maritime administrations with an internation-
ally recognized set of criteria for use by competent authorities either directly or as the
basis for framing national medical examination standards that will be compatible with
international requirements. Valid and consistent guidelines should assist medical practi-
tioners, shipowners, seafarers representatives, seafarers and other relevant persons with
the conduct of medical tness examinations of serving seafarers and seafarer candidates.
Their purpose is to help administrations establish criteria that will lead to equitable de-
cisions about who can safely and efectively perform their routine and emergency duties
at sea, provided these are compatible with their individual health-related capabilities.
These Guidelines have been developed in order to reduce the diferences in the applica-
tion of medical requirements and examination procedures and to ensure that the med-
ical certicates which are issued to seafarers are a valid indicator of their medical tness
for the duties they will perform. Ultimately, the aim of the Guidelines is to contribute
to health and safety at sea.
A medical certificate issued in accordance with the requirements of the STCW
Convention, 1978, as amended, also meets the requirements of the MLC, 2006.
8
Guidelines on the medical examinations of seafarers
II. Contents and use of the Guidelines
The Guidelines are arranged in the following manner:
Part 1 summarizes the purpose and scope of the Guidelines, their contents and the back-
ground to their preparation, and identies the main features of a framework for medical
examinations and the issue of a medical certicate to a seafarer.
Part 2 provides information relevant to competent authorities to assist with the framing
of national regulations that will be compatible with relevant international instruments
on the health and tness of seafarers.
Part 3 provides information relevant to those who are carrying out seafarer medical
assessments. This may be used directly or may form the basis for national guidelines for
medical practitioners.
Part 4 includes a series of appendices on standards for diferent types of impairing con-
ditions, recordkeeping and the contents of the medical certicate.
Some parts of the Guidelines are more appropriate for competent authorities than for
individual medical practitioners, and vice versa. Nevertheless, it is suggested that the
whole of the Guidelines be taken into consideration to ensure that all topics and infor-
mation are taken into account. The Guidelines are designed as a tool to enhance med-
ical examinations and make them more consistent; they cannot and are not intended to
replace the professional skill and judgement of recognized medical practitioners.
III. Background to the preparation of the Guidelines
In 1997, the ILO and WHO published the rst international guidelines concerning the
medical examinations of seafarers. This has been an invaluable document for maritime
authorities, the social partners in the shipping industry and the medical practitioners
who conduct medical examinations of seafarers. Since 1997 there have been important
changes in the diagnosis, treatment and prognosis of many of the medical conditions
that need to be taken into account. The 1997 Guidelines provided detailed information
on the conduct of seafarer medical examinations but they did not, with the exception of
vision, assist by proposing the appropriate criteria to be used when deciding whether a
medical certicate could be issued for other conditions.
The need for revision was recognized by a number of maritime authorities, by the
social partners and by doctors undertaking seafarer medical examinations. This led to
a resolution being adopted by the 94th(Maritime) Session of the International Labour
Conference in 2006 recommending that the need for revision should be considered. The
IMO, in its comprehensive review of the 1978 STCW Convention and Code, also recog-
nized the need to include medical tness criteria that were relevant to maritime safety,
and concluded that the present Guidelines required revision.
The ILO and the IMO subsequently agreed to create a joint working group to develop
revised Guidelines.
IV. Seafarer medical tness examinations
The aim of the medical examination is to ensure that the seafarer being examined is
medically t to perform his or her routine and emergency duties at sea and is not suf-
fering from any medical condition likely to be aggravated by service at sea, to render him
or her unt for service or to endanger the health of other persons on board. Wherever
possible, any conditions found should be treated prior to returning to work at sea so that
9
Part 1. Introduction
the full range of routine and emergency duties can be undertaken. If this is not possible,
the abilities of the seafarer should be assessed in relation to his or her routine and emer-
gency duties and recommendations made on what the seafarer is able to do and whether
any reasonable adjustments could enable him or her to work efectively. In some cases,
problems will be identied that are incompatible with duties at sea and cannot be rem-
edied. Appendices AE provide information on the disabilities and medical conditions
which are not likely to prevent all routine and emergency duties being performed, those
which require adaptation or limitation to routine and emergency duties, and those which
result in either short-term or longer term untness to work at sea.
Medical examination ndings are used to decide whether to issue a medical certicate to
a seafarer. Consistent decision-making needs to be based on the application of criteria
for tness that are applied in a uniform way, both nationally and, because of the global
nature of seafaring and marine transport, internationally. These Guidelines provide the
basis for establishing national arrangements which are compliant with the relevant inter-
national Conventions.
The medical certicate is neither a certicate of general health nor a certication of the
absence of illness. It is a conrmation that the seafarer is expected to be able to meet
the minimum requirements for performing the routine and emergency duties specic to
their post at sea safely and efectively during the period of validity of the medical certi-
cate. Hence, the routine and emergency duties must be known to the examining medical
practitioner, who will have to establish, using clinical skills, whether the seafarer meets
the standards for all anticipated routine and emergency duties specic to their individual
post and whether any routine or emergency duties need to be modied to enable them
to be performed safely and efectively.
The ability to safely and efectively perform routine and emergency duties depends on
both a persons current degree of tness and on the likelihood that they will develop an
impairing condition during the validity period of the medical certicate. Criteria for
performing routine and emergency duties safely will be higher where the person has
critical safety duties, either as part of their routine or in emergencies. Other safety con-
sequences also need to be considered, for instance whether a seafarer is sufering from
any medical condition likely to be aggravated by service at sea, to render the seafarer
unt for such service, or to endanger the health and safety of other persons on board.
The examining medical practitioner should base the decision to issue a medical certi-
cate on whether criteria for minimum performance requirements, as listed in the appen-
dices to this document, are met in the following areas:
(i) vision (Appendix A), hearing (Appendix B) and physical capabilities (AppendixC);
(ii) impairment from the use of medication (Appendix D);
(iii) presence or recent history of an illness or condition (Appendix E).
The consequences of impairment or illness will depend on the routine and emergency
duties and, in some cases, on the distance from shore-based medical facilities.
Thus, the examining medical practitioner needs the skills to assess individual tness
in all these areas and the knowledge to relate their ndings to the requirements of the
individuals routine and emergency duties at sea whenever any limitations in tness are
identied.
Competent authorities may, without prejudice to the safety of the seafarers or the ship,
diferentiate between those persons seeking to start a career at sea and those seafarers
already serving at sea and between diferent functions on board, bearing in mind the
diferent duties of seafarers.
11

Part 2. Guidance for competent authorities
V. Relevant standards of and guidance from the International
Labour Organization, the International Maritime Organization
and the World Health Organization
The Guidelines have taken into account the appropriate Conventions, Recommendations
and other instruments of the ILO, the IMO and WHO. Competent authorities should
ensure that medical practitioners are provided with information on other relevant stand-
ards which may have been formulated after the date of adoption of these Guidelines.
ILO instruments concerning the medical examination
and health of seafarers
Several earlier Conventions on seafarer working conditions have been consolidated in
the MLC, 2006, including requirements for the issue of medical certicates (Regulation
1.2 and associated standards and guidelines) and for medical care on board ship and
ashore (Regulation 4.1 and associated standards and guidelines).
An important objective of the MLC, 2006, is to safeguard the health and welfare of
seafarers. The MLC, 2006, applies to all seafarers except where expressly provided oth-
erwise in the Convention (Article II, paragraph2).
IMO instruments concerning medical
examination requirements for seafarers
The IMO STCW Convention, 1978, as amended, includes requirements for medical ex-
aminations and the issue of medical certicates.
Earlier versions of the STCW Convention included criteria for vision and physical capa-
bility but not for other aspects of medical assessment.
Every seafarer holding a certicate issued under the provisions of the STCW Convention
who is serving at sea must also hold a valid medical certicate issued in accordance with
the provisions of STCW Convention regulation I/9 and of section A-I/9 of the STCW
Code.
WHO measures concerning seafarers health and medical services
and medical examinations of seafarers
The WHO Executive Board and World Health Assembly have adopted resolutions on
the health of seafarers (WHA14.51, EB29.R10, WHA15.21, EB37.R25, EB43.R23), re-
questing to assist nations to improve the health of seafarers, ameliorate the medical
records of seafarers, and make available to seafarers services in each port where the
necessary specialized medical care can be provided. Furthermore, in May 1996, a res-
olution of the 49th World Health Assembly (WHA49.12) on the WHO Global Strategy
for Occupational Health for All and in May 2007, a resolution of the 60th World Health
Assembly (WHA60.26), the Global Plan of Action on Workers Health urge countries to
12
Guidelines on the medical examinations of seafarers
give special attention to full occupational health services for the working population,
including groups at high risk, such as seafarers. In addition, the following guidelines
approved by the WHO Guidelines Review Committee since 2007 include references to
medical examinations: the Guidelines for treatment of tuberculosis (fourth edition); the
WHO policy on TB infection control in health-care facilities, congregate settings and
households; the Guidelines for using HIV testing technologies in surveillance: selection,
evaluation and implementation (2009 update); and the mhGAP Intervention Guide
for mental, neurological and substance use disorders in non-specialized health settings.
VI. Purpose and contents of the medical certicate
The MLC, 2006, (Standard A1.2) and the STCW Convention, 1978, as amended, (sec-
tionA-I/9, paragraph7) specify the information that should be included as a minimum
on the medical certicate. The detailed content of these Guidelines aligns with these
requirements and the other more detailed provisions of the relevant international
Conventions, which should be consulted when developing national procedures. The aim
of the Guidelines is, wherever possible, to avoid subjectivity and to give objective criteria
for decision-making.
The period of validity of the medical certicate is indicated in the MLC, 2006, (Standard
A1.2, paragraph7) and the STCW Convention, 1978, as amended, (regulation I/9). Both
Conventions specify that the medical certicate will remain in force for a maximum
period of two years from the date on which it is granted, unless the seafarer is under
the age of 18, in which case the maximum period of validity is one year. Medical certi-
cates issued in accordance with the STCW Convention, 1978, as amended, which expire
during the course of a voyage will continue to be in force until the next port of call where
the seafarer can obtain a medical certicate from a medical practitioner recognized by
the party, provided that the period does not exceed three months. In urgent cases, the
administration may permit a seafarer to work without a valid medical certicate until
the next port of call where a medical practitioner recognized by the party is available,
provided that the period of such permission does not exceed three months and the sea-
farer concerned is in possession of an expired medical certicate of recent date. In so far
as a medical certicate relates to colour vision, it will remain in force for a period not
exceeding six years from the date it is granted.
Two years is the period over which tness should normally be assessed. However, if the
examining medical practitioner considers that more frequent surveillance of a condition
that may afect health or performance at sea is indicated, a medical certicate of shorter
duration should be issued and arrangements made for reassessment. The examining
medical practitioner should only issue a medical certicate with a duration of less than
two years if they can justify their reasons in a particular case.
The medical practitioner should indicate on the medical certicate whether the person
is t for all duties worldwide within their department (deck/engine/catering/other), as
indicated on their medical certicate; whether they can undertake all routine and emer-
gency duties but are only able to work in specied waters, or whether adaptation of
some routine and emergency duties is required. Safety-critical visual capabilities such as
lookout duties should be specically indicated.
If the seafarer cannot perform routine and emergency duties safely and efectively and
adaptation of duties is not possible, the seafarer should be notied that they are not
t for duty. If adaptation is possible then they should be notied that they are t for
duty with limitations. The notication must be accompanied by an explanation of the
seafarers right to appeal as provided in section IX.
13
Part 2. Guidance for competent authorities
Where illnesses and injuries may impair the ability of a seafarer with a valid medical
certicate to perform routine and emergency duties safely, their current tness may need
to be assessed. Such examinations may be considered in various circumstances such as
more than 30 days incapacitation, disembarkation for medical reasons, hospital admis-
sion or requirement for new medication. Their current medical certicate may be revised
accordingly.
Before training commences, it is advantageous for any person who intends to subse-
quently work at sea to be medically examined to conrm that they meet the required
medical tness standards.
VII. Right to privacy
All persons involved in the conduct of medical examinations, including those who come
into contact with medical examination forms, laboratory results and other medical in-
formation, should ensure the right to privacy of the examinee. Medical examination
reports should be marked as condential and so treated, and all medical data collected
from a seafarer should be protected. Medical records should only be used for deter-
mining the tness of the seafarer for work and for enhancing health care; they should
not be disclosed to others without prior written informed consent from the seafarer.
Personal medical information should not be included on medical certicates or other
documents made available to others following the medical examination. The seafarer
should have the right of access to and receipt of a copy of his/her personal medical data.
VIII. Recognition of medical practitioners
The competent authority should maintain a list of recognized medical practitioners to
conduct medical examinations of seafarers and issue medical certicates. The compe-
tent authority should consider the need for medical practitioners to be personally inter-
viewed and for clinic facilities to be inspected before authorization to conduct medical
examinations of seafarers is given. A list of medical practitioners recognized by the com-
petent authority should be made available to competent authorities in other countries,
companies and seafarers organizations on request.
The competent authority, when developing guidance for the conduct of medical tness
examinations, should take into consideration that general medical practitioners may need
more detailed guidance than medical practitioners with competence in maritime health.
In addition, the provision of an expert helpline can aid decision-making on novel or
complex problems and can be a source of information that may be used to improve the
quality of assessments.
The names of any medical practitioners whose recognition has been withdrawn during
the previous 24 months should continue to be included, with a note to the efect that
they are no longer recognized by the competent authority to conduct seafarers medical
examinations.
A medical practitioner so recognized by the competent authority:
(i) should be a qualied medical practitioner currently accredited by the medical
registration authority for the place where they are working;
(ii) should be experienced in general and occupational medicine or maritime occu-
pational medicine;
(iii) should have knowledge of the living and working conditions on board ships
and the job demands on seafarers in so far as they relate to the efects of health
14
Guidelines on the medical examinations of seafarers
problems on tness for work, gained wherever possible through special instruc-
tion and through knowledge based on personal experience of seafaring;
(iv) should have facilities for the conduct of examinations that are conveniently sit-
uated for access by seafarers and enable all the requirements of the medical
tness examination to be met and conducted with respect for condentiality,
modesty and cleanliness;
(v) should be provided with written guidance on the procedures for the conduct of
medical examinations of seafarers, including information on appeals procedures
for persons denied a medical certicate as a result of an examination;
(vi) should understand their ethical position as examining medical practitioners
acting on behalf of the competent authority, ensuring that any conicts with
this are recognized and resolved;
(vii) should refer any medical problems found, when appropriate, for further investi-
gation and treatment, whether or not a seafarer is issued with a medical certi-
cate; and
(viii) should enjoy professional independence from shipowners, seafarers, and their
representatives in exercising their medical judgement in terms of the medical
examination procedures. Those employed by, or contracted to, a maritime em-
ployer or crewing agency should have terms of engagement which ensure that an
assessment is based on statutory standards.
It is further recommended that such medical practitioners:
(i) should be provided with information on the standard of competence for sea-
farers designated to take charge of medical care on board ships in relevant na-
tional laws and regulations; and
(ii) should be familiar with the latest edition of the International Medical Guide for
Ships, or an equivalent medical guide for use on ships.
In the case of a certicate solely concerned with a seafarers sight and/or hearing, the
competent authority may authorize a person other than a recognized medical practi-
tioner to test the seafarer and issue such a certicate. In such cases, the qualications for
such authorized persons should be clearly established by the competent authority and
such persons should receive information on the appeals procedure described in section
IX of these Guidelines.
The competent authority should have in place quality assurance procedures to ensure
that medical examinations meet the required standards. These should include publicized
arrangements for:
(i) the investigation of complaints from shipowners, seafarers, and their represen-
tatives concerning the medical examination procedures and the authorized med-
ical practitioners;
(ii) collection and analysis of anonymized information from medical practitioners
about the numbers of examinations undertaken and their outcomes; and
(iii) the introduction, where practical, of a nationally agreed review and audit pro-
gramme for examining medical practitioners practices and recordkeeping un-
dertaken by, or on behalf of, the competent authority. Alternatively, they could
endorse appropriate external clinical accreditation arrangements for those un-
dertaking seafarers medical examinations, the results of which would be made
available to the authority.
Recognized medical practitioners who are found by the competent authority as a result
of an appeal, complaint, audit procedure, or other reasons to no longer meet the re-
quirements for recognition should have their authorization to conduct seafarers medical
examinations withdrawn.
15
Part 2. Guidance for competent authorities
IX. Appeals procedures
The MLC, 2006 (Standard A1.2, paragraph5) provides that seafarers that have been
refused a medical certicate or have had a limitation imposed on their ability to work
must be given the opportunity to have a further examination by another independent
medical practitioner or by an independent medical referee. The STCW Code, in section
A-I/9, paragraph6, requires parties to the Convention to establish processes and pro-
cedures to enable seafarers who do not meet tness standards or who have had a limi-
tation imposed on them to have their case reviewed in line with that partys provisions
for appeal.
The competent authority may delegate the arrangements for appeals, or part of them, to
an organization or authority exercising similar functions in respect of seafarers generally.
The appeals procedure may include the following elements:
(i) the medical practitioner or referee undertaking the review should have at least
the same qualications as the medical practitioner who conducted the initial
examination;
(ii) the medical practitioner or referee undertaking the review process should be
provided access to other medical experts;
(iii) the appeals procedure should not result in unnecessary delays for the seafarer or
shipowner;
(iv) the same principles of condentiality called for in the handling of medical re-
cords should apply to the appeals procedure; and
(v) quality assurance and review procedures should be in place to conrm the con-
sistency and appropriateness of decisions taken at appeal.
17

Part 3. Guidance to persons authorized
by competent authorities to conduct
medical examinations and to issue
medical certicates
X. Role of the medical examination in shipboard safety and health
The medical practitioner should be aware of the role of the medical examination in the
enhancement of safety and health at sea and in assessing the ability of seafarers to per-
form their routine and emergency duties and to live on board:
(i) The consequences of impairment from illness while working at sea will depend
on the routine and emergency duties of the seafarer and on the distance of the
ship from shore-based medical care. Such impairments may adversely afect ship
operations, as both the individual and those who provide care will not be avail-
able for normal duties. Illness at sea can also put the individual at risk because
of the limited care available, as ships ofcers only receive basic rst-aid and
other medical training, and ships are only equipped with basic medical supplies.
Medication used by seafarers needs to be carefully assessed as it can lead to im-
pairment from side efects that cannot be readily managed at sea. Where medi-
cation is essential to control a potentially life-threatening condition, inability to
take it may lead to serious consequences.
(ii) Infectious diseases may be transmitted to others on board. This is particularly
relevant to food-borne infections in those who prepare or handle food or drinks.
Screening for relevant infections may be undertaken at the medical examination
or at other times.
(iii) Limitations to physical capability may afect ability to perform routine and
emergency duties (e.g. using breathing apparatus). Such limitations may also
make rescue in the event of injury or illness difcult.
(iv) The medical examination can be used to provide an opportunity to identify
early disease or risk factors for subsequent illness. The seafarer can be advised
on preventive measures or referred for further investigation or treatment in order
to maximize their opportunities for continuing their career at sea. However, the
seafarer should be made aware that it does not replace the need for other clinical
contacts or necessarily provide the main focus for advice on health maintenance.
(v) If a medical condition is identied, any adverse consequences may be reduced
by increasing the frequency of surveillance, limiting duties to those where the
medical condition is not relevant or limiting the pattern of voyages to ensure
that health care is readily available.
(vi) Seafarers need to be able to adjust to living and working conditions on board
ships, including the requirement to keep watches at varying times of the day
and night, the motion of the vessel in bad weather, the need to live and work
within the limited spaces of a ship, to climb and lift weights and to work under
a wide variety of weather conditions (see AppendixC, table B-I/9, for examples
of relevant physical abilities).
(vii) Seafarers should be able to live and work closely with the same people for long
periods of time and under occasionally stressful conditions. They should be ca-
pable of dealing efectively with isolation from family and friends and, in some
cases, from persons of their own cultural background.
18
Guidelines on the medical examinations of seafarers
Shipping operations and shipboard duties vary substantially. For a fuller understanding
of the physical demands of particular categories of work on board ships, medical prac-
titioners should acquire knowledge of the STCW Convention, 1978, as amended, and
appropriate national requirements and should consult the relevant national authority,
shipping company and trade union representatives and otherwise endeavour to learn as
much as possible about seafaring life.
XI. Type and frequency of medical examinations
For most medical conditions, the same criteria are appropriate for medical examinations
undertaken at all stages of a seafaring career. However, where a condition is present that
is likely to worsen in the future and thus limit a cadets or trainees ability to undertake
the range of duties and assignments that are essential for complete training, there may be
less exibility in the application of tness standards than for serving seafarers, in order
to ensure that all training requirements can be met.
Examinations are normally performed every two years. Where there is a health condi-
tion that requires more frequent surveillance, they may be performed at shorter inter-
vals. It is important to recognize that the requirement for more frequent examinations
may limit the ability of a seafarer to obtain employment and lead to additional costs for
the seafarer or their employer. If examinations are at intervals of less than two years,
they may solely concern the condition under surveillance and, in this case, any reissued
medical certicate should not be valid for more than two years from the previous full
examination.
Any examination requirements of employers or insurers should be distinguished from
statutory tness examinations; the seafarer should be informed if both are being as-
sessed at the same time and should consent to this. A medical certicate should be
issued if statutory standards are met, irrespective of compliance with any additional
employer requirements.
Seafarer medical examinations may also provide an opportunity to take measures to
correct or mitigate medical conditions which could adversely afect the health of sea-
farers and should 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.
XII. Conduct of medical examinations
The following suggested procedures do not aim to replace in any way the judgement or
experience of the medical practitioner. They will, however, serve as a tool to assist in
the conduct of examinations of seafarers. A model medical examination form has been
provided in Appendix F.
(i) The medical practitioner should determine whether there is any special purpose
for the examination (e.g. return after illness or follow-up for continuing health
problem) and, if so, should conduct the examination accordingly.
(ii) The identity of the seafarer to be examined should be veried. The number of
his or her seafarers book, passport or other relevant identity document should
be entered on the examination form.
(iii) The examinees intended position on board ship and, as far as practicable, the
physical and mental demands of this work and the anticipated voyage pattern
should be established. This may give insights that enable work to continue but
19
Part 3. Guidance to persons authorized to conduct medical examinations
with limitations based on the nature of the voyage (for example, t for coastal
or harbour service only) and the job to be held.
(iv) Information should be collected from the examinee on his or her previous med-
ical history. Point-by-point questions on the details of previous diseases and
injuries should be asked and the results recorded. Details of other diseases or
injuries not covered should also be recorded. After the information is collected,
the examinee should sign the form to certify that to the best of his/her know-
ledge it is a true statement. An individual should not, however, bear the burden
of proof concerning the consequences of illness, past or present, on his or her
tness for work.
(v) The examinees previous medical records, where appropriate and available,
should be reviewed.
(vi) The physical examination and the necessary additional examinations should be
checked and recorded according to set procedures (see Appendix F).
(vii) Hearing, eyesight and colour vision, if necessary, should be checked and re-
corded. Eyesight should be in compliance with the international eyesight stand-
ards for seafarers set out in section A-I/9 of the STCW Code (see Appendix A
for vision standards and Appendix B for hearing standards). In examinations,
appropriate equipment should be used in the assessment of hearing capacity,
visual acuity, colour vision and night blindness, particularly regarding those
examinees who will be engaged in lookout duties.
(viii) Physical capability should be assessed where the medical examination identies
that it may be limited by an impairment or medical condition (see Appendix C).
(ix) Testing for the presence of alcohol and drugs in the course of a medical ex-
amination does not form part of these international Guidelines. Where it is per-
formed, as a requirement of national authorities or employers, the procedures
used should follow national, if available, or international good practice guide-
lines. These should provide adequate procedural and ethical safeguards for
the seafarer. Consideration should be given to the Guiding Principles on Drug
and Alcohol Testing Procedures for Worldwide Application in the Maritime
Industry, adopted by the Joint ILOWHO Committee on the Health of Seafarers
(Geneva, 1014 May 1993), and any subsequent revisions.
(x) The application of multiple biochemistry or haematology tests or the use of im-
aging techniques applied to all seafarers is not recommended, other than where
indicated in Appendices AE. Such tests should only be used where there is
a clinical indication. The validity of any test used for the identication of a
relevant medical condition will depend on the frequency with which the condi-
tion occurs. Use is a matter for national or local judgement, based on disease
incidence and test validity. In addition, decisions about tness based solely on
the results of single or multiple screening tests in the absence of a specic diag-
nosis or impairment are of limited predictive value. Unless tests have very high
validity, use will result in inappropriate certication of a proportion of those
tested.
(xi) The medical practitioner should be aware that there are no well-validated tests
for the assessment of mental aspects of working ability that are suitable for in-
clusion in the medical examinations of seafarers.
(xii) The results of the examination should be recorded and assessed to determine
if the seafarer is t for the work which will be undertaken. Appendices AE
contain guidance on medical criteria used to consider whether a seafarer is t
or currently unt for work at sea. The age and experience of the seafarer to be
examined, the nature of the duties to be performed and the type of shipping
operation and cargo should be taken into account.
20
Guidelines on the medical examinations of seafarers
There are dened numerical criteria for some aspects of vision (Appendix A) and hearing
(Appendix B). Here, decisions on tness will depend on achieving the levels of percep-
tion that are listed, taking note of the explanatory information in the appendices. For
other conditions, where such numerical criteria do not exist, the criteria have been clas-
sied in three categories, depending on the likelihood of recurrence at diferent stages
and the severity of each condition.
Case-by-case assessment is recommended in the appendices where a specialist view on
prognosis is needed or where there is considerable diversity in capability or likelihood
of recurrence or progression.
(A) Incompatible with the reliable performance of routine and emergency duties safely or
efectively:
(i) expected to be temporary (T), i.e. less than two years;
(ii) expected to be permanent (P), i.e. more than two years.
For seafarers who are determined by the medical practitioner to have a medical con-
dition where such a nding has been made, a medical certicate would not normally
be issued.
This category means that the medical condition is such that the seafarer may cause
a danger to the safety of the vessel or to other persons on board; they may not be
able to perform their routine and emergency duties on board; or their health or life
may be put at greater risk than would be the case if they were on shore. The cate-
gory may be used temporarily until a condition has been treated, returns to normal,
or a period without further episodes indicates that the likelihood of recurrence is
no longer increased. It may be used on a permanent basis where the seafarer has a
condition that can be expected to render them unable to meet the standards in the
future.
(B) Able to perform some but not all routine and emergency duties or to work in some but
not all waters (R): a restricted medical certicate would normally be issued.
Increased surveillance needed (L): a medical certicate of limited duration would
normally be issued.
This category may mean that the seafarer has a condition that requires more fre-
quent medical assessment than the two-year normal interval between medical cer-
ticates i.e. a time-limited medical certicate (L).
Alternatively, they may be capable of performing the routine and emergency duties
required of all seafarers but need some of their own duties to be adapted because
they are expected not to be able to perform some of the duties specic to the work
they normally undertake. They may also be more likely to sufer serious adverse
efects from working in certain climates or beyond a certain distance from onshore
medical care. In these cases, the job adaptations needed are specied and the med-
ical certicate is restricted (R).
Use of this category can enable seafarers to remain working despite the presence of
certain health-related impairments. However, it should be used only when clearly in-
dicated as it may lead to the possibility that an employer will choose not to engage a
seafarer even for duties that are within their capabilities or where duties can readily
be adjusted.
(C) Able to perform all duties worldwide within designated department: an unrestricted
medical certicate of full duration would normally be issued.
This category means that the seafarer can be expected to be t for all duties within
their department on board and can fully discharge all routine and emergency duties
for the duration of the medical certicate.
21
Part 3. Guidance to persons authorized to conduct medical examinations
If the seafarer is found t for the work to be performed, the medical certicate should be
issued. Any restrictions concerning work (i.e. the job the seafarer will perform, the trade
area, the time limit or other considerations) should be reected on the medical certicate
in the description of the work he or she is t to undertake. Further information on the
medical certicate is provided in Appendix G.
If the seafarer is found temporarily or permanently unt for service or has limitations
placed on their duties, he or she should be given an explanation of the reasons and should
be advised of the right to appeal and on how to make an appeal. Additional guidance on
appeals procedures is provided in section IX of these Guidelines. If temporarily unt,
advice should be given on the need to undergo additional tests, to obtain opinions from
specialists or to complete dental or other treatment, rehabilitation and/or appropriate
medical care. The seafarer should be informed when to return for another examination.
As appropriate, the seafarer should be counselled on lifestyle (limiting alcohol intake,
stopping smoking, modifying diet, losing weight, etc.) and on the dangers of and methods
of prevention of malaria, hepatitis, HIV/AIDS and other communicable diseases. Printed
health educational materials on drug and alcohol abuse prevention, smoking cessation,
diet, communicable diseases prevention, etc., should also be provided, if available.
The medical examination records should be clearly marked as condential and retained,
according to national regulations, in the custody of the health establishment where the
medical certicate was issued. The le should be kept condential and should not be
used for any purpose other than facilitating the treatment of seafarers and should be
made available only to persons duly authorized in accordance with national data pro-
tection laws.
Relevant information on his/her health should be given to the seafarer on request and
the seafarer should be advised to take it to the next medical examination or when he
or she is treated for an illness or injury. If possible, a card indicating blood type, any
serious allergies and other vital information should also be given to the seafarer to fa-
cilitate emergency treatment.
A copy of the medical certicate should be kept in the les of the health institution in
which it was issued.
23

Appendix A
Vision standards
Testing
All tests needed to determine the visual tness of a seafarer are to be reliably performed
by a competent person and use procedures recognized by the relevant national authority.
Quality assurance of vision-testing procedures at a persons rst seafarer examination
is particularly important to avoid inappropriate career decisions; competent authorities
may wish to specify this in detail:
Distance vision should be tested using Snellen test type or equivalent.
Near vision should be tested with reading test type.
Colour vision should be tested by colour confusion plates (Ishihara or equivalent).
Supplementary investigations such as lantern tests may be used when appropriate (see
the International Recommendations for Colour Vision Requirements for Transport
of the International Commission on Illumination (CIE-143-2001, including any sub-
sequent versions)). The use of colour-correcting lenses will invalidate test results and
should not be permitted.
Visual elds may initially be assessed using confrontation tests (Donders, etc.) and
any indication of limitation or the presence of a medical condition where visual eld
loss can occur should lead to more detailed investigation.
Limitations to night vision may be secondary to specic eye diseases or may follow
ophthalmological procedures. They may also be noted during other tests or found as
a result of limitations to low-contrast vision testing. Specialist assessment should be
undertaken if reduced night vision is suspected.
Visual correction
Medical practitioners should advise persons required to use spectacles or contact lenses
to perform duties that they should have a spare pair or pairs, as required, conveniently
available on board the ship.
Additional guidance
If laser refractive surgery has been undertaken, recovery should be complete and the
quality of visual performance, including contrast, glare sensitivity and the quality of
night vision, should have been checked by a specialist in ophthalmology.
All seafarers should achieve the minimum eyesight standard of 0.1 unaided in each eye
(STCW Code, section B-I/9, paragraph10). This standard may also be relevant to other
seafarers to ensure visual capability under emergency conditions when visual correction
may be lost or damaged.
Seafarers not covered by the STCW Conventions eyesight standards should have vision
sufcient to perform their routine and emergency duties safely and efectively.
24
Guidelines on the medical examinations of seafarers
STCW Code table A-I/9: Minimum in-service eyesight standards for seafarers
STCW
Convention
regulation
Category
of seafarer
Distance
vision aided
1
Near/intermediate
vision
Colour
vision
3
Visual
elds
4
Night
blindness
4
Diplopia
(double
vision)
4
One
eye
Other
eye
Both eyes together,
aided or unaided
I/11
II/1
II/2
II/3
II/4
II/5
VII/2
Masters, deck
ofcers and ratings
required to undertake
look-out duties
0.5
2
0.5 Vision required for ships
navigation (e.g. chart and
nautical publication reference,
use of bridge instrumentation
and equipment, and identi-
cation of aids to navigation)
See
Note 6
Normal
visual
elds
Vision required
to perform all
necessary functions
in darkness without
compromise
No signicant
condition
evident
I/11
III/1
III/2
III/3
III/4
III/5
III/6
III/7
VII/2
All engineer ofcers,
electro-technical
ofcers, electro-tech-
nical ratings and
ratings or others
forming part of an
engine-room watch
0.4
5
0.4
5
Vision required to read in-
struments in close proximity,
to operate equipment, and to
identify systems/components
as necessary
See
Note 7
Sufcient
visual
elds
Vision required
to perform all
necessary functions
in darkness without
compromise
No signicant
condition
evident
I/11
IV/2
GMDSS radio
operators
0.4 0.4 Vision required to read in-
struments in close proximity,
to operate equipment, and to
identify systems/components
as necessary
See
Note 7
Sufcient
visual
elds
Vision required
to perform all
necessary functions
in darkness without
compromise
No
signicant
condition
evident
Notes:
1
Values given in Snellen decimal notation.
2
A value of at least 0.7 in one eye is recommended to reduce the risk of undetected underlying eye disease.
3
As dened in the International Recommendations for Colour Vision Requirements for Transport by the Commission Internationale de lEclairage (CIE-143-2001, including any
subsequent versions).
4
Subject to assessment by a clinical vision specialist where indicated by initial examination ndings.
5
Engine department personnel shall have a combined eyesight vision of at least 0.4.
6
CIE colour vision standard 1 or 2.
7
CIE colour vision standard 1, 2 or 3.
25

Appendix B
Hearing standards
Testing
Hearing capacity for seafarers apart from those identied below should be an average of
at least 30 dB (unaided) in the better ear and an average of 40 dB (unaided) in the less
good ear within the frequencies 500, 1,000, 2,000 and 3,000 Hz (approximately equiva-
lent to speech-hearing distances of 3 metres and 2 metres, respectively).
It is recommended that hearing examinations should be made by a pure tone audiometer.
Alternative assessment methods using validated and standardized tests that measure im-
pairment to speech recognition are also acceptable. Speech and whisper testing may be
useful for rapid practical assessments. It is recommended that those undertaking deck/
bridge duties are able to hear whispered speech at a distance of 3 metres.
Hearing aids are only acceptable in serving seafarers where it has been conrmed that
the individual will be capable of safely and efectively performing the specic routine
and emergency duties required of them on the vessel that they serve on throughout the
period of their medical certicate. This may well require access to a back-up hearing
aid and sufcient batteries and other consumables. Arrangements need to be in place to
ensure that they will be reliably aroused from sleep in the event of an emergency alarm.
If noise-induced hearing loss is being assessed as part of a health surveillance pro-
gramme, diferent criteria and test methods will be required.
It is recommended that national authorities indicate which tests for hearing are to be
used, based on national audiological practices, using the above thresholds as criteria.
Procedures should include the methods to be adopted in deciding if the use of a hearing
aid is acceptable.
26
Guidelines on the medical examinations of seafarers
Appendix C
Physical capability requirements
Introduction
The physical capability requirements for work at sea vary widely and have to take ac-
count of both routine and emergency duties. The functions that may require assessment
include:
strength;
stamina;
exibility;
balance and coordination;
size compatible with entry into conned areas;
exercise capacity heart and respiratory reserve; and
tness for specic tasks wearing breathing apparatus.
Medical conditions and physical capability
Limitations may arise from a range of conditions, such as:
high or low body mass/obesity;
severely reduced muscle mass;
musculoskeletal disease, pain or limitations to movement;
a condition following an injury or surgery;
lung disease;
heart and blood vessel disease; and
some neurological diseases.
Physical capability assessment
Physical capability testing should be undertaken when there is an indication for it, for
instance because of the presence of one of the above conditions or because of other con-
cerns about a seafarers physical capabilities. The aspects that are tested will depend on
the reasons for doing it. Table B-I/9 gives recommendations for physical abilities to be
assessed for those seafarers covered by the STCW Convention, 1978, as amended, based
on the tasks undertaken at sea.
The following approaches may be used to assess whether the requirements in Table B-I/9
are met:
Observed ability to do routine and emergency duties in a safe and efective way.
Tasks that simulate normal and emergency duties.
Assessment of cardio-respiratory reserve, including spirometry and ergometric tests.
This will predict maximum exercise capacity and hence the seafarers ability to per-
form physically demanding work. A large reserve will also indicate that heart and
lung performance is less likely to be compromised in the next few years. The bench-
mark test is maximum oxygen uptake (VO2 max). This requires dedicated equipment.
27
Appendix C
Step tests such as the Chester or the Harvard, are simpler alternatives, which may be
used for screening. If step tests are abnormal, they should be further validated (e.g.
VO2 max or treadmill stress tests).
Informal testing of reserve, for instance climbing three to six ights of stairs and
assessing any distress, plus the speed of pulse rate decline on stopping. This is not
readily reproducible but can be used for repeat assessment at the same location by the
same medical practitioner.
Clinical assessment of strength, mobility, coordination, etc.
Additional information may come from activities recently or regularly undertaken, as
described by the seafarer, such as:
physically demanding duties on the vessel, e.g. carrying weights or handling mooring
equipment;
attendance at a physically demanding course within the last two years, e.g. reghting,
helicopter escape or STCW basic training; and
a conrmed personal pattern of regular strenuous exercise.
Interpretation of results
(1) Is there any evidence that the seafarer is not able to perform their routine and emer-
gency duties efectively?
(2) Are there any observed limitations to strength, exibility, stamina or coordination?
(3) What is the outcome of any test for cardio-respiratory reserve?
(i) Test performance limited by shortness of breath, musculoskeletal or other pain,
or exhaustion. Causes need to be investigated and taken into account in deter-
mining tness.
(ii) Unable to complete test.
(iii) Completed but stressed or with poor recovery after stopping.
(iv) Completed to good or average standard.
(4) Discuss subjective feelings during the test with the subject and also go over ex-
periences of tness and capability when doing normal tasks and emergency drills.
Obtain corroboration from others if performance at work uncertain.
Decision-making
Information from a range of sources may be required and many of these are not easily
accessed in the course of a medical examination:
(1) Is there any indication that physical capability may be limited (e.g. stifness, obesity
or history of heart disease)?
(i) No do not test.
(ii) Yes consider what tests or observations will enable the seafarers capability to
perform their routine and emergency duties to be determined. Go to (2).
(2) Do the test results indicate that capabilities may be limited?
(i) No provided there are no underlying conditions that afect conduct of assess-
ment. Able to perform all duties worldwide within designated department.
(ii) Yes but duties can be modied to enable safe working, without putting excess
responsibilities on others. Able to perform some but not all duties (R).
(iii) Yes but cause of limitation can be remedied. Incompatible with reliable per-
formance of essential duties safely or efectively (T).
(iv) Yes but cause of limitation cannot be remedied. Incompatible with reliable
performance of essential duties safely or efectively (P).
28
Guidelines on the medical examinations of seafarers
Table B-I/9: Assessment of minimum entry level and in-service physical abilities for seafarers
Shipboard task, function,
event or condition
3
Related physical ability A medical examiner should be
satised that the candidate:
4
Routine movement around vessel:
on moving deck
between levels
between compartments
Note 1 applies to this row
Maintain balance and move with agility
Climb up and down vertical ladders and stairways
Step over coamings (e.g. Load Line Convention
requires coamings to be 600 mm high)
Open and close watertight doors
Has no disturbance in sense of balance
Does not have any impairment or disease that
prevents relevant movements and physical
activities
Is, without assistance,
5
able to:
climb vertical ladders and stairways
step over high sills
manipulate door closing systems
Routine tasks on board:
use of hand tools
movement of ships stores
overhead work
valve operation
standing a four-hour watch
working in conned spaces
responding to alarms,
warnings and instructions
verbal communication
Note 1 applies to this row
Strength, dexterity and stamina to manipulate
mechanical devices
Lift, pull and carry a load (e.g. 18 kg)
Reach upwards
Stand, walk and remain alert for an extended period
Work in constricted spaces and move through
restricted openings (e.g. SOLAS regulation 11-I/3-
6.5.1 requires openings in cargo spaces and emer-
gency escapes to have the minimum dimensions of
600 mm 600 mm)
Visually distinguish objects, shapes and signals
Hear warnings and instructions
Give a clear spoken description
Does not have a dened impairment or diag-
nosed medical condition that reduces ability
to perform routine duties essential to the safe
operation of the vessel
Has ability to:
work with arms raised
stand and walk for an extended period
enter conned space
full eyesight standards (table A-I/9)
full hearing standards set by competent
authority or take account of international
guidelines
hold normal conversation
Emergency duties
6
on board:
escape
reghting
evacuation
Note 2 applies to this row
Don a lifejacket or immersion suit
Escape from smoke-lled spaces
Take part in re-ghting duties, including use of
breathing apparatus
Take part in vessel evacuation procedures
Does not have a dened impairment or diag-
nosed medical condition that reduces ability to
perform emergency duties essential to the safe
operation of the vessel
Has ability to:
don lifejacket or immersion suit
crawl
feel for differences in temperature
handle re-ghting equipment
wear breathing apparatus
(where required as part of duties)
Notes:
1
Rows 1 and 2 of the above table describe: (a) ordinary shipboard tasks, functions, events and conditions; (b) the corresponding physical abilities which may be considered
necessary for the safety of a seafarer, other crew members and the ship; and (c) high-level criteria for use by medical practitioners assessing medical tness, bearing in mind
the different duties of seafarers and the nature of shipboard work for which they will be employed.
2
Row 3 of the above table describes: (a) emergency shipboard tasks, functions, events and conditions; (b) the corresponding physical abilities which should be considered
necessary for the safety of a seafarer, other crew members and the ship; and (c) high-level criteria for use by medical practitioners assessing medical tness, bearing in mind
the different duties of seafarers and the nature of shipboard work for which they will be employed.
3
This table is not intended to address all possible shipboard conditions or potentially disqualifying medical conditions. Parties should specify physical abilities applicable to the
category of seafarers (such as deck ofcer and engine rating). The special circumstances of individuals and for those who have specialized or limited duties should receive
due consideration.
4
If in doubt, the medical practitioner should quantify the degree or severity of any relevant impairment by means of objective tests, whenever appropriate tests are available, or
by referring the candidate for further assessment.
5
The term assistance means the use of another person to accomplish the task.
6
The term emergency duties is used to cover all standard emergency response situations such as abandon ship or reghting as well as the procedures to be followed by
each seafarer to secure personal survival.
29

Appendix D
Fitness criteria for medication use
Introduction
Medication can play an important part in enabling seafarers to continue to work at sea.
Some have side efects that can afect safe and efective performance of duties and some
have other complications that will increase the likelihood of illness at sea.
This appendix is only concerned with continuing prescribed medication use that is iden-
tied at the medical examination. Ship operators need policies in place to reduce the
impairing efects from short-term use of prescribed medication or the use of over-the-
counter preparations.
The use of oral medication at sea may be prevented by nausea and vomiting, and illness
may arise if an oral medication is used to suppress the harmful efects of a condition (e.g.
epilepsy) or if it is used to replace essential body chemicals (e.g. hormones).
The examining medical practitioner will need to assess the known adverse efects of each
medication used and the individuals reaction to it.
The use of specic medication for some conditions listed in Appendix E is noted with
the condition.
If medication is clinically essential for the efective control of a condition, e.g. insulin,
anticoagulants and medication for mental health conditions, it is dangerous to stop it in
an attempt to be t for work at sea.
The medical practitioner should be alert to the need for the seafarer to have written
documentation for the use of their medications. This should be in a form that can be
shown to any ofcial who may question the presence of the medication on board. This is
particularly important for those medications that are legally prescribed controlled drugs
or those drugs which may be abused.
Medications that can impair routine and emergency duties
(1) Medication afecting the central nervous system functions (e.g. sleeping tablets, an-
tipsychotics, some analgesics, some anti-anxiety and anti-depression treatments and
some antihistamines).
(2) Agents that increase the likelihood of sudden incapacitation (e.g. insulin, some of
the older anti-hypertensives and medications predisposing to seizures).
(3) Medication impairing vision (e.g. hyoscine and atropine).
Medications that can have serious adverse consequences
for the user while at sea
(1) Bleeding from injury or spontaneously (e.g. warfarin); individual assessment of like-
lihood needed. Anticoagulants such as warfarin or dicoumarin normally have a
likelihood of complications that is incompatible with work at sea but, if coagulation
values are stable and closely monitored, work that is near to onshore medical facil-
ities and that does not carry an increased likelihood of injury may be considered.
30
Guidelines on the medical examinations of seafarers
(2) Dangers from cessation of medication use (e.g. metabolic replacement hormones
including insulin, anti-epileptics, anti-hypertensives and oral anti-diabetics).
(3) Antibiotics and other anti-infection agents.
(4) Anti-metabolites and cancer treatments.
(5) Medications supplied for use at individual discretion (asthma treatments and anti-
biotics for recurrent infections).
Medications that require limitation of period at sea
because of surveillance requirements
A wide range of agents, such as anti-diabetics, anti-hypertensives and endocrine
replacements.
Issue of medical certicates
Incompatible with the reliable performance of routine and emergency duties safely or
efectively:
on the recommendation of the examining medical practitioner, based on reliable in-
formation about severe impairing side efects;
oral medication where there are life-threatening consequences if doses are missed
because of sickness;
evidence indicating the likelihood of cognitive impairment when taken as prescribed;
established evidence of severe adverse effects likely to be dangerous at sea,
e.g.anticoagulants.
Able to perform some but not all duties or to work in some but not all waters:
(R): medication can cause adverse efects but these only develop slowly, hence work in
coastal waters will allow access to medical care.
(L): surveillance of medication effectiveness or side effects needed more frequently
that full duration of medical certificate (see guidelines on individual conditions in
AppendixE).
Able to perform all duties worldwide within designated department:
No impairing side efects; no requirements for regular surveillance of treatment.
31

Appendix E
Fitness criteria for common
medical conditions
Introduction
The medical practitioner should bear in mind that it is not possible to develop a compre-
hensive list of tness criteria covering all possible conditions and the variations in their
presentation and prognosis. The principles underlying the approach adopted in the table
below may often be extrapolated to conditions not covered by it. Decisions on tness
when a medical condition is present depend on careful clinical assessment and analysis
and the following points need to be considered whenever a decision on tness is taken:
The recommendations in this appendix are intended to allow some exibility of inter-
pretation while being compatible with consistent decision-making that aims to main-
tain safety at sea.
The medical conditions listed are common examples of those that may render sea-
farers unt. The list can also be used to determine appropriate limitations to tness.
The criteria given can only provide guidance for physicians and should not replace
sound medical judgement.
The implications for working and living at sea vary widely, depending on the natural
history of each condition and the scope for treatment. Knowledge about the condition
and an assessment of its features in the individual being examined should be used to
reach a decision on tness.
The table in this appendix is laid out as follows:
Column 1: WHO International Classication of Diseases, 10th revision (ICD-10). Codes
are listed as an aid to analysis and, in particular, international compilation
of data.
Column 2: The common name of the condition or group of conditions, with a brief
statement on its relevance to work at sea.
Column 3: The guideline recommending when work at sea is unlikely to be indicated,
either temporarily or permanently. This column should be consulted rst
when the table is being used to aid decisions about tness.
Column 4: The guideline recommending when work at sea may be appropriate but
when restriction of duties or monitoring at intervals of less than two years
is likely to be appropriate. This column should be consulted if the seafarer
does not t the criteria in column 3.
Column 5: The guideline recommending when work at sea within a seafarers desig-
nated department is likely to be appropriate. This column should be con-
sulted if the seafarer does not t the criteria in columns 3 or 4.
For some conditions, one or more columns are either not relevant or are not an appro-
priate certication category. These are identied by the term Not applicable.
32
Guidelines on the medical examinations of seafarers
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33
Appendix E
I
C
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-
1
0


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a
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34
Guidelines on the medical examinations of seafarers
I
C
D
-
1
0


(
d
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c


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35
Appendix E
I
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1
0


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36
Guidelines on the medical examinations of seafarers
I
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37
Appendix E
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1
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38
Guidelines on the medical examinations of seafarers
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39
Appendix E
I
C
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-
1
0


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r
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p
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r
t
41
Appendix E
I
C
D
-
1
0


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42
Guidelines on the medical examinations of seafarers
I
C
D
-
1
0


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2
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m
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s
43
Appendix E
I
C
D
-
1
0


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44
Guidelines on the medical examinations of seafarers
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45
Appendix E
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47
Appendix E
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.
48
Guidelines on the medical examinations of seafarers
Appendix F
Suggested format for recording medical
examinations of seafarers
Name (last, rst, middle):
Date of birth (day/month/year): / /
Sex: Male Female
Home address:
Method of conrmation of identity, e.g. Passport No./Seafarers book No.
or other relevant identity document No.:
Department (deck/engine/radio/food handling/other):
Routine and emergency duties (if known):
Type of ship (e.g. container, tanker, passenger):
Trade area (e.g. coastal, tropical, worldwide):
Examinees personal declaration
(Assistance should be offered by medical staff)
Have you ever had any of the following conditions?
Condition Yes No
1. Eye/vision problem

2. High blood pressure

3. Heart/vascular disease

4. Heart surgery

5. Varicose veins/piles

6. Asthma/bronchitis

7. Blood disorder

8. Diabetes

9. Thyroid problem

10. Digestive disorder

11. Kidney problem

12. Skin problem

13. Allergies

14. Infectious/contagious diseases

15. Hernia

16. Genital disorder

17. Pregnancy

18. Sleep problem

19. Do you smoke, use alcohol or drugs?

49
Appendix F
Condition Yes No
20. Operation/surgery

21. Epilepsy/seizures

22. Dizziness/fainting

23. Loss of consciousness

24. Psychiatric problems

25. Depression

26. Attempted suicide

27. Loss of memory

28. Balance problem

29. Severe headaches

30. Ear (hearing, tinnitus)/nose/throat problem

31. Restricted mobility

32. Back or joint problem

33. Amputation

34. Fractures/dislocations

If you answered yes to any of the above questions, please give details:
Additional questions Yes No
35. Have you ever been signed off as sick or repatriated from a ship?

36. Have you ever been hospitalized?

37. Have you ever been declared unt for sea duty?

38. Has your medical certicate even been restricted or revoked?

39. Are you aware that you have any medical problems, diseases or illnesses?

40. Do you feel healthy and t to perform the duties of your designated position/occupation?

41. Are you allergic to any medication?

Comments:
Additional questions Yes No
42. Are you taking any non-prescription or prescription medications?

If yes, please list the medications taken, and the purpose(s) and dosage(s):
50
Guidelines on the medical examinations of seafarers
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):
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):
Medical examination
Sight
Use of glasses or contact lenses: Yes/No (if yes, specify which type and for what purpose)
Visual acuity
Unaided Aided
Right eye Left eye Binocular Right eye Left eye Binocular
Distant
Near
Visual elds
Normal Defective
Right eye
Left eye
Colour vision
Not tested Normal Doubtful Defective
Hearing
Pure tone and audiometry (threshold values in dB)
500 Hz 1000 Hz 2000 Hz 3000 Hz
Right ear
Left ear
Speech and whisper test (metres)
Normal Whisper
Right ear
Left ear
51
Appendix F
Clinical ndings
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)
G-U system
Upper and lower extremities
Spine (C/S, T/S and L/S)
Neurologic (full/brief)
Psychiatric
General appearance
Chest X-ray
Not performed Performed on (day/month/year): / /
Results:
52
Guidelines on the medical examinations of seafarers
Other diagnostic test(s) and result(s)
Test: Result:

Medical practitioners comments and assessment of tness, with reasons for any limitations:
Assessment of tness for service at sea
On the basis of the examinees personal declaration, my clinical examination and the
diagnostic test results recorded above, I declare the examinee medically:
Fit for look-out duty Not t for look-out duty
Deck service Engine service Catering service Other services
Fit
Unt
Without restrictions With restrictions Visual aid required Yes No
Describe restrictions (e.g., specic position, type of ship, trade area)
Medical certicates date of expiration (day/month/year): / /
Date medical certicate issued (day/month/year): / /
Number of medical certicate:
Signature of medical practitioner:
Medical practitioner information (name, license number, address):
53

Appendix G
Medical certicate for service at sea
The minimum requirements for medical certificates are specified in STCW Code,
section A-I/9, paragraph7. These form a suitable framework for all seafarer medical cer-
ticates. Certicates meeting the criteria will also meet the requirements of the Maritime
Labour Convention, 2006. Only information directly relevant to the functional require-
ments of the seafarers duties should be included. Details of any medical conditions iden-
tied or test results, other than those listed, should not be recorded on the certicate.
It is recommended that the certicate is in a format which minimizes the likelihood of
alteration of its contents or fraudulent copy.
1. Authorizing authority and the requirements under which the document is issued
2. Seafarer information
2.1. Name: (last, rst, middle)
2.2. Date of birth: (day/month/year)
2.3. Gender: (male/female)
2.4. Nationality
3. Declaration of the recognized medical practitioner
3.1. Conrmation that identication documents were checked at the point of examination: Yes/No
3.2. Hearing meets the standards in STCW Code, section A-I/9: Yes/No/Not applicable
3.3. Unaided hearing satisfactory? Yes/No
3.4. Visual acuity meets standards in STCW Code, section A-I/9? Yes/No
3.5. Colour vision meets standards in STCW Code, section A-I/9? Yes/No
(testing only required every six years)
3.5.1. Date of last colour vision test:
3.6. Fit for lookout duties? Yes/No
3.7. No limitations or restrictions on tness? Yes/No
If no, specify limitations or restrictions:
3.8. Is the seafarer free from any medical condition likely to be aggravated by service at sea or to render the seafarer
unt for such service or to endanger the health of other persons on board? Yes/No
3.9. Date of examination: (day/month/year)
3.10. Expiry date of certicate: (day/month/year)
4. Details of the issuing authority
4.1. Ofcial stamp (including name) of the issuing authority
4.2. Signature of the authorized person
5. Seafarers signature Conrming that the seafarer has been informed of the content of the certicate and of the right
to a review in accordance with paragraph 6 of section A-I/9 of the STCW Code.
6. The certicate should indicate that it is issued to meet the requirements of both the STCW Convention, 1978,
as amended, and the Maritime Labour Convention, 2006.
54
Guidelines on the medical examinations of seafarers
Appendix H
Extract from the Maritime
Labour Convention, 2006
Regulation 1.2 Medical certicate
Purpose: To ensure that all seafarers are medically t to perform their duties at sea
1. Seafarers shall not work on a ship unless they are certied as medically t to perform
their duties.
2. Exceptions can only be permitted as prescribed in the Code.
Standard A1.2 Medical certicate
1. The competent authority shall require that, prior to beginning work on a ship, sea-
farers hold a valid medical certicate attesting that they are medically t to perform
the duties they are to carry out at sea.
2. In order to ensure that medical certicates genuinely reect seafarers state of health,
in light of the duties they are to perform, the competent authority shall, after con-
sultation with the shipowners and seafarers organizations concerned, and giving
due consideration to applicable international guidelines referred to in Part B of this
Code, prescribe the nature of the medical examination and certicate.
3. This Standard is without prejudice to the International Convention on Standards of
Training, Certication and Watchkeeping for Seafarers, 1978, as amended (STCW).
A medical certicate issued in accordance with the requirements of STCW shall be
accepted by the competent authority, for the purpose of regulation 1.2. A medical
certicate meeting the substance of those requirements, in the case of seafarers not
covered by STCW, shall similarly be accepted.
4. The medical certicate shall be issued by a duly qualied medical practitioner or,
in the case of a certicate solely concerning eyesight, by a person recognized by the
competent authority as qualied to issue such a certicate. Practitioners must enjoy
full professional independence in exercising their medical judgement in undertaking
medical examination procedures.
5. Seafarers that have been refused a certicate or have had a limitation imposed on
their ability to work, in particular with respect to time, eld of work or trading area,
shall be given the opportunity to have a further examination by another independent
medical practitioner or by an independent medical referee.
6. Each medical certicate shall state in particular that:
(a) the hearing and sight of the seafarer concerned, and the colour vision in the case
of a seafarer to be employed in capacities where tness for the work to be per-
formed is liable to be afected by defective colour vision, are all satisfactory; and
(b) the seafarer concerned is not sufering from any medical condition likely to be
aggravated by service at sea or to render the seafarer unt for such service or to
endanger the health of other persons on board.
55
Appendix H
7. Unless a shorter period is required by reason of the specic duties to be performed
by the seafarer concerned or is required under STCW:
(a) a medical certicate shall be valid for a maximum period of two years unless the
seafarer is under the age of 18, in which case the maximum period of validity shall
be one year;
(b) a certication of colour vision shall be valid for a maximum period of six years.
8. In urgent cases the competent authority may permit a seafarer to work without a
valid medical certicate until the next port of call where the seafarer can obtain a
medical certicate from a qualied medical practitioner, provided that:
(a) the period of such permission does not exceed three months; and
(b) the seafarer concerned is in possession of an expired medical certicate of recent
date.
9. If the period of validity of a certicate expires in the course of a voyage, the certi-
cate shall continue in force until the next port of call where the seafarer can obtain
a medical certicate from a qualied medical practitioner, provided that the period
shall not exceed three months.
10. The medical certicates for seafarers working on ships ordinarily engaged on inter-
national voyages must as a minimum be provided in English.
Guideline B1.2 Medical certicate
Guideline B1.2.1 International guidelines
1. The competent authority, medical practitioners, examiners, shipowners, seafarers
representatives and all other persons concerned with the conduct of medical tness
examinations of seafarer candidates and serving seafarers should follow the ILO/
WHO Guidelines for Conducting Pre-sea and Periodic Medical Fitness Examinations for
Seafarers, including any subsequent versions, and any other applicable international
guidelines published by the International Labour Organization, the International
Maritime Organization or the World Health Organization.
Regulation 4.1 Medical care on board ship and ashore
Purpose: To protect the health of seafarers and ensure their prompt access to medical care
on board ship and ashore
1. Each Member shall ensure that all seafarers on ships that y its ag are covered by
adequate measures for the protection of their health and that they have access to
prompt and adequate medical care whilst working on board.
2. The protection and care under paragraph1 of this Regulation shall, in principle,be
provided at no cost to the seafarers.
3. Each Member shall ensure that seafarers on board ships in its territory who are in
need of immediate medical care are given access to the Members medical facilities
on shore.
4. The requirements for on-board health protection and medical care set out in the
Code include standards for measures aimed at providing seafarers with health pro-
tection and medical care as comparable as possible to that which is generally avail-
able to workers ashore.
56
Guidelines on the medical examinations of seafarers
Standard A4.1 Medical care on board ship and ashore
1. Each Member shall ensure that measures providing for health protection and medical
care, including essential dental care, for seafarers working on board a ship that ies
its ag are adopted which:
(a) ensure the application to seafarers of any general provisions on occupational
health protection and medical care relevant to their duties, as well as of special
provisions specic to work on board ship;
(b) ensure that seafarers are given health protection and medical care as compa-
rable as possible to that which is generally available to workers ashore, including
prompt access to the necessary medicines, medical equipment and facilities for
diagnosis and treatment and to medical information and expertise;
(c) give seafarers the right to visit a qualied medical doctor or dentist without delay
in ports of call, where practicable;
(d) ensure that, to the extent consistent with the Members national law and practice,
medical care and health protection services while a seafarer is on board ship or
landed in a foreign port are provided free of charge to seafarers; and
(e) are not limited to treatment of sick or injured seafarers but include measures of a
preventive character such as health promotion and health education programmes.
2. The competent authority shall adopt a standard medical report form for use by the
ships masters and relevant onshore and on-board medical personnel. The form,
when completed, and its contents shall be kept condential and shall only be used to
facilitate the treatment of seafarers.
3. Each Member shall adopt laws and regulations establishing requirements for on-
board hospital and medical care facilities and equipment and training on ships that
y its ag.
4. National laws and regulations shall as a minimum provide for the following
requirements:
(a) all ships shall carry a medicine chest, medical equipment and a medical guide,
the specics of which shall be prescribed and subject to regular inspection by the
competent authority; the national requirements shall take into account the type
of ship, the number of persons on board and the nature, destination and dur-
ation of voyages and relevant national and international recommended medical
standards;
(b) ships carrying 100 or more persons and ordinarily engaged on international voy-
ages of more than three days duration shall carry a qualied medical doctor
who is responsible for providing medical care; national laws or regulations shall
also specify which other ships shall be required to carry a medical doctor, taking
into account, inter alia, such factors as the duration, nature and conditions of the
voyage and the number of seafarers on board;
(c) ships which do not carry a medical doctor shall be required to have either at least
one seafarer on board who is in charge of medical care and administering medi-
cine as part of their regular duties or at least one seafarer on board competent to
provide medical rst aid; persons in charge of medical care on board who are not
medical doctors shall have satisfactorily completed training in medical care that
meets the requirements of the International Convention on Standards of Training,
Certication and Watchkeeping for Seafarers, 1978, as amended (STCW); sea-
farers designated to provide medical rst aid shall have satisfactorily completed
training in medical rst aid that meets the requirements of STCW; national laws
or regulations shall specify the level of approved training required taking into
57
Appendix H
account, inter alia, such factors as the duration, nature and conditions of the
voyage and the number of seafarers on board; and
(d) the competent authority shall ensure by a prearranged system that medical advice
by radio or satellite communication to ships at sea, including specialist advice, is
available 24 hours a day; medical advice, including the onward transmission of
medical messages by radio or satellite communication between a ship and those
ashore giving the advice, shall be available free of charge to all ships irrespective
of the ag that they y.
Guideline B4.1 Medical care on board ship and ashore
Guideline B4.1.1 Provision of medical care
1. When determining the level of medical training to be provided on board ships that are
not required to carry a medical doctor, the competent authority should require that:
(a) ships which ordinarily are capable of reaching qualied medical care and medical
facilities within eight hours should have at least one designated seafarer with the
approved medical rst-aid training required by STCW which will enable such
persons to take immediate, efective action in case of accidents or illnesses likely
to occur on board a ship and to make use of medical advice by radio or satellite
communication; and
(b) all other ships should have at least one designated seafarer with approved training
in medical care required by STCW, including practical training and training in
life-saving techniques such as intravenous therapy, which will enable the persons
concerned to participate efectively in coordinated schemes for medical assistance
to ships at sea, and to provide the sick or injured with a satisfactory standard of
medical care during the period they are likely to remain on board.
2. The training referred to in paragraph1 of this Guideline should be based on the
contents of the most recent editions of the International Medical Guide for Ships,
the Medical First Aid Guide for Use in Accidents Involving Dangerous Goods, the
Document for Guidance An International Maritime Training Guide, and the medical
section of the International Code of Signals as well as similar national guides.
3. Persons referred to in paragraph1 of this Guideline and such other seafarers as may
be required by the competent authority should undergo, at approximately ve year
intervals, refresher courses to enable them to maintain and increase their knowledge
and skills and to keep up-to-date with new developments.
4. The medicine chest and its contents, as well as the medical equipment and medical
guide carried on board, should be properly maintained and inspected at regular in-
tervals, not exceeding 12 months, by responsible persons designated by the competent
authority, who should ensure that the labelling, expiry dates and conditions of storage
of all medicines and directions for their use are checked and all equipment func-
tioning as required. In adopting or reviewing the ships medical guide used nation-
ally, and in determining the contents of the medicine chest and medical equipment,
the competent authority should take into account international recommendations in
this eld, including the latest edition of the International Medical Guide for Ships, and
other guides mentioned in paragraph2 of this Guideline.
5. Where a cargo which is classied dangerous has not been included in the most recent
edition of the Medical First Aid Guide for Use in Accidents Involving Dangerous Goods,
the necessary information on the nature of the substances, the risks involved, the
necessary personal protective devices, the relevant medical procedures and specic
antidotes should be made available to the seafarers. Such specic antidotes and per-
sonal protective devices should be on board whenever dangerous goods are carried.
58
Guidelines on the medical examinations of seafarers
This information should be integrated with the ships policies and programmes on oc-
cupational safety and health described in Regulation 4.3 and related Code provisions.
6. All ships should carry a complete and up-to-date list of radio stations through which
medical advice can be obtained; and, if equipped with a system of satellite commu-
nication, carry an up-to-date and complete list of coast earth stations through which
medical advice can be obtained. Seafarers with responsibility for medical care or
medical rst aid on board should be instructed in the use of the ships medical guide
and the medical section of the most recent edition of the International Code of Signals
so as to enable them to understand the type of information needed by the advising
doctor as well as the advice received.
Guideline B4.1.2 Medical report form
1. The standard medical report form for seafarers required under Part A of this Code
should be designed to facilitate the exchange of medical and related information
concerning individual seafarers between ship and shore in cases of illness or injury.
Guideline B4.1.3 Medical care ashore
1. Shore-based medical facilities for treating seafarers should be adequate for the pur-
poses. The doctors, dentists and other medical personnel should be properly qualied.
2. Measures should be taken to ensure that seafarers have access when in port to:
(a) outpatient treatment for sickness and injury;
(b) hospitalization when necessary; and
(c) facilities for dental treatment, especially in cases of emergency.
3. Suitable measures should be taken to facilitate the treatment of seafarers sufering
from disease. In particular, seafarers should be promptly admitted to clinics and
hospitals ashore, without difculty and irrespective of nationality or religious belief,
and, whenever possible, arrangements should be made to ensure, when necessary,
continuation of treatment to supplement the medical facilities available to them.
Guideline B4.1.4 Medical assistance to other ships
and international cooperation
1. Each Member should give due consideration to participating in international cooper-
ation in the area of assistance, programmes and research in health protection and
medical care. Such cooperation might cover:
(a) developing and coordinating search and rescue eforts and arranging prompt
medical help and evacuation at sea for the seriously ill or injured on board a
ship through such means as periodic ship position reporting systems, rescue
coordination centres and emergency helicopter services, in conformity with the
International Convention on Maritime Search and Rescue, 1979, as amended,
and the International Aeronautical and Maritime Search and Rescue (IAMSAR)
Manual;
(b) making optimum use of all ships carrying a doctor and stationing ships at sea
which can provide hospital and rescue facilities;
(c) compiling and maintaining an international list of doctors and medical care facil-
ities available worldwide to provide emergency medical care to seafarers;
(d) landing seafarers ashore for emergency treatment;
(e) repatriating seafarers hospitalized abroad as soon as practicable, in accordance
with the medical advice of the doctors responsible for the case, which takes into
account the seafarers wishes and needs;
59
Appendix H
(f) arranging personal assistance for seafarers during repatriation, in accordance
with the medical advice of the doctors responsible for the case, which takes into
account the seafarers wishes and needs;
(g) endeavouring to set up health centres for seafarers to:
(i) conduct research on the health status, medical treatment and preventive health
care of seafarers; and
(ii) train medical and health service staf in maritime medicine;
(h) collecting and evaluating statistics concerning occupational accidents, diseases
and fatalities of seafarers and integrating and harmonizing the statistics with any
existing national system of statistics on occupational accidents and diseases cov-
ering other categories of workers;
(i) organizing international exchanges of technical information, training material
and personnel, as well as international training courses, seminars and working
groups;
(j) providing all seafarers with special curative and preventive health and medical
services in port, or making available to them general health, medical and re-
habilitation services; and
(k) arranging for the repatriation of the bodies or ashes of deceased seafarers, in
accordance with the wishes of the next of kin and as soon as practicable.
2. International cooperation in the eld of health protection and medical care for sea-
farers should be based on bilateral or multilateral agreements or consultations among
Members.
Guideline B4.1.5 Dependants of seafarers
1. Each Member should adopt measures to secure proper and sufcient medical care for
the dependants of seafarers domiciled in its territory pending the development of a
medical care service which would include within its scope workers generally and their
dependants where such services do not exist and should inform the International
Labour Ofce concerning the measures taken for this purpose.
60
Guidelines on the medical examinations of seafarers
Appendix I
Extract from the International Convention
on Standards of Training, Certication
and Watchkeeping for Seafarers, 1978,
as amended
Regulation I/9
Medical standards
1. Each Party shall establish standards of medical tness for seafarers and procedures
for the issue of a medical certicate in accordance with the provisions of this regu-
lation and of section A-I/9 of the STCW Code.
2. Each Party shall ensure that those responsible for assessing the medical tness of
seafarers are medical practitioners recognized by the Party for the purpose of sea-
farer medical examinations, in accordance with the provisions of section A-I/9 of the
STCW Code.
3. Every seafarer holding a certicate issued under the provisions of the Convention,
who is serving at sea, shall also hold a valid medical certicate issued in accordance
with the provisions of this regulation and of section A-I/9 of the STCW Code.
4. Every candidate for certication shall:
(1) be not less than 16 years of age;
(2) provide satisfactory proof of his/her identity; and
(3) meet the applicable medical tness standards established by the Party.
5. Medical certicates shall remain valid for a maximum period of two years unless the
seafarer is under the age of 18, in which case the maximum period of validity shall
be one year.
6. If the period of validity of a medical certicate expires in the course of a voyage,
then the medical certicate shall continue in force until the next port of call where
a medical practitioner recognized by the Party is available, provided that the period
shall not exceed three months.
7. In urgent cases the Administration may permit a seafarer to work without a valid
medical certicate until the next port of call where a medical practitioner recognized
by the Party is available, provided that:
(1) the period of such permission does not exceed three months; and
(2) the seafarer concerned is in possession of an expired medical certicate of recent
date.
61

Appendix J
Extract from the Seafarers Training,
Certication and Watchkeeping Code
Section A-I/9
Medical standards
1. Parties, when establishing standards of medical tness for seafarers as required by
regulation I/9, shall adhere to the minimum in-service eyesight standards set out in
table A-I/9 and take into account the criteria for physical and medical tness set
out in paragraph2. They should also take into account the guidance given in sec-
tion B-I/9 of this Code and table B-I/9 regarding assessment of minimum physical
abilities.
These standards may, to the extent determined by the Party without prejudice to the
safety of the seafarers or the ship, diferentiate between those persons seeking to start
a career at sea and those seafarers already serving at sea and between diferent func-
tions on board, bearing in mind the diferent duties of seafarers. They shall also take
into account any impairment or disease that will limit the ability of the seafarer to
efectively perform his/her duties during the validity period of the medical certicate.
2. The standards of physical and medical tness established by the Party shall ensure
that seafarers satisfy the following criteria:
(1) have the physical capability, taking into account paragraph5 below, to full all
the requirements of the basic training as required by section A-VI/1, paragraph2;
(2) demonstrate adequate hearing and speech to communicate efectively and detect
any audible alarms;
(3) have no medical condition, disorder or impairment that will prevent the efective
and safe conduct of their routine and emergency duties on board during the va-
lidity period of the medical certicate;
(4) are not sufering from any medical condition likely to be aggravated by service at
sea or to render the seafarer unt for such service or to endanger the health and
safety of other persons on board; and
(5) are not taking any medication that has side efects that will impair judgement,
balance, or any other requirements for efective and safe performance of routine
and emergency duties on board.
3. Medical tness examinations of seafarers shall be conducted by appropriately qual-
ied and experienced medical practitioners recognized by the Party.
4. Each Party shall establish provisions for recognizing medical practitioners. A register
of recognized medical practitioners shall be maintained by the Party and made avail-
able to other Parties, companies and seafarers on request.
5. Each Party shall provide guidance for the conduct of medical tness examinations
and issuing of medical certicates, taking into account provisions set out in section
B-I/9 of this Code. Each Party shall determine the amount of discretion given to rec-
ognized medical practitioners on the application of the medical standards, bearing
in mind the diferent duties of seafarers, except that there shall not be discretion with
62
Guidelines on the medical examinations of seafarers
respect to the minimum eyesight standards for distance vision aided, near/immediate
vision and colour vision in table A-I/9 for seafarers in the deck department required
to undertake lookout duties. A Party may allow discretion on the application of these
standards with regard to seafarers in the engine department, on the condition that
seafarers combined vision fulls the requirements set out in table A-I/9.
6. Each Party shall establish processes and procedures to enable seafarers who, after
examination, do not meet the medical tness standards or have had a limitation
imposed on their ability to work, in particular with respect to time, eld of work
or trading area, to have their case reviewed in line with that Partys provisions for
appeal.
7. The medical certicate provided for in regulation I/9, paragraph3, shall include the
following information as a minimum:
1. Authorizing authority and the requirements under which the document is issued
2. Seafarer information
2.1. Name: (last, rst, middle)
2.2. Date of birth: (day/month/year)
2.3. Gender: (male/female)
2.4. Nationality
3. Declaration of the recognized medical practitioner
3.1. Conrmation that identication documents were checked at the point of examination: Yes/No
3.2. Hearing meets the standards in section A-I/9: Yes/No/Not applicable
3.3. Unaided hearing satisfactory? Yes/No
3.4. Visual acuity meets standards in section A-I/9? Yes/No
3.5. Colour vision* meets standards in section A-I/9? Yes/No
(testing only required every six years)
3.5.1. Date of last colour vision test:
3.6. Fit for lookout duties? Yes/No
3.7. No limitations or restrictions on tness? Yes/No
If yes, specify limitations or restrictions:
3.8. Is the seafarer free from any medical condition likely to be aggravated by service at sea or to render
the seafarer unt for such service or to endanger the health of other persons on board? Yes/No
3.9. Date of examination: (day/month/year)
3.10. Expiry date of certicate: (day/month/year)
* Note: Colour vision assessment only needs to be conducted every six years.
4. Details of the issuing authority
4.1. Ofcial stamp (including name) of the issuing authority
4.2. Signature of the authorized person
5. Seafarers signature Conrming that the seafarer has been informed of the content of the certicate
and of the right to a review in accordance with paragraph 6 of section A-I/9 of the STCW Code.
8. Medical certicates shall be in the ofcial language of the issuing country. If the
language used is not English, the text shall include a translation into that language.
63
Appendix J
Section B-I/9
Guidance regarding medical standards
Medical examination and certication
1. Parties, in establishing seafarer medical tness standards and provisions, should take
into account the minimum physical abilities set out in table B-I/9 and the guidance
given within this section, bearing in mind the diferent duties of seafarers.
2. Parties, in establishing seafarer medical tness standards and provisions, should
follow the guidance contained in the ILOWHO publication Guidelines for Conducting
Pre-sea and Periodic Medical Fitness Examinations for Seafarers, including any sub-
sequent versions, and any other applicable international guidelines published by the
International Labour Organization, the International Maritime Organization or the
World Health Organization.
3. Appropriate qualications and experience for medical practitioners conducting med-
ical tness examinations of seafarers may include occupational health or maritime
health qualications, experience of working as a ships doctor or a shipping company
doctor or working under the supervision of someone with the aforementioned quali-
cations or experience.
STCW Code table A-I/9: Minimum in-service eyesight standards for seafarers
STCW
Convention
regulation
Category
of seafarer
Distance
vision aided
1
Near/intermediate
vision
Colour
vision
3
Visual
elds
4
Night
blindness
4
Diplopia
(double
vision)
4
One
eye
Other
eye
Both eyes together,
aided or unaided
I/11
II/1
II/2
II/3
II/4
II/5
VII/2
Masters, deck
ofcers and ratings
required to undertake
look-out duties
0.5
2
0.5 Vision required for ships
navigation (e.g. chart and
nautical publication reference,
use of bridge instrumentation
and equipment, and identi-
cation of aids to navigation)
See
Note 6
Normal
visual
elds
Vision required
to perform all
necessary functions
in darkness without
compromise
No signicant
condition
evident
I/11
III/1
III/2
III/3
III/4
III/5
III/6
III/7
VII/2
All engineer ofcers,
electro-technical
ofcers, electro-tech-
nical ratings and
ratings or others
forming part of an
engine-room watch
0.4
5
0.4
5
Vision required to read in-
struments in close proximity,
to operate equipment, and to
identify systems/components
as necessary
See
Note 7
Sufcient
visual
elds
Vision required
to perform all
necessary functions
in darkness without
compromise
No signicant
condition
evident
I/11
IV/2
GMDSS radio
operators
0.4 0.4 Vision required to read in-
struments in close proximity,
to operate equipment, and to
identify systems/components
as necessary
See
Note 7
Sufcient
visual
elds
Vision required
to perform all
necessary functions
in darkness without
compromise
No
signicant
condition
evident
Notes:
1
Values given in Snellen decimal notation.
2
A value of at least 0.7 in one eye is recommended to reduce the risk of undetected underlying eye disease.
3
As dened in the International Recommendations for Colour Vision Requirements for Transport by the Commission Internationale de lEclairage (CIE-143-2001, including any
subsequent versions).
4
Subject to assessment by a clinical vision specialist where indicated by initial examination ndings.
5
Engine department personnel shall have a combined eyesight vision of at least 0.4.
6
CIE colour vision standard 1 or 2.
7
CIE colour vision standard 1, 2 or 3.
64
Guidelines on the medical examinations of seafarers
4. The premises where medical tness examinations are carried out should have the fa-
cilities and equipment required to carry out medical tness examinations of seafarers.
5. Administrations should ensure that recognized medical practitioners enjoy full pro-
fessional independence in exercising their medical judgement when undertaking med-
ical examination procedures.
6. Persons applying for a medical certicate should present to the recognized medical
practitioner appropriate identity documentation to establish their identity. They
should also surrender their previous medical certicate.
7. Each Administration has the discretionary authority to grant a variance or waiver
of any of the standards set out in table B-I/9 hereunder, based on an assessment of
a medical evaluation and any other relevant information concerning an individuals
adjustment to the condition and proven ability to satisfactorily perform assigned
shipboard functions.
8. The medical tness standards should, so far as possible, dene objective criteria with
regard to tness for sea service, taking into account access to medical facilities and
medical expertise on board ship. They should, in particular, specify the conditions
under which seafarers sufering from potentially life-threatening medical conditions
that are controlled by medication may be allowed to continue to serve at sea.
9. The medical standards should also identify particular medical conditions, such as
colour blindness, which might preclude seafarers holding particular positions on
board ship.
10. The minimum in-service eyesight standards in each eye for unaided distance vision
should be at least 0.1.*
11. Persons requiring the use of spectacles or contact lenses to perform duties should
have a spare pair or pairs, as required, conveniently available on board the ship. Any
need to wear visual aids to meet the required standards should be recorded on the
medical tness certicate issued.
12. Colour vision testing should be in accordance with the International Recommendations
for Colour Vision Requirements for Transport, published by the Commission
Internationale de lEclairage (CIE 143-2001, including any subsequent versions) or
equivalent test methods.
* Value given in Snellen decimal notation.
65
Appendix J
Table B-I/9: Assessment of minimum entry level and in-service physical abilities for seafarers
Shipboard task, function,
event or condition
3
Related physical ability A medical examiner should be
satised that the candidate:
4
Routine movement around vessel:
on moving deck
between levels
between compartments
Note 1 applies to this row
Maintain balance and move with agility
Climb up and down vertical ladders and stairways
Step over coamings (e.g. Load Line Convention
requires coamings to be 600 mm high)
Open and close watertight doors
Has no disturbance in sense of balance
Does not have any impairment or disease that
prevents relevant movements and physical
activities
Is, without assistance,
5
able to:
climb vertical ladders and stairways
step over high sills
manipulate door closing systems
Routine tasks on board:
use of hand tools
movement of ships stores
overhead work
valve operation
standing a four-hour watch
working in conned spaces
responding to alarms,
warnings and instructions
verbal communication
Note 1 applies to this row
Strength, dexterity and stamina to manipulate
mechanical devices
Lift, pull and carry a load (e.g. 18 kg)
Reach upwards
Stand, walk and remain alert for an extended period
Work in constricted spaces and move through
restricted openings (e.g. SOLAS regulation 11-I/3-
6.5.1 requires openings in cargo spaces and emer-
gency escapes to have the minimum dimensions of
600 mm 600 mm)
Visually distinguish objects, shapes and signals
Hear warnings and instructions
Give a clear spoken description
Does not have a dened impairment or diag-
nosed medical condition that reduces ability
to perform routine duties essential to the safe
operation of the vessel
Has ability to:
work with arms raised
stand and walk for an extended period
enter conned space
full eyesight standards (table A-I/9)
full hearing standards set by competent
authority or take account of international
guidelines
hold normal conversation
Emergency duties
6
on board:
escape
reghting
evacuation
Note 2 applies to this row
Don a lifejacket or immersion suit
Escape from smoke-lled spaces
Take part in re-ghting duties, including use of
breathing apparatus
Take part in vessel evacuation procedures
Does not have a dened impairment or diag-
nosed medical condition that reduces ability to
perform emergency duties essential to the safe
operation of the vessel
Has ability to:
don lifejacket or immersion suit
crawl
feel for differences in temperature
handle re-ghting equipment
wear breathing apparatus
(where required as part of duties)
Notes:
1
Rows 1 and 2 of the above table describe: (a) ordinary shipboard tasks, functions, events and conditions; (b) the corresponding physical abilities which may be considered
necessary for the safety of a seafarer, other crew members and the ship; and (c) high-level criteria for use by medical practitioners assessing medical tness, bearing in mind
the different duties of seafarers and the nature of shipboard work for which they will be employed.
2
Row 3 of the above table describes: (a) emergency shipboard tasks, functions, events and conditions; (b) the corresponding physical abilities which should be considered
necessary for the safety of a seafarer, other crew members and the ship; and (c) high-level criteria for use by medical practitioners assessing medical tness, bearing in mind
the different duties of seafarers and the nature of shipboard work for which they will be employed.
3
This table is not intended to address all possible shipboard conditions or potentially disqualifying medical conditions. Parties should specify physical abilities applicable to the
category of seafarers (such as deck ofcer and engine rating). The special circumstances of individuals and for those who have specialized or limited duties should receive
due consideration.
4
If in doubt, the medical practitioner should quantify the degree or severity of any relevant impairment by means of objective tests, whenever appropriate tests are available, or
by referring the candidate for further assessment.
5
The term assistance means the use of another person to accomplish the task.
6
The term emergency duties is used to cover all standard emergency response situations such as abandon ship or reghting as well as the procedures to be followed by
each seafarer to secure personal survival.
Seafarers are required to undergo medical examinations to reduce
risks to other crew members and for the safe operation of the ship,
as well as to safeguard their personal health and safety. The Maritime
Labour Convention, 2006, and International Convention on Standards
of Training, Certification and Watchkeeping for Seafarers, 1978, as
amended, therefore require seafarers to hold medical certificates
attesting that they are medically fit to perform the duties they are to
carry out at sea.
These Guidelines will assist medical practitioners, shipowners,
seafarers representatives, seafarers and other relevant persons with
the conduct of medical fitness examinations of serving seafarers and
seafarer candidates. They also will help administrations establish
criteria that will lead to equitable decisions about who can safely and
effectively perform their routine and emergency duties at sea, provided
these are compatible with their individual health-related capabilities.
They have been developed in order to reduce the differences in the
application of medical requirements and examination procedures and
to ensure that the medical certificates which are issued to seafarers
are a valid indicator of their medical fitness for the duties they will
perform.
Ultimately, the aim of the Guidelines is to contribute to health and
safety at sea.

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Guidelines on the medical
examinations of seafarers
Sectoral
Activities
Programme