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DRAFT Merchant Shipping Notice No. 00 of 2013 No: 70-NT (1) 200!

-pt Date: 11 07 2013

S"#: Me$ica% Fitne&& '(a)ination& for Seafarer& "n$er ST*+, 1--. a& a)en$e$ (2010 a)en$)ent&) an$ Mariti)e /a#o"r *on0ention 1M/*2, 2003-regar$ing. For the attention of: Seafarer&, Appro0e$ Training 4n&tit"te&, Ship 56ner&, Ship Manager&, D7S 8 R9S /icen&e ho%$er&, Seafarer& :nion&, D7S appro0e$ Me$ica% '(a)iner& an$ '(a)ination *enter& an$ Mercanti%e Marine Depart)ent&, etc. 4ntro$"ction 1. The Directorate vide its Merchant Shipping Notice No. 23 of 2010 dated 4 th November, 2010 developed proced res to grant approval to Medical !"aminers for the p rpose of cond cting #re$sea %ne& entrant' and #eriodical Medical !"amination %e"isting seafarers'. 2. (ndia being signator) to ST*+, 1,,- as amended and Maritime .abo r *onvention, 200/ has obligations to implement and enforce its provisions. !"amination 1 les, 2000. 3. The ne& draft r les conforms to the relevant provisions of ST*+, 1,,- as amended in 2010, Maritime .abo r *onvention 200/ as adopted b) (M2 3 (M24(.245MS42011 incl ding all anne"es relating to revised g idelines on the cond ct of medical e"amination. These draft r les shall replace the e"isting M.S. Medical !"amination 1 les, 2000 after d e prom lgation b) the 6ovt. of (ndia. 4. The prom lgation of these r les shall be nderta0en as per the re7 irements stated nder Section 4-8 of the Merchant Shipping 9ct, 1,-8 that ma) ta0e some time. (n the interim, to give affect to the provisions of ST*+, 2010 %amendments' and M.*, 200/ relating to medical e"amination of seafarers, this M.S. Notice is being iss ed &hich s persedes M.S. Notice No. 23 of 2010. This M.S. Notice primaril) incorporates the salient feat res of ne& draft medical e"amination r les. App%ica#i%it;: -. This notice is applicable to the: -.1 ne& entrant%s' see0ing marine profession: (n vie& of this, the Directorate in cons ltation &ith the sta0eholders has revised the e"isting M.S. Medical

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seafarers ta0ing certificate of competenc) 4 proficienc) e"amination and see0ing relevant endorsements nder ST*+ 1 les as amended for the p rpose of stat tor) safe manning and other matters incidental to this.

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Seafarers being emplo)ed on board ships.

9roce$"re for the appro0a% of )e$ica% e(a)iner& ; /. Medical e"aminers see0ing approval shall$ /.1. send an application d l) completed in the prescribed format as per Sched le ( b) post4speed post to the Directorate 6eneral of Shipping, M mbai: /.2. be a licensed ph)sician and holding at least M<<S degree recogni=ed b) the Medical *o ncil of the *entral4State 6overnment and his4her age not to e"ceed /- )ears from the date of s bmission of application: /.3. /.4. be e"perienced in cond cting medical fitness e"amination of seafarer. have the re7 isite medical facilities and e7 ipments to carr) o t medical fitness e"amination, &hich are convenientl) sit ated for eas) access b) seafarers, and enabling all the re7 irements of medical fitness e"amination to be met and cond cted &ith respect for confidentialit), modest) and cleanliness at the declared premises &ithin the m nicipal limits of the cit). S ch declaration shall be made in the chec0 list as prescribed in sched le (((: /.-. be familiar &ith the relevant sections of the Maritime .abor *onvention 200/ adopted b) (.2 s ch as 1eg lation 1.2$ Medical *ertificate, 1eg lation 3.1$ 9ccommodation and recreational facilities and 1eg lation 4.1 > Medical care on board ship and ashore: /./. be familiar &ith the relevant sections of the ST*+ *onvention and the *odes s ch as 1eg lation (4, Medical standards, section 9$(4,$Medical standards, section <$(4,$Medical e"amination and *ertification and 1esol tion 8$ Development of g idelines to implement international standards of medical fitness for seafarers: /.?. be familiar &ith the latest edition of the (nternational Maritime 6 ide for ships or an e7 ivalent medical g ide for se on ships: possess ade7 ate 0no&ledge of living and &or0ing conditions on board a merchant ships or vessels, or other description of vessels se in navigation and the @ob demands on seafarers in so far as the) relate to the effect of health problems on fitness for &or0. /.8. this 0no&ledge ma) be gained either thro gh special instr ctions

s o$mot or co rses relating to occ pational4maritime medicines cond cted b) the medical professional bodies in (ndia or other&ise d l) approved b) the medical professional bodies in (ndia or thro gh ade7 ate shipboard service onboard sea going ships in the capacit) of medical doctor or as s pern merar) or serving as medical doctor in an) shipping compan) or being associated &ith the approved Medical e"aminer of the D6 Shipping for ade7 ate period % preferabl) at least / months ' &hichever is practical and convenient to him /.,. s bmit along &ith the application an affidavit confirming the, means sed in ac7 iring the nderstanding of 0no&ledge of ship board activities, in the prescribed form as in Sched le ($9: /.10. /.11. /.12. /.13. be &ell conversant &ith at least Aindi or !nglish lang age: states that he4she en@o)s f ll professional independence in e"ercising their medical @ dgment &hen nderta0ing medical e"amination proced res: and s bmit all s pporting doc ments d l) notari=ed or attested b) the 6a=ette officer or self attested. the Medical practitioner shall be personall) intervie&ed b) the d l) designated officer of the Directorate 6eneral of Shipping. facilities at the Diagnostic .aborator) or other premises. /.14. pon receipt of satisfactor) compliance report along &ith the applicable doc mentar) evidences confirming the compliance and f lfilment of administrative proced res and clear recommendations to approve, the Directorate 6eneral of Shipping shall approve the Medical practitioner. The Medical #ractitioner thereafter shall be iss ed &ith letter of approval in the prescribed format as specified in Sched le$(( . This approval shall be valid for empanelled Medical e"aminers for till the validit) of his c rrent registration or ma"im m period of - )ears. /.1-. the empanelled Medical e"aminers, the approval to these ma) be e"tended for f rther till the validit) of his c rrent registration or ma"im m period of - )ears ma) rene& their empanelment &ithin / months of date of coming into force of these r les. /.1/. s ch medical e"aminers &ho attains age of /- )ears, ma) appl) for the e"tension to the 9pproving 9 thorit) in the prescribed format as specified in Sched le (. The Directorate 6eneral of Shipping ma) in s ch cases e"tend the letter of approval for a period of ma"im m - )ears p to a ma"im m age of ?- )ears as The d l) designated officer ma) carr) o t the inspection of his 4 her premises to verif) the

prescribed in sched le ((. No f rther e"tension shall be considered for medical e"aminers above ?- )ears of age. /.1?. all approved Medical e"aminers shall be placed on the panel of the D6S. Their names along &ith contact details shall be disseminated thro gh the D6S &ebsite as soon as possible. /.18. all approved Medical e"aminers, &ho are on the panel of the D6S shall s bmit / monthl) ret rns in the prescribed format as specified in Sched le B((( in electronic form and follo&ed b) hard copies. *hanges in the stat s of the approved Medical e"aminer in terms of his4her medical fitness, place of b siness, n mber of facilities and s b contracting of related services if nderta0en or an) other reasons shall be comm nicated b) the Medical e"aminer to the Directorate 6eneral of Shipping &ithin 30 da)s of s ch sched le thro gh normal postal service. T;pe& of Me$ica% '(a)ination$ ?. The approved Medical e"aminer as per the re7 est of the compan), approved

training instit te, ne& entrant, seafarer or person as case ma) be shall cond ct the follo&ing t)pes of medical e"amination ?.1. a pre sea medical e"amination$this e"amination provides an opport nit) to prevent entr) of ns itable ne& entrant to the seafaring profession for health reasons apparent at that time. This e"amination shall therefore be more stringent in nat re than the periodic medical e"amination. ?.2. a periodic medical e"amination $this e"amination provides an opport nit) to ens re that seafarer or person remains fit for sea service b) identif)ing medical conditions &hich ma) have develop since the seafarer entered the profession. (t shall be more fle"ible than the pre sea e"amination, )et not so fle"ible as to permit nfit seafarer to &or0 at sea or res me ship board d t) or ndergo certificate of competenc) and related e"aminations and obtain applicable endorsements. Fre<"enc; of )e$ica% e(a)ination: 8. Medical !"aminations are normall) performed ever) t&o )ears. +here there is a health condition that re7 ires more fre7 ent s rveillance, the) ma) be performed at shorter intervals. (t is important to recogni=e that the re7 irement for more fre7 ent medical e"aminations ma) limit the abilit) of a seafarer to obtain emplo)ment and lead to additional costs for the seafarer or their emplo)er. (f medical e"aminations are at

intervals of less than t&o )ears, the) ma) solel) concern the condition nder s rveillance and, in this case, an) reiss ed medical certificate shall not be valid for more than t&o )ears from the previo s f ll e"amination: ,. 9n) medical e"amination at the re7 est of emplo)er or training instit te or the seafarer shall be cond cted in accordance &ith this notice. 9 medical certificate shall be iss ed b) the approved medical e"aminer to the seafarer &ho meets all re7 irements &ith regard to medical fitness as prescribed nder the provision of M.S. 9ct, 1,-8 as amended, M.*, 200/ as amended and ST*+, 1,?8 as amended. This medial certificate shall be iss ed in prescribed format in sched le$B(( onl) on the basis of compliance &ith stat tor) standards irrespective of compliance &ith an) additional emplo)er or ins rer re7 irements. 10. Seafarer medical e"aminations ma) also provide an opport nit) to ta0e meas res to correct or mitigate medical conditions &hich co ld adversel) affect the health of seafarers and shall incl de meas res of a preventive character. Tests necessar) to eval ate the occ pational e"pos re at &or0 on board ship ma), &hen appropriate, be performed at the same time as the periodic e"aminations. *on$"ct of Me$ica% '(a)ination #; the Appro0e$ Me$ica% e(a)iner: 11. The approved Medical e"aminer and the associated laborator) shall cond ct the ph)sical, mental tests as per the relevant provisions of these r les and shall se pr dence and professional medical @ dgments and e"perience. Me$ica% Fitne&& Stan$ar$&$ =erification; 12. The medical e"aminer in assessing the medical fitness of seafarers incl ding ne& entrant shall ta0e into acco nt the ph)sical capabilit) re7 irement, fitness criteria for medication se, medication that can impair ro tine and emergenc) d ties and medication that can have serio s adverse conse7 ences for the ser &hile at sea incl ding medications that re7 ire limitations of period at sea beca se of s rveillance re7 irements. (n doing so the medical e"aminer shall ta0en into acco nt the g idelines specified in (.24(M2 p blication C6 idelines on the medical The medical e"aminer shall pa) special e"amination of seafarers$ (.24(M245MS42011412. 12.1. 12.2.

attention to the follo&ing as far as the e"amination and iss ance certification of seafarers: 9ppendi" 9$ Bision standards $ ST*+ *ode table 9$(4,; Minim m in$ service e)esight standards for seafarers 9ppendi" <$ Aearing standards > testing as per the prescribed proced re and criteria

12.3. 12.4. 12.-.

9ppendi" *$ #h)sical capabilit) re7 irements $ Table <$(4,. 9ssessment of minim m entr) level and in$service ph)sical abilities for seafarers. 9ppendi" D$Ditness criteria for medication se as prescribed. 9ppendi" !$ Ditness criteria for common medical conditions as prescribed $

=a%i$it; of Me$ica% '(a)ination *ertificate: 13. Enless a shorter period is re7 ired b) reasons of the specific d ties4f nctions to be performed b) the ne& entrant, seafarers and persons concerned, the validit) of the medical certificate shall be as follo&s; 13.1. the medical certificate shall be valid for a ma"im m period of 2 )ears and colo r vision certificate for ma"im m period of / )ears. Ao&ever, fre7 ent test that ma) incl de e)e sight test 3 other applicable tests as is deemed necessar) b) the 9pproved Medical e"aminer ma) be carried o t: 13.2. nless the ne& entrant, seafarer or person is nder age of 18, in &hich case the ma"im m period of validit) shall be 1 )ear. Ao&ever, fre7 ent test that ma) incl de e)e sight test 3 other applicable tests as is deemed necessar) b) the 9pproved Medical e"aminer: and 13.3. ever) seafarer signing off from the ship on medical gro nds for &hatsoever reasons shall be s b@ected to fresh periodic medical e"amination even if, the e"isting medical certificate held b) him4her is valid.: 13.4. ever) seafarer shall be s b@ected to ph)sical e"amination &hich

ma) inter$alia incl de e"amination of organ or organ s)stems s ch as: 13.4.1. 13.4.2. 13.4.3. 13.4.4. head, e)es, ears, nose, mo th, throat, nec0, chest, abdomen, s0in and limbs etc. vital signs $ blood press re, p lse rate and bod) temperat re etc: vital S)stems$ respirator), cardiovasc lar, nervo s, gastrointestinal and genito rinar) etc: general appearance$ post re, e"pression, restlessness, speech, behavio r and s&eating incl ding &eight and height etc: and

13.4.-.

if deemed necessar) clinical tests based on the declaration made b) the seafarer before the approved medical e"aminer or re7 ested b) the compan) as the case ma) be.

13.4./. 13.-.

the medical certificate for ne& entrant, seafarers or persons shall as a minim m be provided in !nglish.

The medical e"aminer shall assess the ph)sical and mental condition of the applicant and cond ct the relevant clinical test as prescribed in sched le$B. The medical e"aminer ma) as per his professional medical @ dgment in addition carr)$o t additional test ta0ing into acco nt the medical declaration made b) the seafarers as prescribed in sched le $B( and other factors as deem fit for the specific case.

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The seafarer shall not s ppress medical information and declare correct and proper medical information to the medical e"aminer to the best of his

0no&ledge and belief.

(n case of an) &rongf l 9ct or

misrepresentation4s ppression of material fact%s' of information or infringement the concerned seafarer shall be f ll) responsible4liable for the conse7 ences4 damages 4 penalties as per the provisions or applicable la&s.
Appea% 9roce$"re& 14. 9n) applicant &hose case has been re@ected b) the Directorate 6eneral of Shipping for

the

the approval to perform the f nctions of Medical !"aminer or e"tension of approval, s spension or &ithdra&al or a ship$o&ner not accepting the decision of approve medical e"aminer or seafarer having grievance against approved medical e"aminers or ship$o&ner ma) lodge an appeal &ithin three months from the date of iss e of s ch decision. S ch appeal shall be made to the Director 6eneral of Shipping 3 accompanied b) a cop) of the order appealed against in &riting incl ding contents of an) re@ection: 14.2. on receipt of the appeal the Director 6eneral of Shipping shall e"amine the case and ma) give the applicant a reasonable opport nit) of being heard before disposing the case. 14.3. an appeal shall be disposed &ithin a period of si"t) da)s from the date of filing of the appeal: 14.4. the Director 6eneral of Shipping ma) confirm, modif) or reverse the order, appealed against.

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*o)p%iance an$ 'nforce)ent& : 1-.1. 9ll concerned in order to give affect to the provision of M.*, 200/ and ST*+, 2010 in respect of medical e"amination of seafarers are advised to compl) &ith this notice and ins re that the medical certificate prepared and iss ed &hich is based on medical e"amination seafarers declaration. The medical certificate for the ne& entrant and e"isting seafarers before the) embar0ed on board )o r ships are iss ed &hich conforms to the provisions of ST*+, 2010, M.*, 200/ and (M24(.245MS42011 revised g idelines of cond ct of medical e"amination. 1-.2. 9s regards, the trainees or seafarers alread) in emplo)ment of ship$o&ners or ship manager or 1#S license holders and serving on board (ndian Dlag Ships, the medical certificate iss ed nder the e"isting Medical !"amination 1 les, 2000 shall remain valid &herever the (ndian ship is. facilit) of medical e"amination is available. 1-.3. The ship$o&ners, ship managers and 1#S license holder of the Directorate as the case ma) be shall advise their empanelled medical e"aminers &ho are approve b) D.6. Shipping to be g ided b) this notice. 1-.4. 9ll concerned in order to avert an) intervention b) the #ort State *ontrol 9 thorities or Dlag State *ontrol 9 thorities or delegated a thorities of the flag state to vol ntaril) compl) &ith this re7 irement from the date of iss ance of this notice. 1-.-. M.*, 200/, is entering into force internationall) &.e.f. 2040842013 and therefore it is essential that all concerned shall compl) &ith the provisions of this notice strictl). Ao&ever, ship o&ners or managers or 1#S license holders ma) iss e medical certificate or vol ntar) basis prior to this. 1-./. 1-.?. This notice shall comes &.e.f. ............ and ma) be revie&ed if deemed necessar) at periodical interval. These iss es &ith the approval of Director 6eneral of Shipping. (n the event of e"pir) of s ch certificates at sea, it shall remain valid till arrival of ne"t port of call or &here the

%*apt. Deepa0 Fapoor' Dep t) Na tical 9dvisor $c m$ Sr. Dep t) Director 6eneral DD6 %Tech' /i&t of Anne(e& 8 Sched le ($ 9pplication for 9pproval and !"tension of 9pproval Sched le (($ 9ffidavit format

Sched le ((($ .etter of 9pproval4!"tension of 9pproval to the Medical e"aminer Sched le (B$ *hec0 .ist for 9pproval 4!"tension of 9pproval to the Medical !"aminer Sched le B $ Minim m Test for the cond ct of medical e"amination Sched le B( > Medical !"amination of Seafarer %!"amineeGs Declaration'. Sched le B(($ Medical *ertificate to Seafarer Sched le B((( > Aalf Hearl) 1et rns

Sched le ( 9pplication for 9pproval and e"tension of 9pproval

#hotograph %si=e'e 3.3.To Directorate 6eneral of Shipping IIIIIIIIIIIIIIIII 5aha= <havan, IIIIIIIIIIIIIIII +alchand Airachand Marg, <allard !state, M mbai$400 001. 1>in$ Attn: Appro0ing A"thorit; (Na tical 9dviser to the 6overnment of (ndia' 2. JS b@ect;$ 9pproval 4 !"tension of approval to Medical e"aminer $regarding.K Sir, (, Dr. IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII &ish to appl) for the approval of Medical e"aminer 4 e"tension of approval to cond ct medical e"amination. 9 cop) of m) <io$ data along &ith other relevant doc ments pertaining to academic and professional 7 alification, e"perience, previo s letter of approval, proof of age, chec0 list d l) notari=ed or certified and filled in are enclosed. ( declare to e"tend all co$operation to the a thori=ed official of the *ompetent 9 thorit) in co rse of intervie& and inspection of premises before the approval or thereafter. Ho are therefore, re7 ested to iss e a letter of approval 4 e"tension of approval to enable me to perform the f nction of Medical e"aminer for the p rpose of medical e"amination. #lace Date

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Ho rs faithf ll),

%Dr.IIIIIIIIIIIIIIIIIIIII' Name;IIIIIIIIIIIIIIIIII Medical *o ncil of (ndia 1egistration No.IIIIIIIIII Date of iss e; IIIIIIIIIIIIIIIIII %delete as applicable' !nclos res; 1. 2. 3. 4. -. /. ?. 8. ,. *op) of Medical *o ncil of (ndia 1egistration *ertificate. *op) of bio$data &ith s pporting doc ments incl ding an affidavit *op) of chec0 list d l) filled in &ith relevant information. *op) of proof of age. *op) of previo s letter of approval, if applicable. JNote;$ 9 cop) of above mentioned doc ments shall be d l) notari=ed or certified b) 6a=ette officer or self attestedK 9 proof for medical fitness b) 6overnment department in case of e"tension. 9 proof for filing periodical ret rns in case of e"tension. 9 proof stating no pending complaints or legal proceedings for ne& applicant and e"isting cases. T&o passport si=e photograph %3.- " 4.- cm'

Sched le (( 9DD(D9B(T

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(, Dr. IIIIIIIIIIIIII, 1egn. No. IIIIII, %State4*entre' Medical *o ncil, aged IIII )ears, (ndian 1esident, having m) clinic at IIIIIIIIIIIIII, do hereb) on solemn affirmation as nder; 1. ( am f ll) conversant &ith the applicable (ndian Maritime .a&s, the entire process of e"amination the seafarers and good nderstanding in the follo&ing areas; %i' have ade7 ate 0no&ledge of living and &or0ing conditions on board sea going merchant ships of vario s t)pes gained thro gh special instr ctions or attended occ pational4Maritime medicine4health related co rses or other means as prescribed b) the co ncil or association or self efforts. %ii' Medical p blication CThe (nternational Medical g ide for ships or an e7 ivalent national medical g ide for se on ships. %iii' Standard of Training, *ertification and +atch0eeping 1,,- as amended 1!6 (4,$Medical !"amination. %iv' Maritime .abo r *onvention 200/$ Medical !"amination of Seafarers. %v' (nternational .abo r 2rgani=ation4+orld Aealth 2rgani=ation4D.241,,?, as amended$6 idelines for cond cting pre$sea and periodic medical fitness e"amination of seafarers. %vi' 1elevant provisions of Merchant Shipping 9ct, 1,-8, section ,8 etc. %vii' Merchant Shipping %Medical !"amination' 1 les 2000, as amended and D6S4M.S. Notices of Medical !"amination and Sight test iss ed from time to time as available on D6S &ebsite. %viii' #roced re to deal &ith appeal cases etc. ( state that the contents of this affidavit are tr e and correct to m) 0no&ledge. Solemnl) affirmed in IIIIIII on dd4mm4)))) %place' <efore me 9ttested

Sched le ((( .etter of 9pproval 4 !"tension of 9pproval %No.D6S4Medical4IIIIIII' 1eference No. $$$$$$$$$ To, Dr JS b; .etter of 9pproval 4 e"tension of approval to Dr. 1egistration No. $$$ K $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$

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Sir, (n response to )o r application No.IIIIIIIIII dated and s bse7 entl) f lfilling the laid do&n criteria for the approval 4e"tension of approvalK, the *ompetent 9 thorit) is pleased to accord approval or e"tend approval to )o as Medical e"aminer in accordance &ith Section ,8 %4' of Merchant Shipping 9ct, 1,-8. JHo are therefore permitted to cond ct medical e"amination in accordance &ith the relevant provisions of Merchant Shipping 9ct, 1,-8, 1 les framed their nder and other la&s applicable, incl ding an) notification iss ed b) *ompetent 9 thorit) from time to time. Ho r name along &ith contact details given b) )o in the application 4 chec0 list shall be displa)ed on the D6S +ebsite at the earliest. This approval shall remain valid for $$$ )ears till $$$$$$$$$$$ s b@ect to the compliance &ith the follo&ing conditions. 1. 2. 3. The Na tical 9dvisor to the 6overnment of (ndia has the right to s spend or &ithdra& this letter of approval 4 e"tension or report to the concerned a thorities after giving an opport nit) to )o to defend. Ao&ever, )o have the right to appeal to the *ompetent 9 thorit) against s ch decision. Ho rs faithf ll), %9 thori=ed 2fficial of *ompetent 9 thorit)' %delete as applicable' *c; 1. 9ll #rincipals 2fficers, MMD Sched le (B *A!*F .(ST D21 9##12B9.4!LT!NT(2N 2D 9##12B9. T2 M!D(*9. !L9M(N!1 %To be d l) filled in b) the applicant' #91T 9 Name of the applicant$ Date of birth$ Name 3 address of clinic at &hich medical e"amination to be cond cted > #91T < !d cational 7 alification &ith certified copies as attachment$ #rofessional 7 alification &ith certified copies as attachment %at least M.<.<.S.'$

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(M* registration n mber$ Details of e"perience incl ding e"perience on ships or in lie ade7 ate 0no&ledge on living and &or0ing condition on board merchant ships Details of 7 alified s pport staff having ade7 ate e"perience in providing medical services to the seafarers$ Details of other doctors, managerial, #ara$medical and clerical staff incl ding cons ltants$ Details of the clinic%n mbers' and laborator) facilities%n mbers' > ade7 ate area to accommodate medicals officer, staff, record room, &aiting area for seafarers 3 list of medical e"amination facilities at the clinic > .ist of clients giving evidence of integrit), good&ill and nderstanding of seafaring profession $

Names of inspecting team 1. 2. 3.

1emar0s of the (nspecting Team$ 1ecommendations of the (nspecting team$

Date

2fficial Seal

#lace

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Sched le B Minim m Test for the cond ct of medical e"amination

1. #eriodic Medical !"amination %Sea Service 3 *ertification p rposes' %9' Mandator) !"amination and Tests %Sea Service' #h)sical !"amination; +eight, Aeight, Temperat res, <lood #ress re, p lse rate, Sight, Aearing , 2ral Aealth ,general appearance and s)stemic e"amination of &hole bod). <lood Tests ;$ <( *<* <( !S1 1<S 4 D<S S62T S6#T 1-

S66T S *reatinine 3 Erea S *holesterol S Trigl)cerides <lood gro p 3 1h factor% tested onl) once, need not be repeated' Test for Aepatitis < %Abs9g' and * BD1. A(B (3 (( L$ra) chest Erinal)sis !*6 Dr g 3 9lcohol Screening > Morphine, <arbit rates, Mari@ ana, *ocaine, 9mphetamines, 9lcohol 9 diometric Stool 14! 3 +idal for food handlers Eltraso nd %ES6' of the 9bdomen 3 #elvis

%<' 2ptional Tests$ #s)chometric eval ation on case to case basis Stress test 2D echo Doppler st d) %for heart patient' 6l)cos)lated %Ab19c' Spirometr) 3. Mandator) !"amination and Tests %*ertification of *ompetenc) and other endorsements' s b@ect to the candidate not having medical certificate.

1/

%i' #h)sical !"amination; +eight, Aeight, p lse rate, Temperat res, <lood #ress re, Sight, Aearing ,2ral Aealth ,general appearance and s)stemic e"amination of &hole bod). %ii'<lood Tests ;$ <( *<* <( !S1 1<S 4 D<S S62T S6#T S66T S *reatinine S *holesterol S Trigl)cerides <lood gro p 3 1h factor Test for Aepatitis < %Abs9g' and * <( BD1. A(B (3 ((

%iii'L$ra) chest %#9' %iv'!*6 %v' Erine anal)sis 4. #re$sea Medical !"amination%Ne& !ntrant'$ %9' Mandator) !"amination and Tests #h)sical !"amination; +eight, Aeight, Temperat res, p lse rate, <lood #ress re, Sight ,Aearing , 2ral Aealth , general appearance 3 s)stemic e"amination of the &hole bod) . <lood Tests ;$ 1?

<( *<* <( !S1 S62T S6#T S66T S *reatinine S *holesterol S Trigl)cerides <lood gro p 3 1h factor *. Test for Aepatitis < %Abs9g' and * <( BD1. A(B (3 (( L$ra) chest %#9' Erinal)sis Dr g 3 9lcohol Screening > Morphine, <arbit rates, Mari@ ana, *ocaine, 9mphetamines, 9lcohol 9 diometric #s)chometric test cond cted b) an) 7 alified ps)chiatrist 4 ps)chologist Eltraso nd %ES6' of the 9bdomen 3 #elvis %<' 2ptional Tests$ 6l)cos)lated %Ab19c' 1<S4D<S%<lood test' !*6 Stress Test if deem necessar) 2D echo Doppler st d) #s)chometric eval ation on case to case basis -. Baccination nder +A2 or other co ntr)Gs reg lations as applicable$ %i' Baccination at the time of #re$sea and #eriodic test;$ Seafarers shall be vaccinated according to the re7 irements indicated in the +A2 p blication, (nternational Travel 3 Aealth: vaccination re7 irement and health advise pdated periodicall). 18

%ii' Hello& fever is no& onl) decease for &hich vaccination is stat tor) re7 irement in some co ntries and for &hich an (nternational certificate of vaccination is re7 ired. 1esponsibilit) to provide imm ni=ation shall rest &ith the training instit te and the emplo)er of the seafarer as the case ma) be. Hello& Dever > 9t a +A2 designated Hello& Dever *entre onl). <ooster once ever) 10 )ears for seafarer and ne& entrant. Aepatitis < 3 * > 9 primar) co rse of three doses to be completed d ring the training period. <ooster ma) be given once ever) 20 )ears. (n cases of do btf l imm nit), test for 9nti A<S antibod) titre shall be cond cted to assess the s itabilit) of administration of the vaccine. c' T)phoid vaccination $ d ring training 3 to be repeated once ever) three )ears. 9 primar) co rse of t&o doses. d' Tetan s To"oid > Most of the pre$sea trainees &o ld have received their tetan s proph)la"is d ring their childhood imm ni=ation. Ao&ever, tetan s to"oid in@ection shall be given at the time of entr) to the pre$sea training programme. 9 booster in@ection ever) - )ears. e' Aepatitis 9 Baccination. f' Baccination against an) other epidemic or pandemic disease at that period of time. %ii' Baccination at the time of #eriodic Medical !"amination; Note ;$ 1,

The D6 approved Medical e"aminer shall chec0 the imm ni=ation record of ne& entrant or the seafarers as the case ma) be, at the time of pre$sea or periodic medical e"amination and arrange for re$vaccination if and &hen deemed necessar). These records shall be retained &ith the seafarers and to be verified periodicall).

Sched le >B( M!D(*9. !L9M(N9T(2N 2D S!9D91!1S !"amineeMs Declaration 9S; 1. The seafarer shall not s ppress medical information and declare correct and proper medical information to the medical e"aminer to the best of his

0no&ledge and belief. 2. (n case of an) &rongf l 9ct or misrepresentation4s ppression of material fact%s' of information or infringement the concerned seafarer shall be f ll) responsible4liable for the conse7 ences4 damages 4 penalties as per the provisions or the applicable la&s. 20

1. 2. 3. 4. -. /. ?. 8. ,. 10.

Name %last, first, middle'; IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII Date of birth %da)4month4)ear'; .. 4.. 4N. Se"; II Male II Demale Aome address; IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII Method of confirmation of identit), e.g. #assport No.4SeafarerGs boo0 No. or other relevant identit) doc ment No.; IIIII Department %dec04engine4radio4food handling4other'; IIIII 1o tine and emergenc) d ties %if 0no&n'; IIIII T)pe of ship %e.g. container, tan0er, passenger'; IIIII Trade area %e.g. coastal, tropical, &orld&ide'; IIIII !"amineeGs personal declaration

%9ssistance sho ld be offered b) medical staff'

11.

Aave )o ever had an) of the follo&ing conditionsO ?e& !)e4vision problem Aigh blood press re Aeart4vasc lar disease Aeart s rger) Baricose veins4piles 9sthma4bronchitis <lood disorder Diabetes Th)roid problem Digestive disorder Fidne) problem S0in problem 9llergies (nfectio s4contagio s diseases Aernia 6enital disorder #regnanc) No

*on$ition

21

Sleep problem Do )o smo0e, se alcohol or dr gsO 2peration4s rger) !pileps)4sei= re Di==iness4fainting .oss of conscio sness #s)chiatric problems Depression 9ttempted s icide .oss of memor) <alance problem Severe headaches !ar %hearing, tinnit s'4nose4throat problem 1estricted mobilit) <ac0 or @oint problem 9mp tation Dract res4dislocations

(f )o ans&ered C)esP to an) of the above 7 estions, please give details;

12. 9dditional 7 estions Aave )o ever been signed off as sic0 or repatriated from a shipO Aave )o ever been hospitali=edO Aave )o ever been declared nfit for sea d t)O Aas )o r medical certificate even been restricted or revo0edO 9re )o a&are that )o have an) medical problems, diseases or illnessesO Do )o feel health) and fit to perform the d ties of )o r designated position4occ pationO 9re )o allergic to an) medicationO

Hes

No

22

*omments;

13. 9dditional 7 estions 9re )o ta0ing an) non$prescription or prescription medicationsO

Hes

No

(f )es, please list the medications ta0en, and the p rpose%s' and dosage%s'; ( hereb) certif) that the personal declaration above is a tr e statement to the best of m) 0no&ledge. Signat re of e"aminee; IIIIIIIIIIIIIIIIIIIIIIIDate %da)4month4)ear'; ..4..4N. +itnessed b) %signat re'; IIIIIIIIIII Name %t)ped or printed'; IIIIIIIIIIIIIIIII ( hereb) a thori=e the release of all m) previo s medical records from an) health professionals, health instit tions and p blic a thorities to approved medical practitioner'. Signat re of e"aminee; IIIIIIIIIIIIIIIIIIIIIII Date %da)4month4)ear'; ..4..4N. +itnessed b) %signat re'; IIIIIIIIIII Name %t)ped or printed'; IIIIIIIIIIIIIIIII Date and contact details for previo s medical e"amination %if 0no&n'; IIIIIIIII $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ 14. M!D(*9. !L9M(N9T(2N Sight Dr IIIIIIIIIIIIIIIIIIIIII %the

Ese of glasses or contact lenses; Hes4No %if )es, specif) &hich t)pe and for &hat p rpose' IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII Bis al ac it)

IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII Enaided 1ight e)e Distant Near .eft e)e <inoc lar 9ided 1ight e)e .eft e)e <inoc lar

IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII

23

IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII Bis al fields IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII Normal Defective IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII I 1ight e)e .eft e)e IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII *olo r vision Not tested Aearing Normal Do btf l Defective

IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII # re tone and a diometr) %threshold val es in d<' IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII -00 AQ 1 000 AQ 2 000 AQ 3 000 AQ IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII 1ight ear .eft ear IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII Speech and &hisper test %metres' IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII Normal +hisper IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII 1ight ear .eft ear IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII 1-. *linical findings Aeight; IIIII %cm' +eight; IIIII %0g' # lse rate; IIIII4%min te' 1h)thm; IIIII <lood press re; S)stolic; IIIII %mm Ag' Diastolic; IIIII %mm Ag' Erinal)sis; 6l cose; IIIII #rotein; IIIII <lood; IIIII IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII Normal Aead Sin ses, nose, throat Mo th4teeth !ars %general' T)mpanic membrane 9bnormal IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII

24

!)es 2phthalmoscop) # pils !)e movement . ngs and chest <reast e"amination Aeart S0in Baricose veins Basc lar %inc. pedal p lses' 9bdomen and viscera Aernia 9n s %not rectal e"am' 6$E s)stem Epper and lo&er e"tremities Spine %*4S, T4S and .4S' Ne rologic %f ll4brief' #s)chiatric 6eneral appearance 1/. *hest L$ra) Not performed 1es lts; 1?. 2ther diagnostic test%s' and res lt%s'; Test; 1es lt; #erformed on %da)4month4)ear'; ..4..4N.

Medical practitionerGs comments and assessment of fitness, &ith reasons for an) limitations; 18. 9ssessment of fitness for service at sea 2n the basis of the e"amineeGs personal declaration, m) clinical e"amination and the diagnostic test res lts recorded above, ( declare the e"aminee medicall); Dit for loo0$o t d t) Not fit for loo0$o t d t) 2ther services %training4e"amination' Dec0 service !ngine service Dit *atering service 2ther services

2-

Enfit

No

+itho t restrictions &ith restrictions Bis al aid re7 ired Hes

Describe restrictions %e.g., specific position, t)pe of ship, trade area 3 others as applicable'; Medical certificateGs date of e"piration %da)4month4)ear'; IIIIII4IIIIII4IIIIII Date medical certificate iss ed %da)4month4)ear'; IIIIII4IIIIII4IIIIII N mber of medical certificate; IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII Signat re of approved medical e"aminer; IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII 9pproved Medical e"aminer information %name, license n mber, approval n mber, address'; IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII

Sched le B(( M'D4*A/ *'RT4F4*AT' F5R 9R'-S'-TRA4N4N7- *'RT4F4*AT' 5F *5M9'T'N*? 9'R45D4* M'D4*A/ '@AM4NAT45N 8 S'R=4*' AT S'A 9s per medical standards of M.* 200/, as amended ST*+ 2010, as amended and section ,8 of the (ndian Merchant Shipping 9ct, 1,-8 and medical e"amination r les on medical e"amination framed there nder

A99R5='D M'D4*A/ '@AM4N'R NAM' AND ADDR'SS

.ast4Damil) Name #osition applied for

Dirst Name (D %#assport4Discharge boo0' No;

#hoto 2/

Date of <irth *ompan) Name

Se"

Nationalit) Bessel Name

( have eval ated the above$named seafarer4 ne& entrant after establishing his identit) as per the doc ments mentioned above. 2n the basis of the seafarerGs4 ne& entrant personal declaration, m) clinical e"amination, the diagnostic test res lts obtained, and in consideration of the essential re7 irements of the position applied for, m) opinion is $ %a' %b' %c' %d' that the hearing meets the re7 ired ST*+ standards section 9$(4,;$ Hes 4 No Enaided hearing is satisfactor) Hes 4 No Bis al ac it) meets the re7 ired ST*+ *ode standards section 9$(4, Hes 4 No *olor Bision meets the re7 ired ST*+ *ode standards section 9$(4, Hes 4 No %testing onl) re7 ired ever) / )ears nless considered necessar) ' Date of last color vision test % Da)4Month4Hear' NNNNNNNN.. %a' Dit for loo0 o t d t) %b' No. limitation or restrictions on fitness Hes 4 No Hes 4 No

%e'

%if no C specif) limitations or restrictions %c' (s the seafarer free from an) medical condition li0el) to be aggravated b) Service at sea or to render the seafarer nfit for s ch service or to endanger the health of other persons on board ; %d' Date of e"amination; Hes 4 No %Da)4Month4Hear' NNNNNNNNNNN NNNNNNNNN

%e' !"pir) date of certificate; %Da)4Month4Hear'

%f'

this seafarer is :NF4T F5R D:T?RR4F4T F5R D:T? 6ith 6itho"t re&triction&Aa& )entione$ #e%o6, R This Medical *ertificate is iss ed &ith follo&ing restrictions

RR 1easons for being nfit

2?

9pproved Medical !"aminer Signat re;;IIIIIIIIIIIIIIIIIIIIIII

2fficial Stamp

%1egistration No. 3 D6S approval no.' 9pproved Medical !"aminer Name #rinted;IIIIIIIIIIIIIIIIIIIIIIIIIII Date ; Balid till; Appro0ing A"thorit; of Me$ica% '(a)iner: Directorate 7enera% of Shipping, 7o0t. of 4n$ia.
( ac0no&ledge, that ( have been advised of the content of the medical certificate 3 of the right to a revie& in accordance &ith paragraph %/' of section 9$(4, of ST*+ *ode. Seafarers4 Ne& !ntrant Signat re;

Sched le B((( Aalf Hearl) 1et rns Dormat SEMM91H 2D M!D(*9. !L9M(N9T(2N *2NDE*T!D D21 TA! #!1(2D D12M $$$$$$$$$$$$ T2 $$$$$$$$$$ Sr. No . Name of the seafarer Date of <irth41an0 Male 4 Demale *D* No. #re sea 4 #eriodic or additional e"amination Name of shipping *ompan) 4training instit te Enfit 4 Temporar) #ermanent (f nfit reason%s' for nfitness (f referred to 9 thorit)

Signat re of the Medical e"aminer;$ Name of the Medical e"aminer;$ 1egistration No. ;$ D6S approval n mber;$ RRRRRR

28