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RECORD OF HOURS OF WORK / REST

Name of ship: IMO number: Flag of ship:

Seafarer (full name): Position / Rank:

Month and year: Watchkeeper:2 yes no

Please mark period of work or rest as applicable with a continuous line

I agree that this record is an accurate reflection of the hours of work or rest of the seafarer concerned.

Name of master or person authorized by master to sign this record:

Signature of master or authorized person: Signature of seafarer:

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RECORD OF HOURS OF WORK / REST

Hours
NOT TO BE COMPLETED BY
01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Hours of SEAFARER
rest in 24- Hours of work or Hours of work or
Comments
hours rest as applicable rest as applicable
Date period in any 24-hour in any 7-day
period period
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Hours 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24

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