Personnel information gathering form

I. Identification Please complete

1 Surname:
2 First Name:
3 Qatar ID or Passport number:
4 Nationality:
5 Blood type:
6 Employer:
7 Employee number:
8 Job position:
PPE Coverall size: Shoe size: Glove size:
(S to 3XL) (35 to 48) (7 to11)
PPE ☐ I am wearing glasses
II. Personnel Category Please tick
A Offshore worker ☐
B Onshore worker, making offshore visits ☐
C Onshore worker, exposed to industrial risks ☐
D None of the above ☐
III. Documents to provide (if not already transmitted to NOC OH Nurse) Please tick
1 Fitness To Work certificate * ☐
2 * Medical FTW dossier if certificate is not issued by OGUK, ☐
NOGEPA, OLF or Danish Maritime Authority registered doctor
3 Copy of the Qatari ID or Passport with work visa ☐
4 Picture (if not already taken for NOC employee badge) ☐
5 Copy of current medical fitness offshore card (if applicable) ☐
6 Copy of the T-BOSIET/HUET card (or certificate) ☐
7 Copy of the H2S training card (or certificate) ☐
8 Copy of valid QP-Pass (if applicable) ☐
Please send this table and the required documents to
Data per each e-mail should not exceed 18 Mb in size
The provided confidential medical data shall be administered by NOC Occupational Health personnel only