Remote Location Fitness to work

Contractor Certificate for Fitness to Work

Name of Employee: Waleed Juda Jaafar

Date of Birth: 1964

Nationality: Iraqi

Passport Number: 196438588326

Employer:ROSEN

Expiry Date of Certificate:9/2/2024

I certify that I have checked the identification of the above individual and that they have undergone a medical examination to
Majnoon Remote Site Work Standard or the UKOOA/OGUK/NOGEPA medical or equivalent. For standards of fitness (See
OKOOA/OGUK Medical Guidelines for fitness to work offshore.) I further certify they meet the following additional criteria, and they
are fit to work in remote locations in Iraq:

 To work in a hot climate (temperatures in excess of 50 C in Summer)

 To wear body armor and helmet for prolonged periods of time, and have the physical fitness to be able to run 100 yards in
this equipment
 Has no medical conditions that are likely to cause significant ill health during their deployment
 Are not taking medication that would cause a serious adverse health effect if stopped suddenly
 Have no psychological/mental health issues that would impact on their ability to work in Iraq
 HIV, VDRL, Hepatitis B, and Hepatitis C status have all been checked for visa purposes. (All personnel will require testing to
have an exit visa issued)

The validity of the certificate is as follows unless reduced by the examining physician for any reason:

 Less than 40 years old - 5 years from date of issue

 Between 40 to 60 years old - 2 years from date of issue
 More than 60 years old - 1 years from date of issue

Suggested Restrictions/Accommodations:

Examining Doctor Name:Dr.Hassan Majeed Sabir

Clinic Name and Address:Alfayaha private clinic –Basrah- ALzubair-Alshomal street.

Email Address: alfayahaclinic@gmail.com Contact Telephone:07821150229

Date: 9/2/2023

Signature:
 Majnoon Development Project
FITNES TO WORK CERTIFICATE

Employee Data Date:9/2/2023

Last Name:Jaafar First Name:Waleed

I.D No.196438588326 Age:59 Occupation:Driver

Type of Medical Evaluation Mark those applying 

A. Remote location work
 D. Professional driving

B. Catering and food preparation E. Emergency response team work

C. Crane driving F. Breathing apparatus

Work near moving machinery or sharp edges Operate motor vehicles, foklifts or heavy
machinery
Working at height Use a respirator

Pull push carry weight over Kg Repetitive twisting of valves or wrenches

Ascend/descend ladders or stairs Flying

Other (Specifiy)

These restrictions are Temporary until (date) or Permanent.

Temporary Unfit until (date)

Permanently Unfit
Date:9/2/2023 Signature Print Name:Dr.Hassan Majeed
Sabir

Health Advisor Statement: The above named person has been examined according to the
statements laid down in “Protocols & Guidance Notes on the Medical Evaluation of Fitness to
Work”. At this time his/her fitness to work status for the above tasks is valid for ........yrs.
 Remote Location Fitness to
Majnoon Health Appendix D Form Q1
Health Status Questionnaire

Please answer the questions by ticking the correct box. If you are not sure, leave the question blank
and ask your health advisor what it means. Your health advisor may ask you additional questions
during the examination.

Employee Data Date:9/2/2023

First Name:Waleed Last Name:Jaafar
Country of Origin:Iraqi Occupation:Driver
Planned Date Of departure: Contact No+ International dialling code:7801543719

No Yes
1. Are you currently being treated by a doctor for any illness or injury? 

If yes please briefly describe


2. Are you receiving any medical treatment or taking any medication (either prescribed or otherwise)? 

If yes please list

3. Have you ever had, or been told by a doctor that you had any of the following? No Yes
3.1 High blood pressure 

3.2 Heart disease 

3.3 Chest pain, angina 

3.4 Any condition requiring heart surgery 

3.5 Palpitations/irregular heartbeat 

3.6 Abnormal shortness of breath 

3.7 Head injury, spinal injury 

3.8 Seizures, fits, convulsions, epilepsy 

3.9 Blackouts, fainting 

3.10 Stroke 

3.11 Dizziness, vertigo, problems with balance 

3.12 Double vision, difficulty seeing 

3.13 Colour blindness 

3.14 Kidney disease 

3.15 Diabetes 
3.16 Neck, back or limb disorders 

3.17 Hearing loss or deafness or had an ear operation or use a hearing aid 

3.18 Do you have difficulty hearing people on the telephone (including use of hearing aid if worn)? 

Form Q1 Continued
3.19 Have you ever had, or been told by a doctor that you had a psychiatric illness, or nervous disorder? 

3.20 Have you ever had any other serious injury, illness, operation, or been in hospital for any reason? 

4.1 Have you ever had, or been told by a doctor that you had a sleep disorder, sleep apnoea, or narcolepsy? 

4.2 Has anyone noticed that your breathing stops or is disrupted by episodes of choking during your sleep? 

5.1 When was the last time you had more than 4 drinks (female) or 5 drinks (male) in 1 day in the past 3 months
 last 7 dayslast 4 weeks  last 3 months  not in the last 3 months *Non Drinker.
5.2 Has a relative or friend or a doctor or other health worker been concerned about your drinking or suggested you cut down?
No Yes, but not in the last year Yes, during the last year

5.3 Have you ever been treated for alcohol or substance abuse


6. Do you use illicit drugs? 


7. Do you smoke? If yes, what and how much each day?  
8. Do you use any drugs or medications not prescribed for you by a doctor? 

If yes list here.

9. Have you been in a vehicle crash since your last license examination? ( Drivers only) If Yes, please give 
details:

10.Have you ever experienced complications/side effects from vaccination? If "Yes" Describe 

Complications/Side effects:

11. Have you ever experienced complications from antimalarial medicine? If "Yes" Which Complications/Side 

effects?

12.Do you have any allergies e.g. Food /Medications/ Environmental Allergies? If "Yes" Please provide a list of 

allergies:

13.Do you Suffer or are you currently under doctor's treatment for any chronic conditions? If "Yes" please 

provide details:

14.Have ever suffered or even been referred to a Specialist for any form of Cardiac Condition? If "Yes" please 

provide details:

15.Have you ever suffered any form of epileptic attack or being treated for any neurological condition? If "Yes" 

please provide details:

16.Have ever suffered from any mental or Psychological disorder, anxiety, Any form of depression or 

Melancholia? If "Yes" please provide details:

17.Do you currently or have you in the last 6(six) months taken any form of medication that was either 

prescribed or self-administered? If "Yes" please provide details:

18.Have you ever had any Surgery to the Spleen or has your Spleen removed? If "Yes" please provide details: 

19.Women only: Are you Currently pregnant? 
Health Advisor’s comments:

Signature: Name: Dr.Hassan Majeed Sabir Date:9/2/2023

 Majnoon Health Appendix D Form E1
Medical Examination Record
NB Health advisors – only complete examinations and investigations required by protocol, or those that are
clinically indicated from patient history.

Name: Waleed Juda Jaafar Job Type:Driver Date:9/2/2023

Age: 59 I.D No: 196438588326 Blood Group :

Blood Pressure:110/60 Pulse: 75 Height (m): 180 Weight (Kg): 110 BMI: 33.95

Systems Revision Normal / Comment

Abnormal

Head, Eyes, Ears, Mouth, Teeth, Throat Normal

Spine Normal
Breasts Normal
Chest – Respiratory System Normal
Heart - Cardiovascular Normal
Extremities Normal
Musculo-skeletal Normal
Genito-urinary Normal
Rectum-Anus Normal
Abdomen Normal
Neurological System Normal
Skin Normal
Others- inc Immunisation status N/A
Lab Tests* Hb 17.0mg/dL ,R.B.S 194mg/dL, Total serum cholesterol 186mg/dL, HDL
53mg/dL
Vision tests* Normal R 9/6 : L 9/6
Audiogram * N/A
Spirometry * N/A
ECG* N/A
Other* N/A
PLEASE ATTACH COPIES OF IMPORTANT SPECIALIST REPORTS and LAB results
Health Advisor – additional comments may be recorded on reverse of form

Date: 9/2/2023 Signature: Print Name:Dr.Hassan Majeed Sabir

FORM E1 Continued

Health Advisor - additional comments

*He is temporarily fit to work and will be reviewed annually, life style change.

Date Signature Print Name