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Medical Examination Form Seafarers NOTE:the Certificate of Medical Fitness-Seafarers must be sent to Maritime New Zealand (not this form) Please indicate with an X whether this examination is for.

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How to fill out the Seafarers Medical Examination Form online

Filling out the Seafarers Medical Examination Form online is a crucial step for individuals looking to prove their fitness for sea duty. This guide will walk you through each section of the form, ensuring clarity and accuracy in your submissions.

Follow the steps to complete the Seafarers Medical Examination Form online.

  1. Click the 'Get Form' button to obtain the form and open it in your preferred digital environment.
  2. Begin with Section 1: Seafarer declaration. Fill in your surname, first name(s), date of birth, and gender by selecting the appropriate option for male or female. Provide your home address, identity document type, and number. Indicate the type of ship and trade area where you are applying for certification.
  3. Complete the examinee’s personal declaration by marking 'yes' or 'no' for each medical condition listed. Ensure to provide honest responses, as these will be critical for your medical assessment.
  4. If you answered 'yes' to any conditions, provide further details in the space allocated below the personal declaration section.
  5. Move to the additional questions section. Again, indicate 'yes' or 'no' for each question and add comments where applicable, particularly for medications you are taking.
  6. Certify the accuracy of your personal declaration by signing and dating the form. Ensure that your signature is clear and legible.
  7. The next section involves the medical examination details. Here, leave spaces for the medical practitioner to fill in visual acuity, hearing tests, height, weight, and other relevant health metrics.
  8. Take note of any medical category assessments and further documentation required based on the results of your examination. This is crucial for your fitness for service.
  9. Lastly, after ensuring all sections are completed accurately, review the form for any errors. Save your changes, and choose to download, print, or share the form as required.

Begin completing your Seafarers Medical Examination Form online today to ensure your readiness for maritime duties.

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Related links form

RI DoT RI-100A 2016 RI TX-17 2017 RI TX-17 2017 SC DoR C-278 2019

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A medical certificate is a document that serves as proof that a mariner meets the required medical and physical standards, per the publication of the Federal Register (FR). This FR incorporates the 2010 Amendments to the STCW Convention into the U.S. regulations.

A medical exam very similar to an ENG1 requires: Checking your height, weight, blood pressure, and examining your physical condition to determine your fitness level. Testing your eye sight (before and after you put on glasses) and your colour vision.

The ideal BMI is said to be between 18 and 25, while a score of over 25 is classed as overweight and over 30 obese.

Within 2-4 business days we will send you instructions with a clinic address and confirmation of appointment. After your exam you will be sent an email with your results when they are complete. This usually takes 5-14 days. We will notify you by email if there are any additional items required.

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