Appendix 1
Guidelines for the medical examination of seafarers
Part I – Seafaring and medical fitness
1.IntroductionThe Merchant Shipping (Medical Examination) Regulations, 2001 shall be administered by the Ministry of Communications and Transport. The Regulations make provision for the issue of Medical Fitness Certificates for duty at sea of seafarers (masters, mates, engineers and ratings).These guidelines have been compiled for the use of Approved Medical Practitioners who are assessing an individual's fitness to work at sea. The Medical fitness standards have been developed in relation to the basic job task analysis in Appendix 2. An employing company may have more stringent guidelines developed by its own occupational physician. Such guidelines will depend on the nature of the jobs and any specific equipment operated. Where such guidelines exist, they should be followed. While the final judgement on whether or not an applicant is fit to work in a particular job at the sea rests with the Approved Medical Practitioner, these guidelines draw attention to those conditions that have the potential to present a high level of risk in some circumstances.1.1Why fitness1.1.1.Employers have a duty to provide a safe work environment and protect the health, safety and welfare of employees. Employees similarly have a duty of care for their own safety and that of the people they work with and the community. Medical assessment of fitness is one aspect of meeting this duty of care.1.1.2The primary objectives of a medical assessment of fitness for duty of sea are:To ensure that individuals are fit to perform the essential tasks of their job at the sea effectively; andto anticipate and, where possible, prevent the avoidable occurrence of ill-health offshore which could place individuals, their colleagues and emergency personnel at risk.1.1.3Medical conditions may impinge on work in the following areas:(a)The condition may limit, reduce or prevent an individual from performing the job effectively for example loss of mobility and dexterity making engine room work and other maintenance tasks difficult;(b)the condition may be made worse by the job, for example, an asthmatic when exposed to allergens on a grain ship;(c)the condition may make it unsafe for the person to do the job, for example, liability to sudden loss of consciousness whilst transferring from a smaller vessel to a large vessel by climbing a rope ladder;(d)the condition is likely to make it unsafe both for the individual and other crew a ships crane operator liable to sudden loss of consciousness; catering crew with infectious hepatitis or gastroenteritis;(e)the condition is likely to make it unsafe for other shipping, for example, where master or mate is at risk of sudden loss of consciousness due to a cardiac arrhythmia;(f)the condition, if it worsens, is one which will require emergency evacuation for medical treatment such as gastric ulcer haemorrhage.1.2Working environment for seafarers1.2.1Approved Medical Practitioners should bear in mind the aspects of seafaring life, listed below, when assessing fitness for duty at sea.1.2.2As ships often operate far offshore or in inaccessible areas, it is often difficult to replace seafarers who become injured or ill. Many ships have only the minimal number of persons on board necessary to operate the ship; thus the incapacitation of even one seafarer may place a substantial additional burden on his shipmates.1.2.3Ships' officers generally receive basic first aid and other medical training, and ships are usually equipped with basic medical supplies. Nevertheless, it is often quite difficult to transport sick or injured seafarers ashore where they can be treated by qualified physicians. In some geographical areas, the closest medical care ashore may be well below the standard of the seafarer's home country. It is therefore inadvisable and often unsafe to allow persons with certain medical conditions to become seafarers or to return to seagoing employment.1.2.4Seafarers live close to each other at the sea, often for long periods. Contagious diseases therefore may be a serious threat, endangering not only the health of other seafarers but also the safety of the ship and passengers. It is particularly important that seafarers concerned with the preparation of food do not suffer from diseases which may be transmitted to others through their work.1.2.5Seafarers should be medically fit to perform their normal duties correctly and to be able to respond to emergency situations, for example, fighting fires, lowering lifeboats or assisting passengers.1.2.6Seafarers should be able to adjust to the often violent motions of the ship, live and work in sometimes cramped spaces, climb ladders, lift heavy weights and to withstand exposure to harsh weather conditions on deck or excessive heat in the machinery spaces. They should not suffer from conditions which are exacerbated by sea travel.1.2.7Seafarers should be able to live and work closely with the same people for weeks and perhaps months on end and under occasionally stressful conditions. They should be capable of dealing effectively with isolation from family and friends and, in some cases, from persons of their own cultural background.1.2.8Shipping operations and shipboard duties vary substantially. For a fuller understanding of physical demands of particular categories of work on board ship, the Approved Medical Practitioner should consult the employer.2.Procedures2.1Frequency of health assessments2.1.1All seafarers shall be assessed as to medical fitness for duties at sea as follows—(a)for seafarers less than 18 years of age, annually;(b)for seafarers between 18 and 54 years of age, twice-yearly;(c)for seafarers aged 55 years and above, annually with resting ECG (stress ECG, if in safety critical job and clinically indicated);(d)if there is a change in the medical condition of the employee;(e)after prolonged sickness leading to absence of three months or more due to injury or illness.2.2Information which goes to the Ministry and the seafarer confidentiality2.2.1The Ministry and the applicant or seafarer shall receive a copy of Medical Fitness Certificate.2.2.2The Approved Medical Practitioner shall keep all the medical examination forms, including results of investigations in a confidential file, for a period of least thirty years and such information shall not to be released to any person, agency or employer except as required by law.2.3Health assessment outcomes2.3.1An applicant or seafarer is either fit for the intended duties at sea or unfit.2.3.2The applicant or seafarer declared unfit may be temporarily or permanently unfit or may be fit for duties other than the intended duties.2.3.3If temporarily unfit, the Approved Medical Practitioner shall specify a minimum period after which the assessment can be reviewed.3. Forms
3.1Form for Medical Fitness CertificateThe form of the Medical Fitness Certificate is prescribed as Form 1 in Appendix 3 to these Regulations, 2001. Other forms that may be found useful are also attached herein.Part II – Medical standards
I. Overview
1.This section provides information and guidance on medical conditions which may affect individuals in the safe performance of their duties at sea.2.The medical standards attempt to be specific. The standards cannot cover every clinical situation and the Approved Medical Practitioner should exercise judgement in relation to the key objective - maintaining safety. For example, could the condition cause sudden loss of control of a ship, or sudden loss of consciousness when working at heights, or interfere with the performance of emergency duties?3.Approved Medical Practitioners should make a comprehensive medical assessment of overall health in the knowledge that errors or omissions of a critical task in some jobs can lead to serious consequences in terms of human health and life, environmental impact or major property loss.4.The critical time needed for treatment or access to appropriate land-based care is also a consideration when determining fitness.5.Approved Medical Practitioners should consider what medical conditions could increase the probability of poor performance of critical tasks, and the probability and severity of the consequences when determining "Is the applicant medically fit for duty at sea?"II. Infectious diseases
Gastro - Intestinal Infectious Diseases - D until satisfactorily treated. Special care should be taken in respect of catering staff.Other Infectious or Contagious Diseases - D until satisfactorily treated.Active Pulmonary TuberculosisWhen the examining doctor is satisfied, on the advice of a chest physician, that the lesion is fully healed and that the patient has completed a full course of chemotherapy, then re-entry should be considered. In such cases, Category "A(T)" would be appropriate initially to allow for adequate surveillance.Cases where either one or both lungs have been seriously affected are rarely suitable for re-employment. All relapsed cases should be B.Sexually Transmissible DiseasesAll cases of acute infection are D while under treatment. Cases under surveillance having finished treatment will usually be fit for normal service but restricted service may be necessary if facilities for supervision are inadequate. In all cases evidence of satisfactory tests of cure should be produced.AIDS - All confirmed cases - B.III. Malignant Neoplasms
Malignant Neoplasms - including Lymphoma, Leukaemia and similar conditions.Each case should be graded C on diagnosis. Later progression to Categories A, A (T), E or B should be dependent on assessment of progress, prognosis, measure of disability and the need for surveillance following treatment. No unrestricted A grading should be given within 5 years of completion of treatment, except in cases of skin cancer.IV. Endocrine and Metabolic Diseases
(1)Thyroid diseaseServing seafarers developing thyroid disease - D for investigation, then A. A (T), E or B on case assessment.(2)All other cases of endocrine disease in serving seafarers - D for investigation, upon which assessment will depend.(3)Diabetes Mellitus—(a)All cases requiring Insulin - B.(b)Serving seafarers whose diabetes is controlled by food restriction: an initial period of 6 months should be allowed to achieve stabilisation - C. Thereafter, to be subject to medical review at appropriate intervals. The current treatment regimen should be confirmed with the general practitioner at each review A(T).(c)Serving seafarers requiring oral hypoglycaemic agents: an initial period of six months should be allowed to achieve stabilisation - C. Thereafter, in the absence of any complications, service may be considered subject to six monthly medical reviews and assessment for suitable job and sea trade. A(T) on case assessment.(4)ObesityA degree of obesity, with or without complications, adversely affecting exercise tolerance, mobility or general health - D for treatment.Refractory or relapsing cases - B. V. Diseases of the Blood and Blood forming organs
There should not be any significant disease of the haemopoetic system. Unexplained or symptomatic anaemia - D. Then A, (T), E or B on case assessment.VI. Mental Disorders
(1)Acute Psychosis, whether organic, schizophrenic, manic depressive or any other psychosis listed in the International Classification of Diseases - B.(2)Alcohol Abuse (Dependency)If persistent and affecting health by causing physical or behavioural disorder - B.(3)Drug DependenceA history of abuse of drugs or substances within the last five years - B.(4)Psychoneurosis - D for assessment.Chronic or recurrent - B.VII. Diseases of the Nervous System and Sense Organs
(1)Organic Nervous Disease - Usually B. especially those conditions causing defect of muscular power, balance, mobility and co-ordination.Some minor localised disorders not causing symptoms of incapacity and unlikely to progress, may be A.(2)Epilepsy—(a)Any type of epilepsy since the age of five years - B.(b)A single fit in a serving seafarer - D for investigation. Then, providing that the past medical history is clear and investigation has shown no abnormality; re-entry can be considered after one year without treatment or after one year following the cessation of treatment.(c)A serving seafarer - not directly involved with the safety of the ship or of any passenger - with established epilepsy controlled, without fits, for a minimum period of two years, may be considered for service on a vessel carrying a medical officer - E.(d)Serving seafarer who have had cranial surgery or significant traumatic brain damage - C for twelve months - then A, B or E on case assessment.(3)Migraine - Slight infrequent attacks responding quickly to treatment - A. Frequent attacks causing incapacity - B.(4)Syncope and Other Disturbances of Consciousness - D for assessment. Recurrent attacks with complete or partial loss of consciousness should be B.(5)Meniere's Disease - B.(6)Speech defects - If likely to interfere with communication - B.(7)Ear—(a)Acute and Chronic Otitis External - D. Should be completely healed before returning to sea. Care is required in passing fit for tropics.(b)Acute Otitis Media - D. Until satisfactorily treated.(c)Chronic Otitits Media - D. May become A or E after satisfactory treatment or surgery. Special care is required in passing fit for tropics, where air travel is required or if the job involves food handling.(d)Loss of Hearing - A degree of impairment sufficient to interfere with communication - B.(e)Unilateral Complete Loss of Hearing in serving seafarers—(i)assessment of this condition should be considered in relation to the job;(ii)a serving seafarer in whom impaired hearing acuity is found should be referred for full investigation by an ENT surgeon.(f)Hearing Aids—(i)The use of a satisfactory hearing aid at work by certain catering department personnel could be considered where not hearing an instruction would not result in a danger to the seafarer or others. The hearing aid should be sufficiently effective to allow communication at normal conversational tones.(ii)The use of hearing aids by those working in, or associated with, the deck or engine room department, including electricians and radio officers, should not be permitted.VIII. Cardiovascular System
The Cardiovascular system should be free from acute or chronic disease causing significant disability.(1)Valvular disease—(i)causing significant impairment or having required surgery - B.(ii)satisfactorily treated patent ductus arteriosus or atrial septal defect could be accepted.(2)Hypertension—(a)All cases D for investigation.(b)Serving seafarers whose blood pressure can be maintained below 170/100 mm by ant hypertension therapy without significant side effect - A (T) to allow for health surveillance and to ensure that arrangements have been made for continuation of treatment.(3)Ischaemic heart disease—(a)A history of Coronary Thrombosis - B.(4)Other cardiovascular disordersAny clinically significant abnormality of rate or rhythm or disorder of conduction - B.(5)Cerebro-vascular diseases—(a)Any cerebro-vascular accident including transient ischaemic attacks - B.(b)General cerebral arteriosclerosis: including dementia and senility - B.(6)Diseases of ArteriesA history of intermitted claudication: including any case where vascular surgery was required - B.(7)Disease of Veins—(a)Varicose Veins—(ii)moderate degree without symptoms or oedema may be A, but with symptoms D for treatment;(iii)recurrent after operation, with symptoms C;(iv)for further surgical operation or, if not suitable for further treatment - B.(b)Chronic varicose ulceration - B.Thin unhealthy scars of healed ulcers or unhealthy skin of varicose eczema - B.Recurrent or persistent deep vein thrombosis or thrombophlebitis - B.(c)Haemorrhoids - not prolapsed, bleeding or causing symptoms - A. Other cases should be D until satisfactory treatment has been obtained.(d)Varicocoele - Symptomless - A. With symptoms - D or Surgical opinion.IX. Respiratory System
The respiratory system should be free from acute or chronic disease causing significant disability.(1)Acute Sinusitis - D. Until resolved.(2)Chronic Sinusitis - If disabling and frequently relapsing despite treatment - B.(3)Nasal Obstruction—(i)Septal abnormality or polyps - D.(ii)Until satisfactorily treated.A history of frequent sore throats or unhealthy tonsils with adenitis - D. Until satisfactorily treated.(4)Chronic Bronchitis and/or Emphysema - Class depends on severity. Mild uncomplicated cases with good exercise tolerance may be A, but cases with recurring illness causing significant disability in relation to the job should be B.(5)Bronchial Asthma - D for investigation. If confirmed - B.Except for a history of bronchial asthma resolving, without recurrences, before the age of 16.(6)Occupational Asthma - E to avoid the allergy.(7)PneumothoraxAll cases to be classified C for at least twelve months. With recurrences - B.X. Disease of the Digestive System
(1)Diseases of the Oral Cavity—(a)Mouth or gum infection - D until satisfactorily treated.(b)Dental defects - D until satisfactorily treated. Seafarers should be dentally fit.(2)Diseases of the Oesophagus, Stomach and Duodenum—(a)Peptic Ulceration - D for investigation.(i)Cases of proven ulceration should not return to seafaring until they are free from symptoms. The seafarer should have been on ordinary diet, without treatment, for at least three months - A (T).(ii)Where there has been gastro-intestinal bleeding, perforation or recurrent peptic ulceration (in spite of maintenance H2 blocker treatment) or an unsatisfactory operation result - normally B.(b)Recurrent attacks of Appendicitis - D pending surgical removal.(c)Hernia - D until repaired.(d)Diaphragmatic Hernia - To be assessed according to the disability.(e)Non-Infective Enteritis and Colitis.Severe or recurrent or requiring special diet - B.(3)Diseases of the Liver and Pancreas—(a)Cirrhosis of the liver - D for investigation, then where condition is serious or progressive or where complications such as oesophageal varices or ascites are present - B.(b)Biliary Track Diseases.After complete surgical cure - A or A(T) on case assessment.(c)Pancreatitis.Recurrent pancreatitis and all cases where alcohol is an aetiological factor - B.XI. Diseases of the Genito-Urinary Tract
(1)All cases of proteinuria, glycosuria or other urinary abnormalities should be referred for investigation—(a)Acute Nephritis - D until resolved.(b)Subacute or Chronic Nephritis or Nephrosis—(ii)E or B on case assessment.(2)Infections of kidney—(a)Acute urinary infection—(i)D until satisfactorily treated.(ii)Recurrent cases - B unless full investigation has proved satisfactory.(b)Renal or Ureteric Calculus—(i)D for investigation and any necessary treatment.(ii)An isolated attack of renal colic with passage of small calculus may be A after a period of observation, provided urine and renal function remain normal and there is no clinical and radiological evidence of other calculi.(iii)Recurrent stone formation - B.(c)Urinary Obstruction - from any cause - D for investigation, B if not remediable.(d)Removal of Kidney - in serving seafarers, provided the remaining kidney is healthy with normal function - A(T). Such cases may be unsuitable for service in the tropics or other conditions of high temperature - E.(f)Incontinence or Urine - D for investigation. If irremediable - B.(g)Enlarged Prostate - D for investigation.(h)Hydrocoele—(i)Small and symptomless - A.(ii)Large or recurrent D or, if untreated, B.(i)Abnormality of the Primary and Secondary Sexual Characteristics—D for investigation, upon which final assessment will rest.(3)Gynaecological ConditionsThere should be no gynaecological disorder or disease such as heavy vaginal bleeding, lower abdominal pain or prolapse of the genital organs likely to cause trouble on the voyage or affect working capacity.XII. Pregnancy
The doctor should discuss with the seafarer the implications of continuing to work at sea, particularly if it is a first pregnancy.A seafarer with normal pregnancy before the 28th week may be permitted to work on short haul trips or a long haul trip on a vessel carrying a doctor - E to allow for antenatal care.Employment shall not be permitted after the 28th week of pregnancy until at least six weeks after delivery.Abnormal Pregnancy, on diagnosis - C.XIII. Skin
Special care is required in passing fit for service in the tropics if there is a history of skin trouble. Catering staff in particular should have no focus on skin sepsis.Any condition liable to be aggravated by heat, sea, air, oil, caustics or detergents - or due to specific occupational allergens may be A(T), B, C, D or E on case assessment.(1)Infections of Skin—(a)Infections of Skin - D until satisfactorily treated.(b)Acne - Most cases A but severe pustular cystic acne - B.(2)Other Inflammatory Skin Conditions—(a)Atopic Dermatitis and related conditions - D until satisfactorily treated.(b)Contact Dermatitis - D. Refer for dermatological opinion.(c)Acute Eczema - D. No seafarer should return to duty until skin is healthy.Recurrent Eczema of more than minimum extent - B.(d)Psoriasis - Most cases can be A, but some widespread or ulcerates cases should be D for treatment. Severe cases resistant to treatment, frequently relapsing or associated with joint disease - B.XIV. Musculo-Skeletal System
It is essential that seafarers should not have defect of the musculo-skeletal system which might interfere with the discharge of their duties; muscular power, balance, mobility and co-ordination should be unimpaired.(1)Osteo-arthritis - D for assessment.Advanced cases where disability is present - B.Normally a limb prosthesis would not be acceptable.(2)Back painRecurrent incapacitating back pain - B.(3)Eyesight Standards—1.No person should be accepted for training or sea service if any irremediable morbid condition of either eye, or the lids of either eye, is present and liable to the risk of aggravation or recurrence.2.Binocular vision is necessary for all categories of seafarers. However, the following monocular seafarers should be allowed to continue at sea—(a)Seafarers in deck department employment with a satisfactory record of service prior to 1st August, 1998 and not requiring visual aids;(b)Seafarers in non-deck employment with a satisfactory record of service prior to 1st August, 1998.3.In all cases where visual aids (spectacles or contact lenses) are required for the efficient performance of duties, a spare pair must be carried when seafaring.Where different visual aids are used for distant and near vision a spare pair of each must be carried.4.The distant vision standard for the watch keeping deck department personnel is identical to the requirements of the letter test for applicants to enter the examination for a certificate of competency.5.The method of testing vision is by using a colour vision test where another method is used and results differ, the colour vision test method result is accepted as dominant.6.Colour vision for deck officers and ratings may be regarded as normal, when using the Ishihara method, if plates 1, 11, 15, 22 and 23 are read correctly.7.A seafarer, with a record of efficient service, who is required to pass the modified colour vision test but fails should be given the opportunity to pass a suitable trade test.Table 1 – Visual standards
| Distant vision |
|---|
| | Better eye | Other eye | Both eyes | Near vision | Colour vision | Visual fields |
|---|
| Deck department | Not less than | Not less than | Not less than | | | |
|---|
| 1. | 12 Seafarers required to undertake watch keeping duties: | N8 for charts, weather maps and N12 for other reading tasks with or without visual aids | Normal32 | Normal visualfields | | | |
| - With or without glasses or contact lenses43 | 6/6 | 6/9 | 6/6 | | | |
| - Unaided vision | 6/12 | 6/24 | 6/12 | Normal54 | | |
| 2. | Seafarers required to operate lifting plant e.g. ship's cranes, hoists: | | | | | | |
| - with or without glasses or contact lenses65 | 6/9 | 6/12 | 6/9 | N12 with or without visual aids | Distinguish red76 Distinguish red87 | Normal visualfield |
| - unaided vision | 6/12 | 6/60 | 6/60 | | | |
| 3. | Seafarers not required to undertake duties in 1 or 2: (aided vision if necessary) | N12 with or without visual aids | N/A | Sufficient visual field | | | |
2For seafarers who have proof of a satisfactory record of service, monocular vision is permitted excepting those seafarers who have to operate lifting equipment such as cranes.3See colour vision test.4In all cases, where visual aids (spectacles or contact lenses) are required for the efficient performance of duties, a spare pair must be carried when seafaring. When different visual aids are used for distant and near vision, a spare pair of each must be carried.5See colour vision test.6In all cases, where visual aids (spectacles or contact lenses) are required for the efficient performance of duties, a spare pair must be carried when seafaring. When different visual aids are used for distant and near vision, a spare pair of each must be carried.7It is sufficient if the applicant can distinguish red from other colours. See colour vision test.8It is sufficient if the applicant cand istinguish red from other colours. See colour vision test.| Engine room (includes electrician): (aided vision if necessary | 6/12 | 6/60 | 6/12 | N12 to read instruments, gauges on control panels | See colour vision test | Sufficient visual field |
| Catering department: aided vision allowed if necessary | 6/12 | 6/60 | 6/12 | N12 to read instructions and catering equipment control panels | Not required | Sufficient visual field |
Conduct of the tests
1.A sight test comprises a letter and a colour vision test taken in that order. The tests will be conducted under the strict personal supervision of a Sight Test Examiner who will keep a record of all mistakes made by the candidate both in the letter test and in the lantern test.2.Every candidate seeking admission to an examination for a first certificate of competency as a deck officer in the Merchant Navy or Fishing fleets must hold a sight test certificate showing that he has passed in both letter and lantern tests within the six months period preceding the date of the examination. For certificates of competency subsequent to the first a sight test certificate fulfilling the conditions in respect of the letter test only will be required.3.Candidates are cautioned that, when taking the lantern test, they should not attempt to hurry. They should satisfy themselves as to the colours of the lights shown before reporting them to the Examiner. The result of the test can only be judged by what the candidate reports; carelessness may cause failure and thus prevent the candidate from taking up a chosen career at sea.4.Candidates should be in good health when taking the test otherwise then vision may be impaired.5.Candidates other, than New Entrants may take the sight test with or without aids (conventional spectacles or contact) their option but candidates who opt to use aids for the letter or lantern or both must additionally reach a minimum standards in each eye without aids.A. Letter test
1.Conduct of letter test(a)The letter test is conducted by means of sheets of letters viewed indirectly at a distance of 6 metres from the eye. Each sheet contains 7 lines, the 3rd, 4th, 5th and 7th lines corresponding to standard 6/24, 6/18, 6/12, 6/9 and 6/6 respectively.(b)Candidates will be tested in each eye separately.2.Standard of vision required(a)A candidate who opt to take the test without aids will be required to read correctly down to and including line 7 with the better eye and down to and including line 6 with the other eye.(b)A candidate who opts to take the test using aids must first take the test without aids when he or she will be required to read correctly down to and including line 5 with the better eye and line 3 with the other eye. That candidate will then be tested with aids and will be required to read correctly down to and including line 6 with the other eye.3.Method of testing(a)The test sheets and the means of illumination are in accordance with BS 4274-1960 and are placed so that the centre of each sheet as viewed is at the height of eye of the average person in a sitting position. When the candidate is sitting in the correct position one of the sheets will be exposed and he will be asked to read the letters from left to right beginning at the top and going downwards.(b)If with aids or without aids or in both cases the candidates fails to reach the required standards an additional sheet will be given for each eye in that part or parts of the test in which he has failed.(c)If at the conclusion of the letter test the candidate is considered to have reached the required standard he will then proceed to the lantern test unless he holds a certificate of competency for which a lantern test recognised by the Government department or agency responsible for shipping should have been a condition for its issue.(d)If at the conclusion of the letter test the candidate is considered not to have reached the required standard: the examination will be broken off and may be taken on payment of a further fee after a period of not less than one month and a certificate of failure will be issued.(e)Failure to pass the letter test is due to a defect in vision which is sometimes curable. Whenever, therefore, a candidate fails to pass this test he will be advised to consult an ophthalmologist with a view to ascertaining the nature of the defect and whether it is curable.B. Colour vision test
1.Tests1.1The Ishihara pseudoisochromatic tests should be used to screen seafarers in the deck and engine departments for colour vision impairment. If the tests indicate impaired colour vision, further testing should be carried out.1.2In the case of persons in the deck department who are required to keep watches, the further test should use the Holmes-Wright Type B lantern test. This test may be conducted by some ophthalmologists in various hospitals.1.3In the case of persons in the engine department whose duties may include making electrical connections, the further test should be the UK Electricity Supply Industry Colour vision Trade Test.2.Ishihara Test2.1The Ishihara pseudoisochromatic tests (using either the full set of 38 plates or the abridged version of 24 plates) should be used.2.2A satisfactory response on all plates on the first showing, or a single wrong response on first showing which is corrected on a second or third showing, should be considered to indicate "Normal" colour vision. If the tests indicate impaired colour vision, further testing should be carried out.3.Holmes Wright Type B Lantern Test3.1The lantern test is a practical test of a person's ability, in conditions simulated to represent a watch keeping situation, to recognise and discriminate between navigation lights used at sea.3.2A lantern test is conducted by means of a Holmes/Wright type B lantern, which projects red, green and white lights viewed indirectly through a polished mirror at a virtual distance of 6 metres from the eyes. The large aperture of the lantern projects one coloured light at a time and the small apertures project 2 coloured lights side by side at a time. Each full circuit of the lantern contains 9 settings of single large aperture or 9 settings of small apertures. The small apertures of the lantern show any combination of 2 of the 3 colours.3.3A person who uses an aid to vision for a letter test is required to use the same aid to vision in the lantern test.3.4A person who does not use an aid to vision for a letter test is not permitted to use an aid to vision in the lantern test.3.5A person undergoing the lantern test must not wear a tinted aid to vision for the purpose of passing the test.3.6The lantern test must be conducted in a room from which daylight is excluded.3.7A person who requires to adapt to conditions of darkness is to be allowed up to 10 minutes complete or partial darkness in preparation for the lantern test.3.8A person is considered to have passed the lantern test if he correctly names the colours of one full circuit of large apertures, 4 full circuit of small apertures shown in sequence, and 9 sets of small apertures shown at random.3.9The procedures specified in 3.10 to 3.16 should be followed if a person undertaking the lantern test fails to achieve a pass in accordance with 3.8.3.10At the first mistake in naming a colour correctly, the examiner must inform the person being tested of the mistake and continue the test, adding a further circuit.3.11If no further mistake is made in the test and the further circuit, the person being tested will be considered to have passed.3.12If a second mistake is made, the procedure under 3.10 and 3.11 of this section is to be repeated.3.13If a third mistake is made, the test is to be repeated from the start after the person being tested has been given the opportunity to rest his eyes or regain composure.3.14In repeating the test under 3.13, the examiner is to record the result but not inform the person being tested of mistakes being made.3.15A person who in the repeated test under 3.13. correctly names all colours in accordance with 3.8 will be considered to have passed.3.16A mistake of red for green or green for red in the repeated test under 3.13 means failure of the lantern test.3.17A person who has failed the lantern test may request a further test.4Colour Vision Trade Test4.1When mistakes are made on the Ishihara pseudoisochromatic plates, this test should be used.4.2The applicant should sit opposite the Approved Medical Practitioner in good natural light. One at a time, each of the coloured wires should be placed in front of the applicant on a flat surface. The applicant should be asked to identify the colour of the wire. Slowness in answering indicates difficulties. Care must be taken that the applicant cannot compare the colour of one wire with others.4.3Applicants who wrongly identify a colour should be given an individual wire. The candidate should be asked to indicate when there is a match. All nine colours should be tested in this way.4.4Failure to find a correct match shows unreliable colour vision.4.5Matching colours correctly but wrongly identifying them singly, means mistakes will be made in identifying certain colours without comparing them with others.4.6The apparatus required isOne centimetre of coloured plastic covered wire is exposed on a white card housed in a photographic colour transparency slide, size 5 (5 cm), with a viewing window of 3.5 (2.5 cm). Two complete sets of colours are made up (18 slides), these being housed in a slide magazine.For matching purposes 9 individual wires are to be available, one in each colour, each 2.5 cm long.Nine colours are to be used: white, black, yellow, red, grey, blue, orange, green and brown.All wires used should have the same diameter, which should be in the range 0.8 to 1.1 mm. Wire of 0.89 mm diameter is preferred, if available.Hearing standard
1.Hearing is required for communication by radio, by telephone or person to person and therefore the critical frequencies are in the speech range 500 to 2,000 Hz. Hearing loss should be checked throughout the range of 500 to 3,000 Hz using a pure lone audio meter.2.The speech must be reasonably clear and free of stutter and hesitation sufficient to use radios and communicate on deck. Those using cranes must be able to hear whistle signals where these are used.| Table 2: Minimum standards of hearing for deck and engine departments |
|---|
| | Frequency |
| | 500 | 1,000 | 2,000 | 3,000 | 4,000 | 5,000 |
| dB loss in better ear with aids | 30 | 30 | 30 | 30 | 60 | 60 |
| dB loss in better ear without aids | 40 | 40 | 40 | 40 | - | - |
The conduct of the conversation test
4.The following is a recommended procedure for conduct of a conversation test.5.The test should be conducted in a quiet room with a stable background noise level. Hearing aids should be worn if normally used at work or in retesting following their fitting.6.The examiner should face the subject and address him from a distance of three metres for normal speech.7.The subject's eyes should be closed or covered to prevent lip reading.8.A normal conversation vocal volume should be used.9.The test material should be a mixture of alphabetical letters and numerals in any order, not exceeding a total of three in any one phrase, e.g. 6Y3, 2N4, S5G, 7BI.10.Ten combinations should be used, each preceded by the carrier phrase "PLEASE SAY".11.The subject should repeat what was thought to be heard. If uncertain guessing is encouraged.12.Six or more combinations should be repeated without error to be considered satisfactory.13.Applicants who do not pass this test should be referred for further assessment of functional hearing and speech discrimination by an audiologist.14.A functional hearing loss sufficient to interfere with communication or to impede safety (e.g. hearing audible warning devices) presents a high risk.Forms
Recommended forms are as follows:Medical Examination Request FormMedical Examination QuestionnaireApproved Medical Practitioner's ReportMedical Examination Request Form
Medical Examination Request: Work environment
| (To be read by Examining Doctor) |
|---|
| Work at sea may require physical effort within the limits set by applicable international health and safety legislation and awards. This may include exposure to: |
| Noisy work environmentCommunicating by radioHandling solvents, oils, grease or paintManual work e.g. lifting, pulling, reaching, shovellingProlonged sitting/standing | Climbing ladders (rope and steelWorking on confined spacesClose eye work:reading charts, diagrams, safety instructions, manualsusing a computer |
| Hot environment or cold environmentWorking at height up to 30 metresWorking near machineryClimbing on vessels and ships small craft | Colour vision to identity navigationlights, coloured wiresOperating ships, small vessels, cranes,forklifts, hoistsOperating hand tools and powered toolse.g. rattlegun, airhammerWork in areas remote from medical care |
| Job Grouping | Audio-gram | Spiro-metry | Resting ECG | Chest X-Ray | Vision Screening | Faecal specimen |
| All ships' crew | Needed | Needed | 55 years of age and over - Stress ECG, if clinically indicated | Drivers New entrants i.e. pre-sea | Needed | Not needed |
| Catering staff | Needed | Needed | 55 years and over | New entrants i.e. pre-sea | Needed | Needed |
| You will need the following equipment to conduct the medical examination: |
|---|
| height measure | audiometer |
| weight scales | Ishihara colour plates |
| stethoscope | Snellen's eye chart |
| tendon hammer | Times-Roman or Jaegar eye chart |
| tuning fork | sphygmomanometer |
| urine testing sticks (albumin, glucose, blood etc.) |
Medical Examination Questionnaire
Approved Medical Practitioner's Report
Appendix 2
Job task analyses
Table A Master/MateTable B Chief Engineer/Engineer/Electrician/Assistant EngineerTable C Ordinary seaman/Able seaman/wiper/oiler/Efficient general purpose ratingTable D Chief Cook/Cook/StewardTable E Catering Attendant and StewardTable A – Master/Mate
1.VisionRead instructionsRead instructions manualsRead chartsRead weather mapsDistinguish red/white/green navigation lightsDistinguish coloured light alarmsObserve aspect to other vesselsRead radar, GPS and other monitors (digital, analogue and graphic)Read computer screensIdentify navigation lights from beacons, buoys, lighthouse towers, other vesselsKeep watch for obstacles to navigationStanding watch-night vision and depth perception2.Hearings/speechGive/take instructionUse 2 - way radios and telephonesDistinguish different auditory alarms3.ConsciousnessAlert to changes in machinery vibration e.g. EnginesAlert to movements of other vesselsAlert to position of ship's ancillary craftInterpret complex information from digital, analogue and graphic computerised monitoring equipment e. g Radar, GPS, computerised charts, compassRespond to alarmsAlert to changes in weatherHigh level decision making in emergenciesResponsible for safety of ship's crew and safety of vesselAlert to movements and position of crew4.PhysicalClimb narrow, steep stairsClimb 3 metre rope ladders at seaClimb mastClimb steel rungs/laddersLift hatch coversFine motor skills to plot courses on charts, use keyboards on computer, rotate knobs, pull levers, push buttonsAssist with lifting, manual labour e.g. lifting cylinders, 25 litre drums etcCleaning maintenance of the bridge (wheelhouse)Place tags for safety checksClean own cabin, shower i.e. bending, reaching, scrubbing, and wiping (varies from ship to ship)Additional for supply vesselsHandle cargo on the back deck of a supply vesselHandle wires, chains and ropes during anchor handlingHook and unhook tows5.OtherWork shiftwork (4 or 12 hour watches)Occasional long hours of work (18+)Write report (log)Plan ship repairPlan work schedulesAway at sea for up to 6 months at a timeFit through escape hatchesWork at high temperature, humidity and/or in extreme cold & in storms/cyclones etcWear PPE - boots, overalls, hard hat, hearing protection and occasionally respiratorsOrder deck storesUse computers to write report, keep chart catalogueCheck radio equipment, liferaftsInspect oil, other cargo, ballast and water tanks and other confined spacesWork with heavy seas on deckWork in conditions involving heavy rolling and pitching of vesselTable B – Chief Engineer/Engineer/Electrician/Assistant Engineer
1.VisionRead gauges, dialsRead instruction manualNear vision for callipers and other instrumentsNear vision for identifying and using nuts, bolts, screw, pins etcAbility to distinguish basic colours to recognise coloured alarms and coloured wires2.Hearing/SpeechCommunicate by 2 - way radioHear alarms and pagerGive/takes instructions3.ConsciousnessAlert to alarms (visual and auditory)Respond to emergenciesAlert to position of ship's ancillary craftInterpret complex information from monitors and gauges on instrument control panels in engine room4.PhysicalLifting and carrying condenser coils, pipes, motors, pumps up to 35 kg - but can be carried by two personsLifting and carrying 25 kg containers of chemicalsUse lathes, circular saws, hand tools, grinders & pedestal drillWelding/oxy-cuttingFine manual dexterity in placing nuts, bolts screwsTurning valves, leversPushing button controlsClimbing steep stairways, steel rung ladders, rungs on masts and onto ship's craneStanding and walking most of shiftWorking in awkward posturesWorking in confined spacesWorking overheadClean own cabin, shower i.e. bending, reaching, scrubbing and wiping (varies from ship to ship)Additional for supply vesselsHandle cargo on the back deck of a supply vesselHandle wires, chains and ropes during anchor handlingHook and unhook tows5.OtherWork shift work (4 hour watches)write reports (log)Plan ship repairsPlan work schedulesAway at sea for up to 6 months at a timeFit through escape hatchesWork at high temperature, humidity and/or in extreme cold and in storms/cyclones etcWear PPE - boots, overalls, hard hat, hearing protection and occasionally respiratorsOrder engine room storesExposure to heat and fumesUse computers to write report, keep chart cataloguesSafe handling of chemicalsCheck radio equipment, liferaftsInspect water tanksWork in conditions involving heavy rolling and pitching of vesselTable C – Ordinary seaman/Able seaman/Wiper/Oiler/Efficient general purpose rating
1.VisionRead instruction, proceduresRead gauges, dialsRead labels on chemicalsDistance vision when operating small craft, crane, hoistSee navigation lights of other vessels, beacons, lighthouses etcDistinguish red/green coloured lightsDistinguish coloured light alarmsStand watches - night vision and depth perceptionNear vision for identifying shackles, markings on slings, bolts, nuts, screws etc.2.Hearing/speechGive/take instructionsHear whistles for crane/hoist movementsUser 2-way radioListen to machinery e.g. crane, LARCHear warning signals/alarmsUse hands free headset to communicate by radio in rough seas3.ConsciousnessAlert to movements of other persons operating machinery, ship's small craft and helicopterMonitor equipment including radar, digital and analogue read outs on gauges, GPS, compass, and generally assist officer on watch4.PhysicalManual dexterity to tie knots, splice rope, repair/use canvas tarpaulins, place slings use pliers, spanner & other hand toolsPulling knobs, levers, pushing buttons to operate crane, machinery, incineratorReaching and working overheadShovel ash from incinerator and lift bags of rubbish into incineratorLift storesLifting from deck to overhead to load ship's small craftClimbing ship's rope ladders (3 m) in rough seas, and steel rung ladders on towers (up to 30 m) whilst carrying ropes, light tool bagLifting weight up to 50 kg (two person lift)Lift cables, boxes, batteries, winches, hoists up to 40 kgUse powered tools, saws drills, rattleguns, chisel, sledgehammersMooring/ unmooring vesselsUse air/electric chain hoists pulling on ropes, chain, and pressing buttons on handled control boxCarpentry/shipwright dutiesStanding for long periods (3 hours)Clean, own cabin, shower i.e. bending, reaching, scrubbing, and wipingAdditional for supply vesselsHandle cargo on the back deck of vesselHandle wires, chains and ropes during anchor handlingHook handlingHook and unhook tows5.OtherWork at heightsWork in high temperature, humidity and/or in extreme cold. And in storms, cyclones etcLong work hours (up to 10 - 12 hours per day)Away at sea for up to 6 months at a timeFit though escape hatchesShift work when on 4 - hourly watchShip's fire and safety rounds - inspect all areas regularlyPlan work schedulesWear personal protective equipment e.g. Safety boots, earplugs or earmuffs, hard hat, gloves, overalls, safety spectacles and occasionally respiratorsExposure to paints, thinners, oils, antifoul, degreasersUse fire - fighting hoses, extinguishersWork in oil, other cargo, ballast and water tanks and other confined spacesWork in conditions involving heavy rolling and pitching of vesselTable D – Chief Cook/Cook/Steward
1.VisionNear vision for reading labels, menus, recipes, computer, instructions, orders for stores, invoices, telexes, faxesNear vision for cutting, slicing, cooking2.Hearing/SpeechGive/take instructionsUse telephones to contact providers, clientsCommunicate with ship's crew3.ConsciousnessAlert to movements of persons in kitchen because of hot food in saucepans and traysAlert to position of deep fryers, cooking pots, pans especially in rough weatherAlert to hazards on ship e.g. fire etc4.PhysicalLifting, carrying, unpacking stores from gangway or forehead store spaceUnpack and place stores on shelves in fridge's and freezers from floor height to shoulder heightUnpack cartons each trip e.g. soft drinks, cans, foodstuffs, and cleaning gearCleaning pots and utensilsWiping benches, stove topsCleaning kitchen and laundries - mopping, scrubbingScrub mats out of fridgePolish passagewaysStanding for long period (3 hours)Fine manual dexterity to use kitchen utensils, knives and to turn knobs, flick switches on ovens, hot plates and appliancesClean own cabin, shower i.e. bending, reaching, scrubbing, and wipingCleaning grease traps and tanksCleaning ovens and deep freezersNarrow stairways5.OthersOrder all food provisionPlan menusCooking all meals for all persons on boardWork split shifts with early starts plus additional hours for administration and other paperworkAway at sea for up to 6 months at a time although calling in at various ports during the voyageFit through escape hatchesUse a computerWear safety footwearWork in conditions involving heavy rolling and pitching of vesselCleaning ovens and deep freezersNarrow stairwayTable E – Catering Attendant and Steward
1.VisionNear vision for:reading labelsreading instructionscleaning floorssurfaces etc.Distinguish coloured lights/indicator lights on galley range2.Hearing/speechGive/take instructionsHear alarmsCommunicate with ship's crew and passengers3.ConsciousnessAlert to movements of other persons in kitchen, pantry because of hot saucepan, food trays etc.4.PhysicalGeneral interior cleaning of ship e.g. PortholesDaily vacuum of mess roomPolishing mess room twice weekly and other floors weekly (3 levels in all)Lifting, carrying, unpacking storesCarrying hot trays and stocking pantryLifting floor polishing machine (24 kg) up stairs (2 person)Mopping, sweeping and/or vacuumingWiping and scabbing benches, deckheads, bulkheadsWashing dishes/pans in sink at waist heightLoad/empty dishwasher - bending requiredWashing drying crew's bed linen and towels on crew change dayOccasional cleaning of cabins when passengers are on boardKeeping washroom toilets clean on all levelsClean own cabin, i.e. bending, reaching, scrubbing, and wipingVacuum all carpet areas5.OthersAssist cook in food preparation as requiredWork split shifts with early morning startsAway at sea for up to 6 months at a time although calling into various ports during the voyageFit though escape hatchesWear safety footwearWork in conditions involving heavy rolling and pitching of vesselTake an active role in all vessel safety and emergency drillsTake an active role in crisis management in emergenciesAppendix 3
Forms
