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LEGAL ACTS OF THE REPUBLIC OF LATVIA
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Text consolidated by Valsts valodas centrs (State Language Centre) with amending regulations of:

20 December 2016 [shall come into force from 1 January 2017].

If a whole or part of a paragraph has been amended, the date of the amending regulation appears in square brackets at the end of the paragraph. If a whole paragraph or sub-paragraph has been deleted, the date of the deletion appears in square brackets beside the deleted paragraph or sub-paragraph.


Republic of Latvia

Cabinet
Regulation No. 273

Adopted 3 June 2014

Regulations Regarding the Medical Fitness of Seafarers for Work on a Ship

Issued pursuant to
Section 29, Paragraph two and three of the Maritime
Administration and Marine Safety Law

I. General Provisions

1. This Regulation prescribes:

1.1. the procedures for the medical examination of a seafarer and a person planned to be enrolled or matriculated in a professional education programme after the acquisition of which a document certifying the qualification of the seafarer may be received (hereinafter - the applicant for qualification of a seafarer);

1.2. procedures for the issuance of an opinion of a medical practitioner of seafarers on the medical fitness of seafarers for work on a ship (hereinafter - the opinion);

1.3. criteria by which the medical fitness of a seafarer and the applicant for qualification of a seafarer for work on a ship is determined during medical examination.

[20 December 2016]

2. The Regulation shall apply to a person who is getting ready for acquiring a qualification certificate for work on a ship in accordance with the requirements of the laws and regulations regarding certification of seafarers or who is employed or willing to start working on a ship which participates in international navigation, and to the applicant for qualification of a seafarer (hereinafter - the applicant).

[20 December 2016]

3. The Regulation shall not apply to the staff serving on a warship or another ship of State service not related to commercial activity.

4. Medical examinations shall be performed and opinions shall be issued by a medical practitioner of seafarers recognized by the Registry of Seamen of the Maritime Administration of Latvia (hereinafter - the Registry of Seamen) (hereinafter - the recognized medical practitioner) in accordance with the requirements of the International Convention on Standards of Training, Certification and Watchkeeping for Seafarers, 1978, as amended (hereinafter - the STCW Convention), and the Maritime Labour Convention, 2006.

5. If a seafarer or a fisherman is not involved in international navigation and the requirements of the STCW Convention do not apply to him or her, the initial and any regular medical examination may be performed by a certified medical practitioner in occupational health and occupation diseases which issues a document regarding the medical fitness of the relevant seafarer or fisherman for work on a ship. Medical examination shall be performed every 24 months.

6. The recognized medical practitioner shall provide the following opinions:

6.1. a medical certificate of the medical fitness of a seafarer for work on a ship (hereinafter - the medical certificate) (Annex 1);

6.2. a declaration on insufficient medical fitness of a seafarer for work on a ship (hereinafter - the declaration on insufficient fitness) (Annex 2);

6.3. a statement regarding sufficient medical fitness of a person for work on a ship in the selected speciality (hereinafter - the statement) (Annex 2.1 ).

[20 December 2016]

7. The applicant for a medical certificate shall have attained at least 16 years of age.

[20 December 2016]

II. Term of Validity of a Medical Certificate and the Statement

[20 December 2016]

8. The term of validity of the medical certificate shall not exceed 24 months.

[20 December 2016]

9. The term of validity of the medical certificate shall not exceed 12 months, if it has been issued to:

9.1. a person under 18 years of age or a person who undergoes the initial medical examination after attaining 18 years of age;

9.2. a person for work in the catering department or a person whose job is related to any stages of the food circulation.

[20 December 2016]

10. The term of validity of the medical certificate may be shorter than the maximum time period referred to in Paragraphs 8 and 9 of this Regulation, if the recognized medical practitioner substantiates it with the applicant's health problem that has been ascertained.

[20 December 2016]

11. If the validity of the medical certificate expires during the course of a voyage, the medical certificate shall be valid until the next port of call where it is possible to undergo medical examination by the recognized medical practitioner but not for more than three months after the validity of medical certificate has expired.

11.1 The statement shall be valid for submission to the educational institution for 12 months after the date of its issuance.

[20 December 2016]

III. Procedures and Criteria for Medical Examination

[20 December 2016]

12. When performing the initial and any regular medical examination of the applicant, the recognized medical practitioner shall take into account the Guidelines on the medical examinations of seafarers by the International Labour Organisation (ILO) and International Maritime Organisation (IMO) and its subsequent issues.

13. Prior to medical examination, the recognized medical practitioner shall verify the identity of the applicant according to the applicant's personal identity document or seaman's discharge book.

14. When taking the initial medical examination, the applicant shall submit to the recognized medical practitioner:

14.1. an extract from the personal outpatient card on any sustained diseases and injuries or the statement from his health record;

14.2. a psychiatrist's opinion on the person's health condition;

14.3. a narcologist's opinion on the person's health condition;

14.4. a vaccination passport and an international certificate of vaccination or prophylaxis, if any.

15. The applicant shall deliver the previously issued medical certificate, if any, to the recognized medical practitioner and fill in the personal declaration of form of seafarer's health examination (Annex 3, Section A). The applicant shall sign the declaration in the presence of the recognized medical practitioner and it shall remain with the recognized medical practitioner.

[20 December 2016]

16. The applicant's eyesight shall be examined in accordance with the minimum eyesight standards for seafarers indicated in Annex 4 and the following conditions:

16.1. distance vision shall be tested according to the Snellen chart or equivalent thereof;

16.2. near vision shall be tested using the reading test.

17. The applicant's ability to distinguish colours shall be examined at least once every six years by using the Ishihara colour plates or equivalent thereof.

18. The applicant's hearing shall be examined by taking into account the following conditions:

18.1. hearing shall be examined with the pure tone audiometer;

18.2. it is prohibited to use any hearing aids during such test;

18.3. the applicant's hearing ability shall be of no less than 30 dB in one (the more capable) ear and of no less than 40 dB in the other ear, if the frequencies are 500, 1000, 2000 and 3000 Hz;

18.4. any member of the deck department shall be able to hear a whispering speech from a distance of no less than three metres.

19. If the required level of visual acuity can only be reached with the help of glasses or contact lenses, or if the required level of hearing can only be reached with the help of hearing aids, the applicant shall be obliged by the recognized medical practitioner to wear those aids while at work, and to keep the relevant aids and a reserve set thereof on board of the ship.

20. The recognized medical practitioner shall assess:

20.1. whether the applicant suffers from any of the medical conditions referred to in Annex 5 to this Regulation;

20.2. conformity of the applicant's level of physical fitness to the requirements referred to in Annex 6 to this Regulation;

20.3. whether the applicant takes any medication having side effects which reduce the ability to judge, the sense of balance, or any other abilities necessary for effective and safe fulfilment of routine duties and performance of emergency functions on board the ship, or which may endanger safety on board the ship.

21. The following tests and analyses shall be carried out with regard to the applicant for the medical certificate: physical examination, electrocardiography, full blood count, urine test, serological test for syphilis, serological tests for hepatitis B and HIV, chest roentgenogram and blood glucose level measurements. In order to work on a tanker vessel carrying hazardous chemical substances, tests for measuring the level of ALT (alanine aminotransferase) and AST (aspartate aminotransferase) in blood shall, in addition, be taken. A person who works in a catering department or a person whose job is related to any of the stages of food circulation shall, in addition, take tests for the detection of salmonellosis.

[20 December 2016]

21.1 The following tests and analysis shall be carried out with regard to the applicant for the statement: physical examination, clinical blood count, urine test, chest roentgenogram.

[20 December 2016]

22. The applicant for the medical certificate must be vaccinated by taking into account the potential trading area and validity term of his or her employment contract.

[20 December 2016]

22.1 If during the last six months, upon providing health care services to the applicant for the statement, the examinations referred to in Paragraphs 16, 17, and 18 of this Regulation, as well as a chest roentgenogram have been carried out or during the last three months the clinical blood count and a urine test have been carried out, the applicant for the statement is entitled to submit the results of the abovementioned examinations to the recognized medical practitioner. The recognized medical practitioner has an obligation to accept and evaluate the results of examinations.

[20 December 2016]

23. The recognized medical practitioner shall record the results of the medical examination into the form of seafarer's health examination (Annex 3, Section B).

IV. Issuance and Validity of Opinion, and Circulation of Information

24. The recognized medical practitioner shall fill in Section C of the form of seafarer's health examination (Annex 3) by taking into account:

24.1. the conformity of the applicant's health condition to the requirements of this Regulation;

24.2. whether the applicant has had or has any medical conditions referred to in Annex 5 to this Regulation;

24.3. specific nature of the work, living and working conditions on a ship, and other significant factors;

24.4. the applicant's length of service on board the ship.

25. Medical certificate with limitations or restrictions which do not prevent the seafarer from effective and safe performance of routine duties and emergency functions may be issued to the applicant.

26. If the health condition of the person (except for the applicant for qualification of a seafarer) does not conform to the requirements of this Regulation, the recognized medical practitioner shall issue the declaration on insufficient fitness and inform the relevant person thereof. The recognized medical practitioner shall, within one working day after issuance of the declaration, submit a copy of the declaration on insufficient fitness to the Registry of Seamen.

[20 December 2016]

27. If any medications must be taken during the term of validity of the medical certificate, the recognized medical practitioner shall issue a document to the applicant regarding the need to use medicinal products and a description of medicinal products. If the medication contains any narcotic or psychotropic substances, the document shall be issued in accordance with the requirements of laws and regulations regarding the procedures for circulation of narcotic and psychotropic substances and medication. The seafarer shall take the said document on a ship in order to present it to any officials, if necessary.

[20 December 2016]

28. If a seafarer has a valid medical certificate, he or she has the obligation to notify the recognized medical practitioner within 15 days from ascertaining the following conditions:

28.1. the seafarer has suffered from the incapacity to work for more than 30 days;

28.2. the seafarer has been repatriated from the ship due to medical reasons;

28.3. the seafarer is aware that his or her health condition may endanger health or safety of other persons on a ship or his or her health condition does not conform to the requirements determined for work on a ship.

29. If the recognized medical practitioner is aware of setting in of the circumstances referred to in Paragraph 28 of this Regulation, he or she has an obligation to evaluate the information and, if necessary:

29.1. to carry out a medical examination of the seafarer in conformity with the following conditions:

29.1.1. if the seafarer has turned to the recognized medical practitioner who has issued the medical certificate, the recognized medical practitioner has the right to perform a medical examination only in relation to the problem indicated by the seafarer. If it has been ascertained after the said examination that the seafarer's health condition conforms to the requirements determined for work on a ship, the validity period of the last issued medical certificate shall be considered the validity period of the medical certificate;

29.1.2. if the seafarer has turned to another recognized medical practitioner, the seafarer shall undergo medical examination in accordance with the requirements of this Regulation and a new opinion shall be issued;

29.2. to issue the declaration on insufficient fitness if the seafarer has not turned to the recognized medical practitioner and the recognized medical practitioner establishes that the health condition of the seafarer may endanger the health or safety of other persons on a ship or if the health condition of the seafarer does not conform to the requirements laid down for work on a ship.

[20 December 2016]

30. The medical certificate may not contain deletions, obliterations, corrections or additions.

[20 December 2016]

31. The Registry of Seamen shall inform the recognized medical practitioner on any received declarations on insufficient fitness in order to prevent the cases when the applicant hides his or her health problems during repeated medical examination.

32. The applicant which has received the medical certificate with limitations or restrictions or the declaration on insufficient fitness has the right to undergo one repeated medical examination at another recognized medical practitioner. If necessary, during the repeated medical examination the recognized medical practitioner shall identify the reason for the limitation or restriction indicated in the medical certificate or for the issuance of the declaration on insufficient fitness.

33. The medical certificate or declaration on insufficient fitness shall cease to be in effect if a new medical certificate or declaration on insufficient fitness has been issued to the person.

[20 December 2016]

34. The recognized medical practitioner shall ensure the storage and record-keeping of the medical documentation related to medical examinations and issued opinions.

35. Any applicant shall be provided access to his or her medical documentation. The recognized medical practitioner has an obligation to inform the applicant of this right.

36. The recognized medical practitioner shall, within one working day after the issuance of the opinion, provide the Registry of Seamen with the following information:

36.1. the name, surname, and date of birth of the recipient of the opinion;

36.2. the number, date of issuance and validity term of the opinion;

36.3. the fitness for work in deck, engine, catering or other department;

36.4. the ascertained limitations or restrictions, if any.

V. Closing Provisions

37. Cabinet Regulation No. 374 of 8 July 2003, Procedures for Determination of Medical Fitness of Seafarers for Work on a Ship and Criteria for Conformity Determination (Latvijas Vēstnesis, 2003, No. 105; 2005, No. 92; 2008, No. 92), is repealed.

38. Any seafarer's medical examination reports/certificates and declarations on insufficient fitness issued prior to the day of coming into force of this Regulation shall be valid until the expiry of the validity period thereof.

Informative Reference to the European Union Directives

This Regulation contains legal norms arising from:

1) Directive 2008/106/EC of the European Parliament and of the Council of 19 November 2008 on the minimum level of training of seafarers;

2) Directive 2009/13/EC of the Council of 16 February 2009 implementing the Agreement concluded by the European Community Shipowners' Associations (ECSA) and the European Transport Workers' Federation (ETF) on the Maritime Labour Convention, 2006, and amending Directive 1999/63/EC;

3) Directive 2012/35/EC of the European Parliament and of the Council of 21 November 2012 amending Directive 2008/106/EC on the minimum level of training of seafarers.

Prime Minister Laimdota Straujuma

Minister for Transport Anrijs Matīss

 

Annex 1
Cabinet Regulation No. 273
3 June 2014

(1st side)

Latvijas
Jūras administrācija

Lesser State coat of arms

Maritime Administration
of Latvia


JŪRNIEKA MEDICĪNISKAIS SERTIFIKĀTS Nr.
SEAFARER'S MEDICAL CERTIFICATE No.

_________________________
   
Vārds(-i)
(Name(-s))
Uzvārds
(Surname)
Pārbaudīts identifikācijas dokuments:
(Identification document checked:
pase/
passport
personas apliecība/
identity card
jūrnieka grāmatiņa Nr.
seaman's discharge book No.)
Dzimšanas datums (Date of birth) Valstspiederība (Nationality) Dzimums (Gender)

Vīrietis Sieviete
(Male) (Female)

_______________________________________ (dd.mm.gggg)
(dd.mm.yyyy)
Dzirde atbilst standartiem, kas noteikti STCW kodeksa A-I/9 iedaļā
(Hearing meets the standards in section A-I/9 of STCW code)
(Yes) (No)
Dzirde bez palīglīdzekļiem ir apmierinoša (Unaided hearing satisfactory) (Yes) (No)
Redzes asums atbilst standartiem, kas noteikti STCW kodeksa A-I/9 iedaļā
(Visual acuity meets standards in section A-I/9 of STCW code)
(Yes) (No)
Krāsu redze atbilst standartiem, kas noteikti STCW kodeksa A-I/9 iedaļā
(Colour vision meets standards in section A-I/9 of STCW code)
(Yes) (No)
Krāsu redzes pēdējās pārbaudes datums (Date of the last colour vision test) _______________________________ (dd.mm.gggg)
(dd.mm.yyyy)
Bez veselības problēmām, kas var saasināties reisa laikā vai kuru dēļ jūrnieks var kļūt nepiemērots savu pienākumu pildīšanai vai apdraudēt citu uz kuģa esošo personu veselību
(Free from any medical condition likely to be aggravated by service at sea or to render the seafarer unfit for such service or to endanger the health of other persons on board)
(Yes) (No)
Nepieciešams lietot medikamentus reisa laikā
(Needs to take medication during service at sea)
(Yes) (No)
Piemērots(-a) navigācijas sardzes un novērošanas pienākumu pildīšanai
(Fit for navigational watch and look-out duties)
(Yes) (No)
Nepieciešamas brilles vai kontaktlēcas
(Spectacles or contact lenses required)
(Yes) (No)
Atbilst darbam (nepiemērojamo izsvītrot) (Fit for duty within (delete which do not apply)): 
klāja komandā
(deck department)
 mašīntelpas komandā
(engine department)
 ēdināšanas komandā
(catering department)
 cits (norādīt)
(other (specify)) _____________
Veselības atbilstības ierobežojumi (piemēram, īpašu pienākumu izpilde, kuģošanas rajons un/vai ilgums, kuģa tips)
(Limitations or restrictions on fitness (e.g. specific duties, trading area and/or duration, type of ship))
 
(No)
(norādīt ierobežojumus)
(Yes (specify limitations or restrictions))
Veselības pārbaudes datums
(Date of health examination)
Ārstniecības iestādes nosaukums, adrese, kontaktinformācija un oficiālais zīmogs
(Issuing authority's name, address, contact information and official stamp)
 
(dd.mm.gggg) (dd.mm.yyyy)
Sertifikāta derīguma termiņš
(Expiry date of certificate)
(dd.mm.gggg) (dd.mm.yyyy)
Jūrnieka paraksts
(Seafarer's signature)

Valsts akciju sabiedrības "Latvijas Jūras administrācija" Jūrnieku reģistra atzītā jūrnieku ārsta paraksts un zīmogs
(Signature and stamp of medical practitioner recognized by the Registry of Seamen of the State stock company "Maritime Administration of Latvia")

Z. v.

Šis medicīniskais sertifikāts ir izdots saskaņā ar 1978. gada Starptautisko konvenciju par jūrnieku sagatavošanu un diplomēšanu, kā arī sardzes pildīšanu ar grozījumiem un 2006. gada Konvenciju par darbu jūrniecībā. Medicīnisko sertifikātu var apstrīdēt atbilstoši nacionālo normatīvo aktu prasībām.
This certificate is issued in accordance with the International Convention on Standards of Training, Certification and Watchkeeping for Seafarers, 1978, as amended and Maritime Labour Convention, 2006. Medical certificate may be appealed in accordance with the national legislation.

(2nd side)

SVARĪGA INFORMĀCIJA
IMPORTANT INFORMATION

1. Parakstot šo medicīnisko sertifikātu, jūrnieks apliecina, ka medicīniskās pārbaudes laikā jūrnieku ārstam ir sniedzis patiesu informāciju par savu veselības stāvokli, ciktāl viņam tā ir zināma, un ir informēts par medicīniskā sertifikāta saturu.
(By signing this medical certificate a seafarer is confirming that he (she) has provided true information to the best of his (her) knowledge about the state of his (her) health to the recognized medical practitioner and he (she) is informed of the content of the medical certificate.)

2. Strādājot uz kuģa, jūrnieka rīcībā jābūt medicīniskā sertifikāta oriģinālam, lai apliecinātu sava veselības stāvokļa atbilstību darbam uz kuģa. Nākamās veselības pārbaudes laikā šis medicīniskais sertifikāts ir jānodod jūrnieku ārstam, kurš veic veselības pārbaudi.
(A seafarer must retain the original of this certificate as evidence of medical fitness while serving on board of ship. This certificate must be surrendered to the recognized medical practitioner when attending next medical examination.)

3. Ja jūrnieks nepieciešamo redzes asumu var sasniegt tikai ar brillēm vai kontaktlēcām vai nepieciešamo dzirdes līmeni var sasniegt tikai ar dzirdes palīglīdzekļiem, jūrnieka pienākums ir izmantot minētos palīglīdzekļus darba laikā un uz kuģa glabāt attiecīgo palīglīdzekļu un to rezerves komplektu.
(If required visual acuity can only be achieved with glasses or contact lenses or required hearing capacity can only be achieved with hearing aids, a seafarer must use these aids while performing his (her) duties and keep on board of ship a spare set of those aids and their consumables.)

4. Ja pretendentam kuģa reisa laikā ir jālieto medikamenti, jūrnieku ārsts pretendentam izsniedz dokumentu par zāļu lietošanas nepieciešamību un zāļu aprakstu. Ja medikamenti satur narkotiskās un psihotropās vielas, dokumentu izsniedz saskaņā ar normatīvo aktu prasībām par narkotisko un psihotropo vielu un zāļu aprites kārtību. Minētais dokuments jūrniekam jāņem līdzi uz kuģa, lai, ja nepieciešams, to uzrādītu kompetentām amatpersonām.
(If a seafarer needs to take medication during service at sea, he (she) must carry on board of ship documentation for use of medication and description of the medication issued by the recognized medical practitioner to show it to any officials if necessary. If medication contains narcotic and psychotropic substances, the document must be issued in accordance with the statutory requirements of procedures for the legal trade of narcotic and psychotropic substances and medicinal products.)

5. Ja šī medicīniskā sertifikāta derīguma termiņa laikā jūrniekam ir iestājusies darbnespēja, ilgāka par 30 dienām, vai jūrnieks medicīnisku iemeslu dēļ ir repatriēts no kuģa, vai jūrniekam ir zināms, ka viņa veselības stāvokļa dēļ var tikt apdraudēta citu personu veselība vai drošība uz kuģa, vai jūrnieka veselības stāvoklis neatbilst prasībām, kas noteiktas darbam uz kuģa, viņa pienākums ir 15 dienu laikā no attiecīgās problēmas konstatēšanas brīža ziņot par to jūrnieku ārstam (vēlams - tam ārstam, kurš ir izsniedzis šo medicīnisko sertifikātu).
(If during validity of this medical certificate a seafarer has suffered more than 30 days incapacitation or seafarer has been repatriated from the ship due to medical reasons, or seafarer is aware that he (she) is no longer medically fit for duty or his (her) health condition may endanger health or safety of other persons on board, it is seafarer's responsibility to notify a recognized medical practitioner (preferably the one who issued this medical certificate) within 15 days from the occurrence of the mentioned cases.)

Minister for Transport Anrijs Matīss

 

Annex 2
Cabinet Regulation No. 273
3 June 2014

Deklarācija par jūrnieka veselības stāvokļa neatbilstību darbam uz kuģa
Declaration on Insufficient Medical Fitness of a Seafarer for Work on a Ship

Vārds(-i)
Name(s)
________________________________
Uzvārds
Surname
_______________________
Dzimšanas datums
Date of birth
________________
Personas kods
Identity number
      -     
Adrese 
Domicile
___________________________________________________________________
Jūrnieka veselības stāvoklis neatbilst prasībām, kas noteiktas darbam uz kuģa: 
Seafarer is not medically fit for work on a ship:
pilnīgi
completely
________
uz nenoteiktu laiku
for an unspecified period
________
uz noteiktu laiku*
for a specified period
* ________
  (norādīt datumu) (indicate the date)
* Uz laiku, līdz kuram var tikt noskaidroti īpaši medicīniskie rādītāji, vai minimālais termiņš, līdz kuram var būt pilnīgi izārstēti noteiktie simptomi.
* Up to a time, when certain medical indicators will be ascertained, or the minimum time required to completely cure the respective symptoms.
Deklarācijas izsniegšanas datums
Date of issuance of the Declaration
____________________________
Ārstniecības iestādes nosaukums, adrese, kontaktinformācija un oficiālais zīmogs 
Issuing authority's name, address, contact information and official stamp
 
Jūrnieku ārsta vārds(-i), uzvārds 
Recognized medical practitioner's name(s) and surname
_____________________
Jūrnieku ārsta paraksts
Recognized medical practitioner's signature
_________________________

Z.v
Stamp

Deklarācijas oriģināls tiek izsniegts jūrniekam, viena kopija tiek nosūtīta Jūrnieku reģistram, otra kopija paliek jūrnieku ārsta glabāšanā. Deklarāciju var apstrīdēt atbilstoši nacionālo normatīvo aktu prasībām.
The original of this Declaration shall be issued to a seafarer, one copy shall be sent to the Registry of Seamen and the recognized medical practitioner shall keep other copy. The Declaration may be appealed in accordance with the national legislation.

Minister for Transport Anrijs Matīss

 

Annex 2.1
Cabinet Regulation No. 273
3 June 2014

[20 December 2016]

STATEMENT No. ____________________
regarding sufficient medical fitness of a person for work on a ship in the selected speciality

Name(s) ________________________________________________________________________
Surname(s) ______________________________________________________________________
Date of birth

__________________________________________________________________________________________________________________________
(dd. mm. yyyy)

Personal identity document (passport or identity card)

Passport No. ___________________________________ Identity card No. _____________________________________________

Medical examination of a person has been carried out in accordance with the procedures and criteria for the medical examination of a person who is planned to be enrolled or matriculated in a professional education programme after acquisition of which a document certifying qualification of the seafarer may be received laid down in Cabinet Regulation No. 273 of 3 June 2014, Regulations Regarding the Medical Fitness of Seafarers for Work on a Ship.

OPINION

The health condition of a person conforms / does not conform for work on a ship in the selected speciality(if it conforms - mark the corresponding speciality and delete the inapplicable ones; if it does not conform - delete all specialities):

ship navigation speciality (including deck rating speciality)

marine engineering or marine electrical automation speciality (including the speciality of an engine rating, an electro-technical rating, a refrigeration engineer, a fitter, a turner, and a welder)

other speciality (indicate) _____________________________________________________________________________________
Date of issuance of the statement

__________________________________________________________________________________________________________________________
(dd. mm. yyyy)

The statement is valid for submission to the educational institution for 12 months after the date of its issuance
Issuing authority's name, address, contact information and official stamp  
Recognized medical practitioner's name(s) and surname(s)

___________________________________________________________________________

Recognized medical practitioner's signature __________________________________________________________________ Place for a seal

 

Annex 3
Cabinet Regulation No. 273
3 June 2014

[24 December 2016]

JŪRNIEKA VESELĪBAS PĀRBAUDES LAPA

Form of Seafarer's Health Examination

KONFIDENCIĀLI/CONFIDENTIAL

Vārds(-i), uzvārds
Name(s), surname ___________________________
Dzimšanas datums
Date of birth ____________________
Dzimums V/S
Gender M/F ______
Dzīvesvietas adrese
Domicile ___________________________________________________
Kuģa tips
Type of ship _______
Identifikācijas dokuments:
Identification document:
pase/
passport/
personas apliecība/
identity card/
jūrnieka grāmatiņa Nr.
seaman's discharge book No. _____
Komanda (klāja/mašīntelpas/radiosakaru/ēdināšanas/cita):
Department (deck / engine / radio / catering / other): _________________
Kuģošanas rajons
Trading area _______________

A. Personiskā deklarācija (ja nepieciešams, aizpilda ar medicīnas personāla palīdzību)

A. Examinees personal declaration (assistance offered by medical staff if necessary)

Vai jūs esat kādreiz saskāries ar kādu no norādītajām veselības problēmām?
(Have you ever had any of the following conditions?)

Veselības problēma
Condition


Yes


No

Veselības problēma
Condition


Yes


No

1. Acu/redzes problēmas
(Eye/vision problems)
    10. Nieru/uroģenitālās slimības
(Kidney/genital disorder)
   
2. Sirds-asinsvadu slimībass
(Heart, blood vessel problems)
    11. Kaulu/locītavu/muskuļu sistēmas slimības
(Bone/joint/muscle problems)
   
3. Plaušu slimības
(Lung diseases)
    12. Ausu/kakla/deguna slimības
(Ear/nose/throat diseases)
   
4. Gremošanas trakta slimības
(Digestive disorder)
    13. Operācijas/bruka
(Operations/hernia)
   
5. Vairogdziedzera slimības
(Thyroid problems)
    14. Neiroloģiskas slimības
(Neurological diseases)
   
6. Asins/asinsrades orgānu slimības
(Blood/blood forming organs disorders)
    15. Psihiskas problēmas, atmiņas traucējumi
(Psychiatric problems, loss of memory)
   
7. Ādas slimības/alerģijas
(Skin problem/allergies)
    16. Pašnāvības mēģinājums
(Attempted suicide)
   
8. Infekcijas
(Infections)
    17. Grūtniecība
(Pregnancy)
   
9. Diabēts
(Diabetes)
         
Papildjautājumi (Additional questions)


Yes


No

18. Vai jūs esat bijis norakstīts kā slims vai repatriēts no kuģa?
(Have you ever been signed off as sick or repatriated from a ship?)
   
19. Vai jūs esat bijis hospitalizēts?
(Have you ever been hospitalized?)
   
20. Vai jūs esat bijis atzīts par nepiemērotu darbam jūrā?
(Have you ever been declared unfit for sea duty?)
   
21. Vai jūsu medicīniskais sertifikāts ir bijis ar ierobežojumiem vai atsaukts?
(Has your medical certificate ever been restricted or revoked?)
   
22. Vai jums ir zināmas kādas jūsu veselības problēmas vai slimības?
(Are you aware that you have any health problems, diseases or illnesses?)
   
23. Vai Jūs smēķējat vai lietojat narkotikas, vai ir problēmas ar alkoholu?
(Do you smoke, or use drugs, or have trouble with alcohol?)
   
24. Vai jūs lietojat kādus bezrecepšu vai recepšu medikamentus?
(Are you taking any non-prescription or prescription medications?)
   
     

Ja uz kādu no jautājumiem esat atbildējis "jā", lūdzu, sniedziet papildinformāciju, norādot, ja iespējams, kad tas bija. Ja lietojat medikamentus, lūdzu, norādiet lietotos medikamentus, to lietošanas nolūku(-us) un lietoto devu(-as)

(If you answered "yes" to any of the above questions, please give details, including, if possible, when it was. If you are taking any medications, please list the medications taken, and the purpose(s) and dosage(s))

 

Apliecinu, ka sniegtā informācija atbilst patiesībai, ciktāl man tā ir zināma, un atļauju visus manus iepriekšējos medicīniskos datus no citām ārstniecības personām, ārstniecības iestādēm un valsts iestādēm darīt pieejamus jūrnieku ārstam

(atzītā jūrnieku ārsta vārds, uzvārds)

 
(I hereby certify that the personal declaration above is a true statement to the best of my knowledge, and I authorize the release of all my previous medical records from any health professionals, health institutions and public authorities to Dr.

(name, surname of the recognized medical practitioner))

 
Pārbaudāmā(-s) paraksts
Signature of examinee __________________
Datums (dd.mm.gggg)
Date (dd.mm.yyyy) ____________________
Apliecinu (paraksts)
Witnessed by (signature) ________________
Vārds, uzvārds
Name, surname _______________________
 

Iepriekšējās veselības pārbaudes datums un kontaktinformācija (ja zināma) _______________

Date and contact details of previous medical examination (if known) ___________________

B. Veselības pārbaude

B. Medical examination

Redze (Sight)

Lieto brilles vai kontaktlēcas: Jā/Nē (ja lieto, norāda veidu un lietošanas nolūku) __________

(Use of glasses or contact lenses: Yes/No (if yes, specify which type and for what purpose))

Redzes asums (Visual acuity)

Bez palīglīdzekļiem (Unaided)

Ar palīglīdzekļiem (Aided)

Labā acs
(Right eye)

Kreisā acs
(Left eye)

Abas acis
(Binocular)

Labā acs
(Right eye)

Kreisā acs
(Left eye)

Abas acis
(Binocular)

Tālumā
(Distant)
           
Tuvumā
(Near)
           

Krāsu redze (Colour vision)

Iepriekšējās krāsu redzes pārbaudes datums, ja zināms
(Date of previous colour vision test, if known) ___________________________
Piezīmes par redzes asumu, krāsu redzi vai acu veselības problēmām, ja nepieciešams
(Remarks regarding visual acuity, colour vision or eye health problems, if necessary)
Nav pārbaudīta _____
(Not tested)
Apšaubāma _____
(Doubtful)
 
Normāla _____
(Normal)
Traucēta _____
(Defective)

Aizliegts lietot palīglīdzekļus, lai uzlabotu krāsu redzi.

(The use of contact lenses or glasses to improve colour vision is not permitted.)

Redzes lauki (Visual fields)

Normāli
(Normal)

Nepilnīgi
(Defective)

Piezīmes, ja redzes lauki nepilnīgi
(Remarks, if visual fields are defective)

Labā acs
(Right eye)
     
Kreisā acs
(Left eye)
     

Dzirde (Hearing)

Tīrais tonis un audiometrija (robežvērtības dB) (Pure tone and audiometry (threshold values in dB))
500 Hz 1000 Hz 2000 Hz 3000 Hz
Labā auss
(Right ear)
       
Kreisā auss
(Left ear)
       
Pārbaude ar runas un čukstus balsi (metri) (Speech and whisper test (meters))
 

Runas balsī (Normal voice)

Čukstus balsī (Whisper)

Labā auss
(Right ear)
   
Kreisā auss
(Left ear)
   

Klīniskā atrade (Clinical findings)

Augums
(Height) ______ cm)
Svars
(Weight) ________(kg)
Pulss
(Pulse rate) _____/min
Ritms (Rhythm)__________________
Sistoliskais spiediens
(Systolic BP) ______________ (mmHg)
Diastoliskais spiediens
(Diastolic BP) ____________________ (mmHg)
 

Norma
(Normal)

Patoloģisks
(Abnormal)

 

Norma
(Normal)

Patoloģisks
(Abnormal)

Sirds-asinsvadu sistēma
(Cardiovascular system)
    Neiroloģiskais stāvoklis
(Neurological condition)
   
Elpceļu orgānu sistēma
(Respiratory tract)
    Psihiskais stāvoklis
(Psychic condition)
   
Muskuļu, kaulu, locītavu sistēma
(Musculoskeletal, joint system)
    Uroģenitālā sistēma
(Urogenital system)
   
Dzirdes orgāni
(Hearing system)
    Ārējais izskats
(General appearance)
   
Mutes dobums, zobi
(Oral cavity, teeth)
         

Krūšu kurvja rentgenoloģiskā pārbaude (Chest X-ray)

Nav veikta
(Not performed)
Ir veikta
(Performed) __________________(dd.mm.gggg) (dd.mm.yyyy)

Rezultāti (Results)

 

Cita(-as) diagnosticējoša(-as) pārbaude(-es) un rezultāti (Other diagnostic test and results)

Pārbaude (Test)

Rezultāti (Results)

 

 

Papildu informācija (ja nepieciešams) (Additional information (if necessary))

Jūrnieku ārsta piezīmes par veselības pārbaudē konstatēto un/vai piemērojamo veselības atbilstības ierobežojumu pamatojums
(Medical practitioner's comments on the findings and/ or reasons for any limitations or restrictions on fitness)

C. Slēdziens

C. Conclusion

Pamatojoties uz pārbaudāmās personas sniegto informāciju, manis veikto medicīnisko apskati un iepriekš norādītajiem pārbaužu rezultātiem, atzīstu pārbaudāmo personu par medicīniski

(On the basis of the examinee's personal declaration, my clinical examination and the diagnostic test results recorded above, I declare the examinee medically):

piemērotu navigācijas sardzes un novērošanas pienākumu pildīšanai
(Fit for navigational watch and look-out duties)
nepiemērotu navigācijas sardzes un novērošanas pienākumu pildīšanai
(Not fit for navigational watch and look-out duties)

Klāja komandā
(Deck department)

Mašīntelpas komandā
(Engine department)

Ēdināšanas komandā
(Catering department)

Citā komandā
(Other department)

Piemērots darbam
(Fit for duty within)
Nepiemērots darbam
(Not fit for duty within)
Bez ierobežojumiem
(Without limitations or restrictions)
Ar ierobežojumiem
(With limitations or restrictions)
Nepieciešamas brilles vai kontaktlēcas:
(Spectacles or contact lenses required):

(Yes)

(No)
Nepieciešami dzirdes palīglīdzekļi:
(Hearing aids required):

(Yes)

(No)
Nepieciešams lietot medikamentus reisa laikā
(Needs to take medication during service at sea)

(Yes)

(No)
Medikamentu nosaukums _______________
(Name of the medication) _______________
 
Veselības atbilstības ierobežojumi (piemēram, īpašu pienākumu izpilde, kuģošanas rajons un/vai ilgums, kuģa tips))
(Limitations or restrictions on fitness (e. g. specific duties, trading area and/or duration, type of ship))
Medicīniskā sertifikāta derīguma termiņš ______________________
Expiry date of medical certificate
________________________
Ja personai ir izsniegta deklarācija par jūrnieka veselības stāvokļa neatbilstību darbam uz kuģa, norādīt iemeslus, ieskaitot medicīniskā stāvokļa kodu(-us) saskaņā ar SSK
(If the Declaration on Insufficient Medical Fitness of Seafarer for Work on a Ship has been issued, reasons, including diagnostic code(s) according to the ICD, should be given below)
Datums (dd.mm.gggg) ______________________________
(Date (dd.mm.yyyy))
Jūrnieku ārsta vārds, uzvārds, paraksts ___________________________________________
(Recognized medical practitioner's name, surname, signature)

Z. v.

Minister for Transport Anrijs Matīss

 

Annex 4
Cabinet Regulation No. 273
3 June 2014

Minimum Eyesight Standards for Seafarers

STCW Convention regulation

Category of seafarer

Distance vision aided1

Near/intermediate vision

Colour vision3

Visual fields4

Night blindness4

Diplopia (double vision)4

one eye

other eye

both eyes together, aided or unaided

I/11
II/1
II/2
II/3
II/4
II/5
VII/2
Masters, deck officers and ratings required to undertake look-out duties

0.52

0.5

Vision required for ship's navigation (e.g., chart and nautical publication reference, use of bridge instrumentation and equipment, and identification of aids to navigation) See Note 6 Normal Visual fields Vision required to perform all necessary functions in darkness without compromise No significant condition evident
I/11
III/1
III/2
III/3
III/4
III/5
III/6
III/7
VII/2
All engineer officers, electro-technical officers, electro-technical ratings and ratings forming part of an engine-room watch 0.45 0.4

See Note 5

Vision required to read instruments in close proximity, to operate equipment, and to identify systems/ components as necessary See Note 7 Sufficient visual fields Vision required to perform all necessary functions in darkness without compromise No significant condition evident
I/11
IV/2
GMDSS Radio operators 0.4 0.4 Vision required to read instruments in close proximity, to operate equipment, and to identify systems/ components as necessary See Note 7 Sufficient visual fields Vision required to perform all necessary functions in darkness without compromise No significant condition evident
Seafarer's unaided distance vision in each eye shall be at least 0.1

Notes.

1 Values given in decimal notation (Snellen charts).

2 A value of at least 0.7 in one eye is recommended to reduce the risk of undetected underlying eye disease.

3 The International Recommendations for Colour Vision Requirements for Transport (CIE-143-2001 including any subsequent versions) by the International Commission on Illumination (Commission Internationale de l'Eclairage) or any other equivalent method.

4 Subject to assessment by an ophthalmologist, if it has been indicated so in the initial opinions of a medical practitioner.

5 Combined eyesight vision of a seafarer working in an engine department shall be at least 0.4.

6 CIE colour vision standard 1 or 2, or any other equivalent method.

7 CIE colour vision standard 1, 2 or 3, or any other equivalent method.

Minister for Transport Anrijs Matīss

 

Annex 5
Cabinet Regulation No. 273
3 June 2014

Medical Conditions due to which a Person may not be Qualified as Fit for Work on a Ship or may be Qualified with Limitations or Restrictions

[20 December 2016]

ICD (diagnostic codes)

Condition

(justification for criteria)

Health condition is incompatible with reliable performance of routine and emergency duties safely or effectively - expected to be temporary (T), expected to be

permanent (P)

Able to perform some but not all duties or to work in some but not all waters (R). Increased frequency of surveillance needed (L)

Able to perform all duties worldwide in designated position/within designated department

A00-B99

I. Infections

A00-09 Gastrointestinal infection

Transmission to others, recurrence

T - If detected while onshore (current symptoms or awaiting test results on carrier status); or confirmed carrier status until elimination demonstrated Not applicable Non-catering department: when satisfactorily treated or resolved.

Catering department: fitness decision to be based on specialist advice - bacteriological clearance may be required

A15-16 Pulmonary TB

Transmission to others, recurrence

T - Positive screening test or clinical history, until investigated. If infected, until treatment stabilized and lack of infectivity confirmed.

P - Relapse or severe residual damage

Not applicable Successful completion of a course of treatment in accordance with WHO Treatment of Tuberculosis guidelines
A50-64 Sexually transmissible infections

Acute impairment, recurrence

T - If detected while onshore, until diagnosis confirmed, treatment initiated and impairing symptoms resolved.

P - Untreatable impairing late complications

R - Consider near coastal if oral treatment regime in place and symptoms non-incapacitating On successful completion of treatment
(B15) Hepatitis A

Transmissible by food or water contamination

T - Until jaundice resolved and liver function tests returned to normal Not applicable On full recovery
(B16-19) Hepatitis B, C, etc.

Transmissible by contact with blood or other bodily fluids. Possibility of permanent liver impairment and liver cancer

T - Until jaundice resolved and liver function tests returned to normal.

P - Persistent liver impairment with symptoms affecting safe work at sea or with likelihood of complications

R, L - Uncertainty about total recovery or lack of infectivity.

Case-by-case decision-making based on duties and voyage patterns

On full recovery and confirmation of low level of infectivity
(B20-24) HIV+

Transmissible by contact with blood or other bodily fluids.

Progression to HIV-associated diseases or AIDS

T - Until stabilized on treatment with CD4 level

of > 350 or when treatment changed and tolerance of new medication uncertain

P - Non-reversible impairing HIV-associated diseases. Continuing impairing effects of medication

R, L - Time limited and/or near coastal: HIV+ and low likelihood of progression; on no treatment or on stable medication without side effects, but requiring regular specialist surveillance HIV+, no current impairment and very low* likelihood of disease progression. No side effects of treatment or requirements for frequent surveillance
(A00-B99)

(Not listed separately)

Other infections

Personal impairment, infection of others

T - If detected while onshore: until free from risk of transmission and capable of performing duties

P - If continuing likelihood of repeated incapacity or infectious recurrences

Case-by-case decision based on nature of infection On full recovery and confirmation of low level of infectivity
(C00-48)

II. Cancers

(C00-48) Malignant neoplasms including lymphoma, leukaemia and related conditions

Recurrence - especially acute complications, e.g. harm to self from bleeding and

to others from seizures

T - Until investigated, treated and prognosis assessed.

P - Continuing impairment with symptoms affecting safe work at sea or with high likelihood of recurrence

L - Time limited to interval between specialist reviews if: cancer diagnosed <5 years ago; and there is no current impairment of performance of normal or emergency duties or living at sea; there is a low likelihood of recurrence and minimal risk of requirement for urgent medical treatment.

R - Restricted to near coastal waters if any continuing impairment does not interfere with essential duties and any recurrence is unlikely to require emergency medical treatment

Cancer diagnosed more than 5 years ago, or specialist reviews no longer required and no current impairment or low continuing likelihood of impairment from recurrence. To be confirmed by specialist report with evidence for opinion stated
(D50-89)

III. Blood disorders

(D50-59) Anaemia/Haemoglobinopathies

Reduced exercise tolerance. Episodic red cell breakdown

T - Distant waters, until haemoglobin normal and stable.

P - Severe recurrent or continuing anaemia or impairing symptoms from red cell breakdown that are untreatable

R, L - Consider restriction to near coastal waters and regular surveillance if reduced haemoglobin level but asymptomatic Normal levels of haemoglobin
(D73) Splenectomy (history of surgery)

Increased susceptibility to certain infections

T - Post surgery until fully recovered R - Case-by-case assessment. Likely to be fit for coastal and temperate work but may need restriction on service in tropics Case-by-case assessment
(D50-89)

(Not listed separately)

Other diseases of the blood and blood-forming organs

Varied recurrence of abnormal bleeding and also possibly reduced exercise tolerance or low resistance to infections

T - While under investigation

P - Chronic coagulation disorders

Case-by-case assessment for other conditions Case-by-case assessment
(E00-90)

IV. Endocrine and metabolic

(E10) Diabetes - Insulin using

Acute impairment from hypoglycaemia. Complications from loss of blood glucose control Increased likelihood of visual, neurological and cardiac problems

T - From start of treatment until stabilized

P - If poorly controlled or not compliant with treatment. History of hypoglycaemia or loss of hypoglycaemic awareness. Impairing complications of diabetes

R, L - Subject to evidence of good control, full compliance with treatment recommendations and good hypoglycaemia awareness Fit for near coastal duties without solo watch keeping. Time limited until next specialist check-up. Must be under regular specialist surveillance Not applicable
(E11-14) Diabetes - Non-insulin treated, on other medication

Progression to insulin use, increased likelihood of visual, neurological and cardiac problems Increased likelihood of visual, neurological and cardiac problems

T - Distant waters and watch keeping until stabilized R - Near coastal waters and non-watch keeping duties until stabilized

R - Near coastal waters, no solo watch keeping if minor side effects from medication. Especially when using sulphonylureas

L - Time limited if compliance poor or medication needs frequent review. Check diet, weight and vascular risk factor control

When stabilized, in the absence of impairing complications
  Diabetes - Non-insulin treated, treated by diet alone

Progression to insulin use, increased likelihood of visual, neurological and cardiac problems

T - Distant waters and watch keeping until stabilize R - Near coastal waters and non-watch keeping duties until stabilized

L - Time limited when stabilized, if compliance poor. Check diet, weight and vascular risk factor control

When stabilized, in the absence of impairing complications
(E65-68) Obesity/abnormal body mass - high or low

Accident to self, reduced mobility and exercise tolerance for routine and emergency duties. Increased likelihood of diabetes, arterial diseases and arthritis

T - If duties cannot be performed in emergency situation, capability or exercise test performance is poor.

P - If duties cannot be performed in emergency situations, capability or exercise test performance is poor with failure to achieve improvements.

Note. Body mass index is a useful indicator of when additional assessment is needed. National norms of this indicator may vary, therefore it should not form the sole basis for decisions on capability

R, L - Time limited validity of the medical certificate and restricted to work near coastal waters or to restricted duties if unable to perform certain tasks but able to meet routine and emergency capabilities for assigned duties in emergency situations Capability and exercise test performance average or better. Weight steady or reducing and no co-morbidity
(E00-90)

(Not listed separately)

Other endocrine and metabolic diseases

Thyroid, adrenal (including Addison's disease), pituitary, ovaries, testes diseases.

Likelihood of recurrence or complications

T - Until treatment established and stabilized without adverse effects

P - If continuing impairment, need for frequent adjustment of therapy/medication or increased likelihood of major complications

R, L - Case-by-case assessment with specialist advice if any uncertainty about prognosis or side effects of treatment. Need to consider likelihood of impairing complications from condition or its treatment, including problems taking medication, and consequences of infection or injury while at sea If medication stable with no problems in taking at sea and surveillance of conditions infrequent, no impairment and very low likelihood of complications. Addison's disease: the risks will usually be such that an unrestricted certificate should not be issued.
(F00-99)

V. Mental, cognitive and behavioural disorders

(F10) Alcohol abuse (dependency)

Recurrence, accidents, erratic behaviour/safety performance

T - Until investigated and stabilized and criteria for fitness met. Until one year after initial diagnosis or one year after any relapse

P - If persistent or there is co- morbidity likely to progress or recur while at sea

R, L - Time limited, not to work as master in charge of vessel or without close supervision and continuing medical monitoring, provided that: treating physician reports successful participation in rehabilitation program; and there is an improving trend in liver function tests After three years from end of last episode without relapse and without co-morbidity
(F11-19) Drug dependence/persistent substance abuse, includes both illicit drug use and dependence on prescribed medications

Recurrence, accidents, erratic behaviour/safety performance

T - Until investigated and stabilized and criteria for fitness met. Until one year after initial diagnosis or one year after any relapse

P - If persistent or there is co- morbidity likely to progress or recur while at sea

R, L - Time limited, not to work as master in charge of vessel or without close supervision and continuing medical monitoring, provided that:

- treating physician reports successful participation in rehabilitation program; and

- evidence of completion of unannounced/

random program of drug screening for at least three months with no positives and at least three negatives; and

- continuing participation in drug screening program

After three years from end of last episode without relapse and without co-morbidity
(F20-31) Psychosis (acute) - whether organic, schizophrenic or other category listed in the ICD. Bipolar (manic depressive disorders)

Recurrence leading to changes to perception/cognition, accidents, erratic and unsafe behaviour

Following single episode with provoking factors:

T - Until investigated and stabilized and criteria for fitness met. At least three months after episode

Following single episode without provoking factors or more than one episode with or without provoking factors:

T - Until investigated and stabilized and conditions for fitness met. At least two years since last episode

P - More than three episodes or continuing likelihood of recurrence. Criteria for fitness with or without restrictions are not met

R, L - Time limited, restricted to near coastal waters and not to work as master in charge of vessel or without close supervision and continuing medical monitoring, provided that:

- the seafarer has insight;

- is compliant with treatment; and

- has no adverse effects from medication

R, L - Time limited, restricted to near coastal waters and not to work as master in charge of vessel or without close supervision and continuing medical monitoring, provided that:

- the seafarer has insight;

- is compliant with treatment; and

- has no impairing adverse effects from medication

Case-by-case assessment at least one year after the episode, provided that provoking factors can and will always be avoided

Case-by-case assessment to exclude likelihood of recurrence, at least five years since end of episode if no further episodes; no residual symptoms; and no medication needed during last two years

(F32-38) Mood/affective disorders Severe anxiety state, depression, or any other mental disorder likely to impair performance

Recurrence, reduced performance, especially in emergencies

T - While acute, under investigation or if impairing symptoms or side effects of medication present. At least three months on stable medication

P - Persistent or recurrent work disability

R, L - Restrict to near coastal waters and not to work as master in charge of ship, only when seafarers has:

- good functional recovery;

- insight;

- is fully compliant with treatment;

- has no impairing adverse effects from medication;

- a low likelihood of recurrence

Case-by-case assessment to exclude likelihood of recurrence. At least two years with no further episodes and with no medication or on medication with no impairing effects
  Mood/affective disorders Minor or reactive symptoms of anxiety/depression

Recurrence, reduced performance, especially in emergencies

T - Until symptom free. If on medication to be on a stable dose and free from impairing adverse effects

P - Persistent or recurrent work disability

R, L - Time limited and consider geographical restriction if on stable dose of medication and free from impairing symptoms or impairing side effects from medication Case-by-case assessment after one year from end of episode if symptom free and off medication or on medication with no impairing effects
(F00-99)

(Not listed separately)

Other disorders, e.g. disorders of personality, attention (e.g. ADHD), development (e.g. autism)

Impairment of performance and reliability and impact on relationships

P - If considered to have safety- critical consequences R - As appropriate if capable of only limited duties No anticipated adverse effects while at sea. No incidents during previous periods of sea service
(G00-99)

VI. Diseases of the nervous system

(G40-41) Single seizure

Harm to ship, others and self from seizures

Single seizure

T - While under investigation and for one year after seizure

R - One year after seizure and on stable medication.

Non-watch-keeping duties in near coastal waters

One year after seizure and one year after end of treatment. If provoked, there should be no continuing exposure to the provoking agent
  Epilepsy - No provoking factors (multiple seizures)

Harm to ship, others and self from seizures

T - While under investigation and for two years after last seizure

P - Recurrent fits, not controlled by medication

R - Off medication or on stable medication with good compliance: case-by-case assessment of fitness, restricted to non-watch-keeping duties in near-coastal waters Seizure-free for at least the last ten years. Has not taken anti-epilepsy drugs during that ten-year period. Low risk of a continuing likelihood of seizures
  Epilepsy - provoked by alcohol, medication, head injury (multiple seizures)

Harm to ship, others and self from seizures

T - While under investigation and for two years after last seizure

P - Recurrent fits, not controlled by medication

R - Case-by-case assessment after two years' abstention from any known provoking factors, seizure-free and either off medication or on stable medication with good compliance. Non- watch-keeping duties in near coastal waters Seizure-free for at least the last five years. Has not taken anti-epilepsy drugs during that five-year period, provided there is not continuing exposure to the provoking agent.
(G43) Migraine (frequent attacks causing incapacity)

Likelihood of disabling recurrences

P - Frequent attacks leading to incapacity R - As appropriate. If only capable of limited duties No anticipated incapacitating adverse effects while at sea. No incidents during previous periods of sea service
(G47) Sleep apnoea

Fatigue and episodes of sleep while working

T - Until treatment started and successful for three months

P - Treatment unsuccessful or not being complied with

L - Once treatment demonstrably working effectively for three months, including compliance with CPAP (continuous positive airway pressure) machine use confirmed.

Six-monthly assessments of compliance based on CPAP machine recording

Case-by-case assessment based on job and emergency requirements, informed by specialist advice
  Narcolepsy

Fatigue and episodes of sleep while working

T - Until controlled by treatment for at least two years

P - Treatment unsuccessful or not being complied with

R, L - Near coastal waters and no watch-keeping duties, if specialist confirms full control of treatment for at least two years. Annual review Not applicable
(G00-99)

(Not listed separately)

Other organic nervous disease, e.g. multiple sclerosis, Parkinson's disease

Recurrence/progression. Limitations on muscular power, balance, coordination and mobility

T - Until diagnosed and stable

P - If limitations affect safe working or unable to meet physical capability requirements

R, L - Case-by-case assessment based on job and emergency requirements, informed by specialist advice Case-by-case assessment based on job and emergency requirements, informed by specialist advice
(R55) Syncope and other disturbances of consciousness

Recurrence causing injury or loss of control

T - Until investigated to determine cause and to demonstrate control of any underlying condition Event is:

(a) simple faint;

(b) not a simple faint; unexplained disturbance, not recurrent and without any detected underlying cardiac, metabolic or neurological cause

T - Four weeks

(c) Disturbance; recurrent or with possible underlying cardiac, metabolic or neurological cause

T - With possible underlying cause that is not identified or treatable; for six months after event if no recurrences

T - With possible underlying cause or cause found and treated; for one month after successful treatment

(d) Disturbance of consciousness with features indicating a seizure (see G40-41).

P - For all of above if recurrent, incidents persist despite full, investigation and appropriate, treatment

R, L - Case-by-case decision, near coastal with no lone watch-keeping

R, L - Case-by-case decision, near coastal with no lone watch-keeping

Simple faint; if no incapacitating recurrences; three months after event if no recurrences.

With possible underlying cause but no treatable cause found; one year after event if no recurrences

With possible underlying cause found and treated; three months after successful treatment

With seizure markers - not applicable

(T90) Intra-cranial surgery/injury, including treatment of vascular anomalies or serious head injury with brain damage

Harm to ship, others and self from seizures.

Defects in cognitive, sensory or motor function.

Recurrence or complication of underlying condition

T - For one year or longer until seizure likelihood low, based on advice from specialist

P - Continuing unfitness from underlying condition or injury or recurrent seizures

R - After at least one year, near coastal, no lone watch-keeping if seizure likelihoods low* and no incapacity from underlying condition or injury

Conditional on continued compliance with any treatment and on periodic review, as recommended by specialist

No impairment from underlying condition or injury, not on anti-epilepsy medications. Seizure likelihood very low*

Conditional on continued compliance with any treatment and on periodic review, as recommended by specialist

(H00-99)

VII. Diseases of the eyes and ears

(H00-59) Eye disorders: Progressive or recurrent (e.g. glaucoma, maculopathy, diabetic retinopathy, retinitis pigmentosa, keratoconus, diplopia, blepharospasm, uveitis, corneal ulceration and retinal detachment)

Future inability to meet vision standards, risk of recurrence

T - Temporary inability to meet relevant vision standards and low likelihood of subsequent deterioration or impairing recurrence once treated or recovered

P - Inability to meet relevant vision standards or, if treated, increased likelihood of subsequent deterioration or impairing recurrence

R - Near coastal waters if recurrence unlikely but foreseeable and treatable with early medical intervention

L - If risk of progression foreseeable but unlikely and can be detected by regular monitoring

Very low likelihood of recurrence. Progression to a level where vision standards are not met during period of certificate is very unlikely
(H65-67) Otitis - External or media

Recurrence,

risk as infection source in food handlers,

problems using hearing protection

T - Until treated

P - If chronic discharge from ear in food handler

Case-by-case assessment.

Consider effects of heat, humidity and hearing protection use in otitis externa

Effective treatment and no excess likelihood of recurrence
(H68-95) Progressive (e.g. otosclerosis) T - Temporary inability to meet relevant hearing standards and low likelihood of subsequent deterioration or impairing recurrence once treated or recovered

P - Inability to meet relevant hearing standards or, if treated, increased likelihood or subsequent deterioration or impairing recurrence

L - If risk of progression foreseeable but unlikely and can be detected by regular monitoring Very low likelihood of recurrence. Progression to a level where hearing standards are not met during period of certificate is very unlikely
(H81) Ménière's disease and other forms of chronic or recurrent disabling vertigo

Inability to balance, causing loss of mobility and nausea

T - During acute phase

P - Frequent attacks leading to incapacity

R - As appropriate. If only capable of limited duties

R, L - If frequent specialist surveillance required

Low* likelihood of impairing effects while at sea
(I00-99)

VIII. Cardiovascular system

(I05-08)

(I34-39)

Congenital and valve disease of heart (including surgery for these conditions) Heart murmurs not previously investigated

Likelihood of progression, limitations on exercise

T - Until investigated and, if required, treated

P - If exercise tolerance limited or episodes of incapacity occur or if on anticoagulants or if permanent high likelihood of impairing event

R - Near coastal waters if case-by-case assessment indicates either likelihood of acute complications or rapid progression.

L - If frequent surveillance is recommended

Heart murmurs - where unaccompanied by other heart abnormalities and considered benign by a specialist cardiologist following examination Other conditions - case-by-case assessment based on specialist advice
(I10-15) Hypertension

Increased likelihood of ischemic heart disease, eye and kidney damage and stroke. Possibility of acute hypertensive episode

T - Normally if >160 systolic or >100 diastolic mm Hg until investigated and treated in accordance with national or international guidelines for hypertension management

P - If persistently >160 systolic or >100 diastolic mm Hg with or without treatment

L - If additional surveillance needed to ensure level remains within national guideline limits If treated in accordance with national guidelines and free from impairing effects from condition or medication
(I20-25) Cardiac event, i.e. myocardial infarction, ECG evidence of past myocardial infarction or newly recognized left bundle-branch block, angina, cardiac arrest, coronary artery bypass grafting, coronary angioplasty

Sudden loss of capability, exercise limitation. Problems of managing repeat cardiac event at sea

T - For three months after initial investigation and treatment, longer if symptoms not resolved

P - If criteria for issue of the medical certificate not met and further reduction of likelihood of recurrence improbable

L - If excess likelihood of recurrence is very low* and fully compliant with risk reduction recommendations and no relevant co-morbidity, issue six-month certificate initially and then annual certificate

R, L - If excess likelihood of recurrence is low.* Restricted to:

- no lone working or watch-keeping/lookout; and

- operations in near-coastal waters, unless working on vessel with ship's doctor

Issue six-month certificate initially and then annual certificate

R, L - If likelihood of recurrence is moderate* and asymptomatic. Able to meet the physical requirements or their normal and emergency duties:

- no lone working or watch-keeping/lookout; and

- operating within one hour of port, unless working on vessel with ship's doctor

Case-by-case assessment. Annual review

Not applicable
(I44-49) Cardiac arrhythmias and conduction defects (including those with pacemakers and implanted cardioverter defibrillators (ICD))

Acute impairment from recurrence.

Reduced exercise tolerance.

Pacemaker/ICD activity may be affected by strong electric fields

T - Until investigated, treated and effectiveness of treatment confirmed

P - If disabling symptoms present or excess likelihood of impairment from recurrence, including ICD implant

L - Surveillance needed at shorter intervals and no impairing symptoms present and very low* excess likelihood of impairment from recurrence, based on specialist report

R - Restrictions on solo duties or for distant waters if low* likelihood of acute impairment from recurrence or foreseeable requirement for access to specialist care

Surveillance and treatment regime to be specified. If pacemaker fitted, duration of certificate to coincide with pacemaker surveillance

Surveillance not needed or needed at intervals of more than two years; no impairing symptoms present; and very low* likelihood of impairment from recurrence, based on specialist report
(I61-69G46) Ischaemic cerebrovascular disease (stroke or transient ischaemic attack)

Increased likelihood of recurrence, sudden loss of capability, mobility limitation. Liable to develop other circulatory disease

T - Until treated and any residual impairment stabilized and for three months after event

P - If residual symptoms interfere with duties or there is significant excess likelihood of recurrence

R, L - Case-by-case assessment of fitness for duties; exclude from lone watch-keeping. Assessment should include likelihood of future cardiac events. General standards of physical fitness should be met

Annual assessment

Not applicable
(I73) Arterial-claudication

Likelihood of other circulatory disease causing sudden loss of capability.

Reduced exercise tolerance.

T - Until assessed

P - If incapable of performing duties

R, L - Consider restriction to non-watch-keeping duties in coastal waters, provided symptoms are minor and do not impair essential duties or if they are resolved by surgery or other treatment and general standard of fitness can be met. Assess likelihood of future cardiac events (follow criteria in I20-25). Review at least annually Not applicable
(I83) Varicose veins Possibility of bleeding if injured, skin changes and ulceration T - Until treated if impairing symptoms. Post-surgery for up to one month Not applicable No impairing symptoms or complications
I80.2-3 Deep vein thrombosis/pulmonary embolus Likelihood of recurrence and ofserious pulmonary embolus Likelihood of bleeding from anticoagulant treatment T - Until investigated and treated and normally while on short-term anticoagulants

P - Consider if recurrent events or on permanent anticoagulants

R, L - May be considered fit for work with a low liability for injury in national coastal waters, once stabilized o anticoagulants with regular monitoring of level of coagulation Full recovery with no anticoagulant use
(I00-99)

(Not listed separately)

Other heart disease (e.g. cardio-myopathy, pericarditis, heart failure)

Likelihood of recurrence, sudden loss of capability, exercise limitation

T - Until investigated, treated and adequacy of treatment confirmed

P - If impairing symptoms or likelihood of impairment from recurrence

Case-by-case assessment, based on specialist reports Case-by-case assessment, very low* likelihood of recurrence
(J00-99)

IX. Respiratory system

(J02-044)

(J30-39)

Nose, throat and sinus conditions

Impairing for individual. May recur. Transmission of infection to food/other crew in some conditions

T - Until resolved

P - If impairing and recurrent

Case-by-case assessment When treatment complete, if no factors predisposing to recurrence
(J40-44) Chronic bronchitis and/or Emphysema

Reduced exercise tolerance and impairing symptoms

T - If acute episode

P - If repeated severe recurrences or if general fitness standards cannot be met or if impairing shortness of breath

R, L - Case-by-case specialist assessment. More stringency for distant water duties. Consider fitness for emergencies and ability to meet general standards of physical fitness. Annual review Not applicable
(J45-46) Asthma (detailed assessment with information from specialist in all new entrants)

Unpredictable episodes of severe breathlessness

T - Until episode resolved, cause investigated (including any occupational link) and effective treatment regime in place

In person under age 20 with hospital admission or oral steroid use in last three years

P - If foreseeable likelihood of rapid life-threatening asthma attack while at sea or history of uncontrolled asthma, i.e. history of multiple hospital admissions

R, L - Near coastal waters only or on ship with doctor if:

- history of moderate** adult asthma, with good control with inhalers and no episodes requiring hospital admission or oral steroid use in last two years;

- history of mild asthma;

- exercise-induced asthma that requires regular treatment

Under age 20: if history of mild or moderate** childhood asthma, but with no hospital admissions or oral steroid treatment in last three years and no requirements for continuing regular treatment

Over age 20: if history of mild** or exercise-induced** asthma and no requirements for continuing regular treatment

(J93) Pneumothorax (spontaneous or traumatic)

Acute impairment from recurrence

T - Normally for 12 months after initial episode or shorter duration as advised by specialist

P - After recurrent episodes unless pleurectomy or pleurodesis performed

R - Duties in harbour areas only once recovered Normally 12 months after initial episode or shorter duration as advised by specialist

Post-surgery - based on advice of treating specialist

(K00-99)

X. Digestive system

(K01-06) Oral health

Acute pain from toothache. Recurrent mouth and gum infections

T - If visual evidence of untreated dental defects or oral disease

P - If excess likelihood of dental emergency remains after treatment completed or seafarer non-compliant with dental recommendations

R - Limited to near coastal waters, if criteria for full fitness not met, and type of operation will allow for access to dental care without safety-critical manning issues for vessel If teeth and gums (gums alone of edentulous and with well-fitting dentures in good repair) appear to be good. No complex prosthesis; or if dental check in last year, with follow-up completed and no problems since
(K25-28) Peptic ulcer

Recurrence with pain, bleeding or perforation

T - Until healing or cure by surgery or by control of H. Pylori and on normal diet for three months

P - If ulcer persists despite surgery and medication

R - Consider case-by-case assessment for earlier return to near coastal duties When cured and on normal diet for three months
(K40-41) Hernias - Inguinal and femoral

Likelihood of strangulation

T - Until surgically investigated to confirm no likelihood of strangulation and, if required, treated R - Untreated: Consider case-by-case assessment for near coastal waters When satisfactorily treated or exceptionally when surgeon reports that there is no likelihood of strangulation
(K42-43) Hernias - Umbilical, ventral

Instability of abdominal wall on bending and lifting

Case-by-case assessment depending on severity of symptoms or impairment.

Consider implications of regular heavy whole-body physical effort

Case-by-case assessment depending on severity of symptoms or impairment.

Consider implications of regular heavy whole-body physical effort

Case-by-case assessment depending on severity of symptoms or impairment.

Consider implications of regular heavy whole-body physical effort

(K44) Hernias - Diaphragmatic (hiatus)

Reflux of stomach contents and acid causing heartburn, etc.

Case-by-case assessment based on severity of symptoms when lying down and on any sleep disturbance caused by them Case-by-case assessment based on severity of symptoms when lying down and on any sleep disturbance caused by them Case-by-case assessment based on severity of symptoms when lying down and on any sleep disturbance caused by them
(K50, 51, 57, 58, 90) Non-infectious enteritis, colitis, Crohn's disease, diverticulitis, etc.

Impairment and pain

T - Until investigated and treated

P - If severe or recurrent

R - Does not meet the requirements for unrestricted certificate but rapidly developing recurrence unlikely: near coastal duties Case-by-case specialist assessment. Fully controlled with low likelihood of recurrence
(K60, I84) Anal conditions: Piles (hemorrhoids), fissures, fistulae

Likelihood of episode causing pain and limiting activity

T - If piles prolapsed, bleeding repeatedly or causing symptoms; if fissure or fistula painful, infected, bleeding repeatedly or causing faecal incontinence

P - Consider if not treatable or recurrent

Case-by-case assessment of untreated cases for near coastal duties When satisfactorily treated
(K70, 72) Cirrhosis of liver

Liver failure. Bleeding oesophageal varices

T - Until fully investigated

P - If severe or complicated by ascites or oesophageal varicoses

R, L - Case-by-case specialist assessment Not applicable
(K80-83) Biliary tract disease

Biliary colic from gallstones. Jaundice, liver failure

T - Biliary colic until definitely treated

P - Advanced liver disease, recurrent or persistent impairing symptoms

R, L - Case-by-case specialist assessment. Does not meet requirements for unlimited certificate. Sudden onset of biliary colic unlikely Case-by-case specialist assessment. Very low likelihood of recurrence or worsening in next two years
(K85-86) Pancreatitis

Likelihood of recurrence

T - Until treated

P - If recurrent or alcohol related, unless confirmed abstention

Case-by-case assessment based on specialist reports Case-by-case assessment based on specialist reports Very low likelihood of recurrence
(Y83) Stoma (ileostomy, colostomy)

Impairment if control is lost - need for bags, etc. Potential problems during prolonged emergency

T - Until stabilized

P - Poorly controlled

R - Case-by-case assessment Case-by-case specialist assessment.
(N00-99)

XI. Genito-urinary conditions

(N00, N17) Acute nephritis

Renal failure, hypertension

P - Until resolved Case-by-case assessment if any residual effects Full recovery with normal kidney function and no residual damage
(N03-05, N18-19) Sub-acute or chronic nephritis or nephrosis

Renal failure, hypertension

T - Until investigated R, L - Case-by-case assessment by specialist, based on renal function and likelihood of complications Case-by-case assessment by specialist, based on renal function and likelihood of complications
(N20-23) Renal or ureteric calculus

Pain from renal colic

T - Until investigated and treated

P - Recurrent stone formation

R - Consider if concern about ability to work in tropics or under high temperature conditions. Case- by-case assessment for near coastal duties Case-by-case assessment by specialist with normal urine and renal function without recurrence
(N33, N40) Prostatic enlargement/

urinary obstruction

Acute retention of urine

T - Until investigated and treated

P - If not remediable

R - Case-by-case assessment for near coastal duties Successfully treated; low* likelihood of recurrence
(N70-98) Gynaecological conditions - Heavy vaginal bleeding, severe menstrual pain, endometriosis, prolapse of genital organs or other

Impairment from pain or bleeding

T - If impairing or investigation needed to determine cause and remedy it R - Case-by-case assessment if condition is likely to require treatment on voyage or affect working capacity Fully resolved with low* likelihood of recurrence
(R31, 80, 81, 82) Proteinuria, haematuria, glycosuria or other urinary abnormality

Indicator of kidney or other diseases

T - If initial findings clinically significant

P - Serious and non-remediable underlying cause - e.g. impairment of kidney function

L - When repeat surveillance required

R, L - When uncertainty about cause but no immediate problem

Very low likelihood of serious underlying condition
(Z90.5) Removal of kidney or one non- functioning kidney

Limits to fluid regulation under extreme conditions if remaining kidney not fully functional

P - Any reduction of function in remaining kidney in new seafarer. Significant dysfunction in remaining kidney of serving seafarer R - No tropical or other heat exposure. Serving seafarer with minor dysfunction in remaining kidney Remaining kidney must be fully functional and not liable to progressive disease, based on renal investigations and specialist report
(O00-99)

XII. Pregnancy

(O00-99) Pregnancy

Complications, late limitations on mobility. Potential for harm to mother and child in the event of premature delivery at sea

T - Late stage of pregnancy and early postnatal period. Abnormality of pregnancy requiring high level of surveillance R, L - Case-by-case assessment if minor impairing effects. May consider working until later in pregnancy on near coastal vessel Uncomplicated pregnancy with no impairing effects - normally until 24th week. Decisions to be in accord with national practice and legislation. Pregnancy should be declared at an early stage so that national recommendations on antenatal care and screening can be followed
(L00-99)

XIII. Skin

(L00-08) Skin infections

Recurrence, transmission to others

T - Until satisfactorily treated

P - Consider for catering staff with recurrent problems

R, L - Based on nature and severity of infection Cured with low likelihood of recurrence
(L10-99) Other skin diseases, e.g. eczema, dermatitis, psoriasis

Recurrence, sometimes occupational cause

T - Until investigated and satisfactorily treated Case-by-case assessment.

R - As appropriate if aggravated by heat, or substances at work

Stable, not impairing
(M00-99)

XIV. Musculoskeletal

(M10-23) Osteoarthritis, other joint diseases and subsequent joint replacement

Pain and mobility limitation affecting normal or emergency duties. Possibility of infection or dislocation. Limited life of replacement joints

T - Full recovery of function and specialist advice required before return to sea after hip or knee replacement.

P - For advanced and severe cases.

R - Case-by-case assessment based on job requirements and history of condition. Consider emergency duties an evacuation from ship. Should meet general fitness requirements. Case-by-case assessment. Able to fully meet routine and emergency duty requirements. With very low likelihood of worsening such that duties could not be undertaken
(M24.4) Recurrent instability of shoulder or knee joints

Sudden limitation of mobility, with pain

T - Until satisfactorily treated Case-by-case assessment of occasional instability Treated; very low* likelihood of recurrence
(M54.5) Back pain

Pain and mobility limitation affecting normal or emergency duties. Exacerbation of impairment

T - In acute stage

P - If recurrent or incapacitating

Case-by-case assessment Case-by-case assessment
(Y83.4)

(Z97.1)

Limb prosthesis

Mobility limitation affecting normal or emergency duties

P - If essential duties cannot be performed R - If routine and emergency duties can be performed but there are limitations on specific non-essential activities If general fitness requirements are fully met. Arrangements for fitting prosthesis in emergency must be confirmed

XV. General

(R47, F80) Speech disorders

Limitations to communication ability

P - Incompatible with reliable performance of routine and emergency duties safely or effectively R - If assistance with communication is needed to ensure reliable performance of routine and emergency duties safely and effectively Specify assistance No impairment to essential speech communication
(T78 Z88) Allergies (other than allergic dermatitis and asthma)

Likelihood of recurrence and increasing severity of response. Reduced ability to perform duties

T - Until fully investigated by specialist

P - If life-threatening response reasonably foreseeable

Case-by-case assessment of likelihood and severity of response, management of the condition and access to medical care.

R - Where response is impairing rather than life-threatening, and reasonable adjustments can be made to reduce likelihood of recurrence

Where response is impairing rather than life-threatening, and effects can be fully controlled by long-term non-steroidal self-medication or by lifestyle modifications that are practicable at sea with no safety-critical adverse effects
(Z94) Transplants - kidney, heart, lung, liver (for prosthetics, i.e. joints, limbs, lenses, hearing aids, heart valves. See the corresponding section)

Possibility of rejection. Side effects of medication

T - Until effects of surgery and anti-rejection medication stable

P - Case-by-case assessment, with specialist advice

R, L - Case-by-case assessment, with specialist advice Not applicable
Classify by condition Progressive conditions, which are currently within criteria, e.g. Huntington's chorea (including family history) and keratoconus T - Until investigated and, if required, treated

P - Consider at pre-sea medical if likely to prevent completion or limit scope of training

Case-by-case assessment, with specialist advice. Such conditions are acceptable if harmful progression before next medical examination is judged unlikely. Case-by-case assessment, with specialist advice. Such conditions are acceptable if harmful progression before next medical examination is judged unlikely.
Classify by condition Conditions not specifically listed T - Until investigated and, if required, treated

P - If permanently impairing

Use analogy with related conditions as a guide. Consider excess likelihood of sudden incapacity, of recurrence or progression and limitations on performing normal and emergency duties. If in doubt, obtain advice or consider restriction and referral to referee. Use analogy with related conditions as a guide. Consider excess likelihood of sudden incapacity, of recurrence or progression and limitations on performing normal and emergency duties. If in doubt, obtain advice or consider restriction and referral to referee.

Notes.

1. * Risk of recurrence: where the terms, such as very low, low and moderate risk, are used, they indicate the severity and frequency of possible recurrence. These are essentially clinical judgments but in some cases risks of recurrence are clinically and statistically proved. Where this is available, e.g. for seizure and cardiac events, additional investigations are required to determine the risk of recurrence for the specific person. Approximate quantitative division of risks of recurrence:

1.1. very low - likelihood of recurrence is less than 2 % per year;

1.2. low - likelihood of recurrence is 2-5 % per year;

1.3. moderate - likelihood of recurrence is 5-20 % per year.

2. ** Asthma division and severity:

2.1. childhood asthma:

2.1.1. mild: onset age is over 10 years of age, few or no hospitalizations, no limited physical activities between the episodes, asthma controlled by anti-asthma inhaler therapy alone, remission by age 16, normal lung function;

2.1.2. moderate: few hospitalizations, frequent use of anti-asthma inhalers between episodes, limited ability to engage in physical activities, remission by age 16, normal lung function;

2.1.3. severe: frequent episodes requiring intensive therapy, regular hospitalization, frequent oral or intravenous steroid use, lost schooling, abnormal lung function;

2.2. adult asthma:

Asthma may persist from childhood or starts approximately at 16 years of age. There is a wide range of intrinsic and external factors affecting development of asthma in adult life. If a person begins his or her career late and has history of adult asthma, the role of specific allergens, including those causing occupational asthma, should be identified. Less specific potential asthma inducers, such as cold, exercise and respiratory infection, should also be taken into account. All these conditions may affect fitness for work at sea. Levels of asthma severity:

2.2.1. mild intermittent asthma: rare episodes of mild wheezing occurring less than once every two weeks which are readily and rapidly relieved by beta agonist inhaler;

2.2.2. mild asthma: frequent episodes of wheezing requiring the use of beta agonist inhaler or the introduction of steroid inhaler. Taking regular inhaled steroids (or steroid/long-acting beta agonists) may effectively eliminate symptoms and the need for use of beta agonist treatment;

2.2.3. exercise-induced asthma: episodes of wheezing and breathlessness provoked by exercise, especially in the cold. Episodes may be effectively treated by inhaled steroids (or steroid/long-acting beta agonist) or other oral medication;

2.2.4. moderate asthma: frequent episodes of wheezing despite the regular use of inhaled steroid (or steroid/long acting beta agonist), in addition, continued use of inhaled beta agonists or other medication is required, occasional use of oral steroids may be required;

2.2.5. severe asthma: frequent episodes of wheezing and breathlessness, frequent hospitalization, frequent use of oral steroids is required.

Minister for Transport Anrijs Matīss

 

Annex 6
Cabinet Regulation No. 273
3 June 2014

The Minimum Level of Physical Fitness for a Seafarer to Start and Continue Working on a Ship

No.

Shipboard tasks, functions, events or conditions1

Necessary physical fitness

The recognized medical practitioner performing the medical examination should make certain that2:

1. Routine movements on the vessel3:

- on moving deck;

- between levels;

- between compartments

Maintain balance and move with agility.

Climb up and down vertical ladders and stairways.

Step over coamings (e.g., Load Line Convention requires coamings to be 600 mm high).

Be able to open and close watertight doors

The applicant has no disturbance in sense of balance;

does not have any impairment or disease that prevents the applicant to perform necessary movements and physical activities.

The applicant is, without assistance4, able to:

- climb vertical ladders and stairways;

- step over high sills;

- manipulate door closing systems.

2. Routine tasks on board3:

- use of hand tools;

- movement of ship's stores;

- overhead work;

- valve operation;

- standing a four-hour watch;

- working in confined spaces;

- responding to alarms, warnings and instructions;

- verbal communication

Strength, dexterity and stamina to manipulate mechanical devices.

Lift, pull and carry a load (e.g., 18 kg).

Reach upwards.

Stand, walk and remain alert for an extended period of time.

Work in constricted spaces and move through restricted openings (e.g., SOLAS regulation II-1/3-6.5.1 requires openings in cargo spaces and emergency escapes to have the minimum dimensions of 600 mm x 600 mm).

Visually distinguish objects, shapes and signals.

Hear warnings and instructions.

Be able to give a clear spoken description

The applicant does not have a defined impairment or diagnosed medical condition that reduces ability to perform routine duties essential to the safe operation of the vessel.

The applicant has ability to:

- work with arms raised;

- stand and walk for an extended period of time;

- enter confined spaces;

- fulfil eyesight standards (see Annex 4 to this Regulation);

- fulfil hearing standards pursuant to this Regulation and international guidelines;

- hold normal conversation.

3. Emergency duties5 on board6:

- escape;

- fire-fighting;

- evacuation.

Don a lifejacket or immersion suit.

Escape from smoke-filled spaces.

Take part in fire-fighting duties, including use of breathing apparatus.

Take part in vessel evacuation procedures.

The applicant does not have a defined impairment or diagnosed medical condition that reduces ability to perform emergency duties essential to the safe operation of the vessel.

The applicant has ability to:

- don lifejacket or immersion suit;

- crawl;

- feel for differences in temperature;

- handle fire-fighting equipment;

- wear breathing apparatus (where required as part of duties).

Notes.

1 The table does not include all possible shipboard conditions or all possible medical conditions due to which an applicant may be recognized as unfit for work on a ship. Due consideration should be given to special circumstances affecting specific persons and to those who have specialized or limited duties.

2 When in doubt, the recognized medical practitioner should quantify the degree of severity of any relevant impairment by means of objective tests, whenever appropriate tests are available, or an applicant should be referred for further assessment.

3 Rows 1 and 2 of the table describe:

a) routine shipboard tasks, functions, events and conditions;

b) the corresponding physical fitness considered necessary for the safety of a seafarer, other crew members and a ship;

c) high-level criteria which the recognized medical practitioner may use to assess medical fitness by taking into account the different duties of seafarers and the expected work on a ship.

4 The term "assistance" means the use of another person to accomplish the specific task.

5 The term "emergency duties" refers to all measures taken in emergency situations, such as the abandonment of a ship or fire fighting, as well as the basic procedures to be followed by all seafarers in order to increase chances of personal survival and thus prevent situations when special assistance from other crew members would be required.

6 Row 3 of the table describes:

a) emergency shipboard tasks, functions, events and conditions;

b) the corresponding physical fitness which should be considered necessary for the safety of a seafarer, other crew members and a ship;

c) high-level criteria which the recognized medical practitioner may use to assess medical fitness by taking into account the different duties of seafarers and the expected work on a ship.

Minister for Transport Anrijs Matīss

 


Translation © 2017 Valsts valodas centrs (State Language Centre)

 
Document information
Status:
In force
in force
Issuer: Cabinet of Ministers Type: regulation Document number: 273Adoption: 03.06.2014.Entry into force: 11.06.2014.Publication: Latvijas Vēstnesis, 112, 10.06.2014. OP number: 2014/112.1
Language:
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