Marine Orders Part 9: Health- Medical Fitness, Issue 5 (Amendment) (Order No. 5 of 2001) (Cth)
| MARINE ORDERS Part 9 Health- Medical Fitness Issue 5 (Amendment) Order No 5 of 2001 Pursuant to Section 425(1AA) of the Navigation Act 1912, I hereby make this Order amending Marine Orders, Part 9, Issue 5 by omitting pages (i), 5 to 22, 27, 28 and 37 to 63 and substituting the attached pages (i), 5 to 22, 27, 28 and 37 to 50, to come into operation on 1 March 2001.
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Table of Contents
1 Interpretation
2 Purpose and application
3 Review of decisions
4 Penal provisions
5 Requirement to be medically fit
6 Evidence of medical fitness
7 Certificate of Medical Fitness
8 Aids to vision or hearing
Appendix 1 Medical certificate evidencing fitness for work in a sea-going vessel
Appendix 2 Guidelines for the medical examination of seafarers and coastal pilots
Appendix 3 Form of Certificate of Medical Fitness
Previous issues
Issue 1, Order No 6 of 1983
Issue 2, Order No 5 of 1985
Issue 3, Order No 5 of 1988
Issue 4, Order No 1 of 1993
—Amended by Order No 4 of 1993
Issue 5, Order No 22 of 1999
(i) Certificate of Medical Fitness; or
(ii) certificate issued by a qualified medical practitioner in accordance with Appendix 1; and
(b) there is no evidence that his or her medical condition has altered since the previous medical examination to an extent that would make him or her unfit for the duties to be performed.
7 Certificate of Medical Fitness
7.1 Application for Certificate of Medical Fitness
A person requiring a Certificate of Medical Fitness must apply to a Medical Inspector of Seamen.
Note: Under s.123 of the Navigation Act, Medical Inspectors of Seamen are appointed by AMSA. No person will be appointed unless he or she is registered as a medical practitioner in a State or Territory of Australia. Preference is given to a person who either has a Fellowship of the Australasian Faculty of Occupational Medicine (AFOM), or is a trainee of AFOM and works under the direct supervision of a Fellow. The names of Medical Inspectors of Seamen may be obtained from any AMSA office.
7.2 Medical examination etc
A Medical Inspector of Seamen is to conduct such examinations, tests and interviews and make such enquires in relation to an applicant as appear appropriate to determine whether the applicant is medically fit to perform the intended duties as a seafarer or as a coastal pilot on a ship.
7.3 Determination of fitness
7.3.1 In determining if an applicant is medically fit, a Medical Inspector of Seamen must, in addition to applying normal medical fitness considerations, have regard to the Guidelines for the medical examination of seafarers and coastal pilots, set out in Appendix 2, and any report from an independent panel of medical practitioners convened under 7.3.2.
Note: Where an employer has additional fitness requirements for particular duties or voyages (such as for the handling of specific cargoes or voyages to the Antarctic), the employer should advise the Medical Inspector of Seamen of those requirements and request a supplementary report against them.
7.3.2 If a person has been declared unfit for duty at sea, that person or his or her employer may apply for further examination by an independent panel of medical practitioners, of whom one must be an occupational physician and one a specialist physician/surgeon from the appropriate specialty.
Note: The seafarer may bring further evidence of fitness for duty at sea, including medical reports from treating medical practitioners, for consideration by the independent panel.
7.4 Issue of Certificate of Medical Fitness
7.4.1 If a Medical Inspector of Seamen:
(a) is satisfied as to the identity of an applicant;
(b) is able to attest to the true state of the applicant’s health; and
(c) determines that the applicant is medically fit to perform the proposed duties,
he or she is to issue to the applicant a Certificate of Medical Fitness in accordance with Appendix 3.
7.4.2 If a Medical Inspector of Seamen:
(a) is satisfied as to the identity of an applicant;
(b) is able to attest to the true state of the applicant’s health; and
(c) determines that the applicant is medically fit to perform duties other than those proposed,
he or she may issue to the applicant a Certificate of Medical Fitness in accordance with Appendix 3, endorsed to indicate the duty or duties for which the applicant is medically fit.
7.5 Further examination
7.5.1 A person who is refused a Certificate of Medical Fitness may make a second application.
7.5.2 A seafarer who is the holder of a valid Certificate of Medical Fitness may at any time be required by the owner or master of a ship, or by the Manager, to obtain a new certificate where as a result of illness, injury or other cause it is believed the seafarer may no longer meet the standards specified in this Part.
7.5.3 A coastal pilot who is the holder of a valid certificate of medical fitness may at any time be required by the Manager to obtain a new certificate where as a result of illness, injury or other cause it is believed the coastal pilot may no longer meet the standards specified in this Part.
7.6 Period of validity of Certificate of Medical Fitness
7.6.1 Except as provided in 7.6.2, 7.6.3, 7.6.5 and 7.6.6, and subject to 7.7, a Certificate of Medical Fitness is valid from the date of issue for a period of 2 years.
7.6.2 Subject to 7.7, a Certificate of Medical Fitness in respect of a person who on the date of issue was:
(a) less than 17 years of age; or
(b) 54 years of age or more,
is valid from the date of issue for a period of one year.
7.6.3 An expired Certificate of Medical Fitness may be extended by the Manager for a period of 3 months from the date of its expiry if the holder is to be employed on a ship and;
(b) the holder is unable to be issued with a new Certificate of Medical Fitness in accordance with this Part prior to the ship being taken to sea; and
(c) the expired Certificate of Medical Fitness has not already been extended by virtue of this provision.
7.6.4 A Certificate of Medical Fitness extended under 7.6.3 is not valid for use by a coastal pilot.
7.6.5 If the period of validity of a Certificate of Medical Fitness expires during the course of a voyage, the Certificate of Medical Fitness continues to be valid until the end of that voyage, except for use by a coastal pilot.
7.6.6 A Certificate of Medical Fitness may be issued for less than the full period if the Medical Inspector of Seamen considers it appropriate.
Note: An example might be where a Medical Inspector of Seamen considers that a person, although fit at the time of the examination, needs to be re-examined to determine the continued efficacy of treatment for a condition.
7.7 Cancellation
A Certificate of Medical Fitness is deemed to be cancelled when the person to whom it is issued:
(a) is issued with a later Certificate of Medical Fitness; or
(b) is required in accordance with 7.5.2 or 7.5.3 to obtain a further Certificate of Medical Fitness.
7.8 Production of Certificate of Medical Fitness
A person required by Marine Orders to be the holder of a valid Certificate of Medical Fitness must not fail, except with reasonable excuse, to produce the certificate on demand to the owner or master of a ship on which the person serves or intends to serve, or to a surveyor.
7.9 Delivery of cancelled Certificate of Medical Fitness
A person whose Certificate of Medical Fitness is deemed to be cancelled under 7.7 must deliver the Certificate of Medical Fitness to the Manager on demand.
8 Aids to vision or hearing
A seafarer or coastal pilot whose Certificate of Medical Fitness indicates that an aid to vision or hearing was used for the purpose of being found fit must at all times when on duty on a ship use such aid or aids and, in the case of an aid to vision, keep a spare aid to vision available.
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Appendix 1
Medical certificate evidencing fitness
for work in a sea-going vessel
A medical certificate in respect of a person may only be issued by a duly qualified medical practitioner who, being satisfied after conducting such examinations, tests and interviews and making such enquires in relation to the person as appear appropriate, is satisfied that the person is medically fit to serve on a ship.
In deciding on fitness for service, the medical practitioner is, in addition to normal medical fitness considerations, to have regard to the age of the person and the nature of the duties to be performed.
A medical certificate is to attest:
(a) that the hearing and sight of the person and, in the case of a person to be employed in the deck department, colour vision, are all satisfactory;
(b) that the person is not suffering from any disease likely to be aggravated by, or to render the person unfit for, service at sea or likely to endanger the health of other persons on board.
A medical certificate is to remain in force for a period not exceeding 2 years from the date on which it was granted.
Colour vision needs to be examined only every 6 years.
If the period of validity of a medical certificate expires in the course of a voyage, the certificate is to continue in force until the end of that voyage.
A person who has been refused a medical certificate is entitled to a second examination by a medical practitioner who is independent of any shipowner or of any organisation of shipowners or seafarers.
8. A person who is the holder of a valid medical certificate may at any time be required by the owner or master of a ship to obtain a new certificate where as a result of illness, injury or other cause it is believed the person may no longer meet appropriate minimum standards.
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Appendix 2
Guidelines for the medical examination
of seafarers and coastal pilots
How to use these guidelines
These guidelines should be read in full, at least once, at the time of issue.
When a seafarer presents for a medical:
| 1. Refer to the relevant job task analysis in Annex 1 of these Guidelines. 2. Examine the person and note any abnormalities on either history or physical examination. 3. If any abnormalities are detected, refer to the appropriate section in the guidelines. 4. Complete the Certificate of Medical Fitness and make appropriate follow-up and referral arrangements for seafarers found to be temporarily or permanently unfit for duties. 5. If unclear about administrative procedures, contact the Manager, Ship Operations and Qualifications at the Australian Maritime Safety Authority on: 1800 021 098. |
Contents
Part A Seafaring and medical fitness
1. Introduction
- Why is fitness important?
- The work environment of seafarers
2. Procedures
- Frequency of health assessment
- What information goes to the employer, AMSA and the seafarer?
- Health assessment outcomes
3. Forms
Part B Medical standards
1. Overview
2. Obesity
- Body morphology
3. Eyes/vision
- visual acuity
- colour vision
- Table 1: Seafarers’ visual standards
4. Hearing, ear, nose and throat
- Hearing standard
- Table 2: Minimum standards of Hearing for Deck and Engine Departments
- The conduct of the conversation test
- Other ear, nose and throat conditions
5. Cardiovascular
- Ischaemic heart disease
- Arrhythmia/pacemaker
- Valvular heart disease
- Cardiomyopathy
- Aneurysms
- Hypertension
- Congenital heart disease
- Peripheral circulation
- Pulmonary circulation
6. Respiratory
- Pneumothorax
- Asthma
- Reduced lung function
- Tuberculosis
- Chest X-rays
7. Gastrointestinal
- Teeth and gums
- Peptic ulcer
- Liver and pancreas
- Gall bladder disease
- Hernia
- Colostomies
- Enteric diseases
8. Genitourinary
9. Neurological system
- Epilepsy
- Migraine
- Stroke
- Transient ischaemic attacks (TIAs)
- Neuromuscular Disorders including Multiple Sclerosis, Parkinsonism
10. Psychiatric conditions
11. Prescribed medication, drugs and alcohol
- Prescribed drugs
- Table 3: Classes of drugs with potential to affect an individual’s skills to operate ships, boats, plant and equipment, including cranes
- Illegal drugs
- Alcohol
12. Musculoskeletal
13. Diabetes and endocrine
- Diabetes mellitus
- Thyroid disease
- Adrenal disease
14. Skin disorders
- Infections
- Dermatoses
15. Haemopoietic
16. Infectious diseases
17. Neoplasms
Part A Seafaring and Medical Fitness
1 Introduction
Marine Orders, Part 9 (Medical Fitness of Seafarers) is administered by the Australian Maritime Safety Authority. Part 9 makes provision for the issue of Certificates of Medical Fitness for duty at sea of seafarers (masters, mates, engineers and integrated ratings) and gives effect to Article 3 of ILO convention 73.
These guidelines have been compiled for the use of Medical Inspectors who are assessing an individual’s fitness to work at sea. The medical fitness standards have been developed in relation to the basic job task analyses in Annex 1 to these Guidelines. An employing company may have more stringent guidelines developed by its own occupational physician. Such guidelines will depend on the nature of the jobs and any specific equipment operated. Where such guidelines exist, they should be followed.
While the final judgement on whether or not an applicant is fit to work in a particular job at sea rests with the Medical Inspector, these guidelines draw attention to those conditions that have the potential to present a high level of risk in some circumstances.
1.1 Why is fitness important?
1.1.1 Employers have a duty of care to provide a safe work environment and protect the health, safety and welfare of employees. Employees similarly have a duty of care for their own safety and that of the people they work with and the community. Medical assessment of fitness is one aspect of meeting this duty of care.
1.1.2 The primary objectives of a medical assessment of fitness for duty at sea are:
to ensure that individuals are fit to perform the essential tasks of their job at sea effectively
and
to anticipate and, where possible, prevent the avoidable occurrence of ill-health offshore which could place individuals, their colleagues and emergency personnel at risk.
1.1.3 Medical conditions may impinge on work in the following areas:
(a) the condition may limit, reduce or prevent an individual from performing the job effectively eg loss of mobility and dexterity making engine room work and other maintenance tasks difficult;
(b) the condition may be made worse by the job eg an asthmatic exposed to allergens on a grain ship;
(c) the condition may make it unsafe for the person to do the job eg liability to sudden loss of consciousness whilst transferring from a smaller vessel to a larger vessel by climbing a rope ladder;
(d) the condition is likely to make it unsafe both for the individual and other crew eg a ships crane operator liable to sudden loss of consciousness; catering crew with infectious hepatitis or gastro-enteritis;
(e) the condition is likely to make it unsafe for other shipping eg a master or mate who is at risk of sudden loss of consciousness due to a cardiac arrhythmia;
(f) the condition, if it worsens, is one which will require emergency evacuation for medical treatment eg gastric ulcer haemorrhage.
1.2 The work environment of seafarers
1.2.1 Medical Inspectors should bear in mind the aspects of seafaring life, listed below, when assessing fitness for duty at sea.
1.2.2 As ships often operate far offshore or in inaccessible areas, it is often difficult to replace seafarers who become injured or ill. Many ships have only the minimal number of persons on board necessary to operate the ship; thus the incapacitation of even one seafarer may place a substantial additional burden on his or her shipmates.
1.2.3 Ships’ officers generally receive basic first-aid and other medical training, and ships are usually equipped with basic medical supplies. Nevertheless, it is often quite difficult to transport sick or injured seafarers ashore where they can be treated by qualified physicians. In some geographical areas, the closest medical care ashore may be well below the standard of the seafarer’s home country. It is therefore inadvisable and often unsafe to allow persons with certain medical conditions to become seafarers or to return to seagoing employment.
1.2.4 Seafarers live close to each other at sea, often for long periods. Contagious diseases therefore may be a serious threat, endangering not only the health of other seafarers but also the safety of the ship and, where carried, passengers. It is particularly important that seafarers concerned with the preparation of food do not suffer from conditions which may be transmitted to others through their work.
1.2.5 Seafarers should be medically fit to perform their normal duties correctly and to be able to respond to emergency situations (eg fighting fires, lowering lifeboats, assisting passengers).
1.2.6 Seafarers should be able to adjust to the often violent motions of the ship, to be able to live and work in sometimes cramped spaces, to be able to climb ladders, to lift heavy weights and to be able to withstand exposure to harsh weather conditions on deck or excessive heat in the machinery spaces. They should not suffer from conditions which are exacerbated by air travel.
1.2.7 Seafarers should be able to live and work closely with the same people for weeks and perhaps months on end and under occasionally stressful conditions. They should be capable of dealing effectively with isolation from family and friends and, in some cases, from persons of their own cultural background.
1.2.8 Shipping operations and shipboard duties vary substantially. For a fuller understanding of physical demands of particular categories of work on board ship, the Medical Inspector should consult the employer.
2 Procedures
2.1 Frequency of health assessments
2.1.1 All seafarers and coastal pilots should be assessed as to medical fitness for duties at sea:
· less than 18 years of age: annually
· 18 - 54 years of age: two-yearly
· 55 years of age and over: annually with resting ECG (stress ECG, if in safety critical job and clinically indicated)
· if there is a change in the medical condition of the employee
· after prolonged sickness absence of 3 months or more due to injury or illness.
2.2 What information goes to the employer, AMSA and the seafarer?
Confidentiality
2.2.1 The employer, AMSA and the applicant/seafarer will receive a copy of the Certificate of Medical Fitness.
2.2.2 The Medical Inspector (or successor) should keep all the medical examination forms, including results of investigations in a confidential file, for a period of at least 30 years. This information is not to be released to any person, agency or employer without a signed consent form or as required by law.
2.3 Health assessment outcomes
2.3.1 An applicant or seafarer is either fit for the intended duties at sea or unfit.
2.3.2 Those declared unfit may be temporarily or permanently unfit or may be fit for duties other than the intended duties.
2.3.3 If temporarily unfit, the Medical Inspector should specify a minimum period after which the assessment can be reviewed.
3 Forms
The form of the Certificate of Medical Fitness is prescribed in Appendix 3 to Marine Orders, Part 9. Other forms that may be found useful are available from AMSA, freecall 1800 021 098 or from the AMSA web site at align="center">Part B Medical Standards
1 Overview
1.1 This section provides information and guidance on medical conditions which may affect individuals in the safe performance of their duties at sea.
1.2 The medical standards attempt to be specific and give examples of tasks/jobs which may be affected. The standards cannot cover every clinical situation and the Medical Inspector should exercise judgement in relation to the key objective - maintaining safety. For example, could the condition cause sudden loss of control of a ship, or sudden loss of consciousness when working at heights, or interfere with the performance of emergency duties?
1.3 Medical Inspectors should make a comprehensive medical assessment of overall health in the knowledge that errors or omissions of a critical task in some jobs can lead to serious consequences in terms of human health and life, environmental impact and/or major property loss.
1.4 The critical time needed for treatment/access to appropriate land-based care is also a consideration when determining fitness.
1.5 Medical Inspectors of Seafarers should consider what medical conditions could increase the probability of poor performance of critical tasks, and the probability and severity of the consequences when determining “Is this applicant medically fit for duty at sea?”.
2. Obesity
Body morphology
2.1 As obesity can hamper evacuation procedures, persons with a body mass index of more than 30 kg/m2 should be able to demonstrate that they can climb ladders and fit through hatches. An Occupational Physician or an Occupational Therapist may need to conduct a functional assessment on board ship.
2.2 A body mass index of more than 35 kg/m2 presents a high risk. Applicants in this category may need to undertake weight reduction and be reassessed. It should be noted that sleep apnoea is more common in those with morbid obesity, as are diabetes and hypertension.
3. Eyes / vision
Visual acuity
3.1 Far vision is required for:
(a) watchkeeping duties; and
(b) control of ships, ships’ small craft and cranes.
3.2 Near vision is required to read charts, weather maps, computer screens, monitors and instructions.
3.3 Night and depth vision are required for watchkeeping and control of the ship; (depth vision is especially important for operating cranes at close distances).
Colour vision
3.4 Good colour vision is required for bridge watchkeeping duties to distinguish red and green port and starboard channel markers, navigation beacons and ships’ navigation lights. The ability to identify red, green and white navigation lights is an essential part of the job for masters, deck officers and seamen required to carry out lookout duties.
3.5 Impaired colour vision presents a risk to engineers who may be required to distinguish the colours of electrical wiring in order to make proper electrical connections. As such, it presents a risk depending on the degree of impairment that may affect a person’s ability to perform his duties. However, engineers and ratings may provide evidence from a relevant employer that, within the last two years, impaired colour vision, if present, has not been found to affect their work.
3.6 When testing colour vision, coloured lenses should not be worn by the seafarer.
Note: The wearing of contact lenses or spectacles with chromagen lenses with red filters will increase the contrast of greens, yellows & browns, thus enabling a colour deficient seafarer to pass the Ishihara test. Unfortunately, these lenses are not sufficient to enable safe watchkeeping duties at sea.
3.7 Information regarding colour vision impairment must be provided on the medical certificate to assist the employer to make an appropriate decision regarding engagement or continued employment.
Note: Guidance on appropriate screening for colour vision is contained in Annex 2 of these Guidelines.
Table 1: Visual standards
| Distant vision | Near | Visual | ||||||||
| Better eye | Other eye a | Both eyes | vision a | Colour vision | fields | |||||
| Deck department | not less than | not less than | not less than | |||||||
| 1. Seafarers required to undertake watchkeeping duties: | ||||||||||
(a) for new entrants | ||||||||||
| - with or without glasses or contact lenses c - unaided vision | 6/6 6/12 | 6/9 6/24 | 6/6 6/12 | N8 for charts, weather maps and N12 for other reading tasks with or without visual aids | Normal(b) Normal(b) | Normal visual fields | ||||
(b) for existing staff | ||||||||||
| - with or without glasses or contact lenses c - unaided vision | 6/6 6/36 | 6/9 6/36 | 6/6 6/36 | N8 for charts, weather maps and N12 for other reading tasks with or without visual aids | Normal(b) Normal(b) | Normal visual fields | ||||
| 2. Seafarers required to operate lifting plant eg ships’ cranes, hoists: | ||||||||||
| - with or without glasses or contact lenses c - unaided vision | 6/9 6/60 | 6/12 6/60 | 6/9 6/60 | N12 | Distinguish red(d) Distinguish red(d) | Normal visual fields | ||||
| 3. Seafarers not required to undertake duties in 1 or 2: (aided vision if necessary) | 6/18 | 6/60 | 6/18 | N12 with or without visual aids | N/A | Sufficient visual fields | ||||
Table 1: Visual standards (continued)
| Distant vision | Near | Visual | ||||||||
| Better eye | Other eye a | Both eyes | vision a | Colour vision | fields | |||||
| Other departments | not less than | not less than | not less than | |||||||
| Engine room (includes electrician): | 6/12 | 6/60 | 6/12 | N12 to read instruments, gauges on control panels | See Annex 2 | Sufficient visual fields | ||||
| Catering department: aided vision allowed if necessary | 6/12 | 6/60 | 6/12 | N12 to read instructions and catering equipment control panels | Not required | Sufficient visual fields | ||||
| Note: (a) For seafarers who have proof of a satisfactory record of service, monocular vision is permitted excepting those seafarers who have to operate lifting equipment such as cranes. (b) See Annex 2 (c) In all cases, where visual aids (spectacles or contact lenses) are required for the efficient performance of duties, a spare pair must be carried when seafaring. When different visual aids are used for distance and near vision a spare pair of each must be carried. (d) It is sufficient if the applicant can distinguish red from other colours. See Annex 2. | ||||||||||
3.8 Any eye disease or defect which affects vision needs to be corrected.
3.9 A history of glaucoma or uveitis needs ophthalmological assessment.
3.10 The vision standards listed in Table 1 are those that are internationally accepted as appropriate.
4. Hearing, ear, nose and throat conditions
Hearing standard
4.1 Hearing is required for communication by radio, by telephone or person to person and therefore the critical frequencies are in the speech range 500 to 2,000 Hz. Hearing loss for new entrants should be checked by means of an audiogram. If the new entrant uses a hearing aid, the person should be referred to an audiology centre unless evidence is produced of recent testing and hearing using the aid is apparently satisfactory. For existing seafarers, an audiogram is only required if hearing is not apparently satisfactory in conversation. Additionally, those seafarers wearing hearing aids who have unsatisfactory hearing in normal conversation should have their hearing aid checked by the supplier and may also require a practical test to assess functional hearing.
4.2 The speech must be reasonably clear and free of stutter and hesitation sufficient to use radios and communicate on deck. Those using cranes must be able to hear whistle signals where these are used.
Table 2: Minimum Standards of Hearing for Deck and Engine Departments
| Frequency Hz | ||||
| 500 | 1,000 | 2,000 | 3,000 | |
| dB loss in better ear without aids | 40 | 40 | 40 | 40 |
4.3 If hearing loss is 40dB or more at the frequencies specified in Table 2, ability to use a radio will need to be demonstrated. In this circumstance the applicant must pass a conversation test.
The conduct of the conversation test
4.4 The following is a recommended procedure for conduct of a conversation test.
4.5 The test should be conducted in a quiet room with a stable background noise level. Hearing aids should be worn if normally used at work or if retesting following their fitting.
4.6 The examiner should face the subject and address him/her from a distance of 3 metres for normal speech.
4.7 The subject should be seated facing away from the examiner to preclude lip reading and the use of non-verbal clues.
4.8 A normal conversational vocal volume should be used.
4.9 The test material should be a mixture of alphabetical letters and numerals in any order, not to exceed a total of three in any one phrase, eg 6Y3, 2N4, S5G, 7BL.
4.10 Ten combinations should be used, each preceded by the carrier phrase “PLEASE SAY”.
4.11 The subject should repeat what was thought to be heard. If uncertain guessing is encouraged.
4.12 Six or more combinations should be repeated without error to be considered satisfactory.
4.13 Applicants who do not pass this test should be referred for further assessment of functional hearing and speech discrimination by an audiologist.
4.14 A functional hearing loss sufficient to interfere with communication or to impede safety (eg hearing audible warning devices) presents a high risk.
Other ear, nose and throat conditions
4.15 Acute infections require treatment. Although chronic middle ear disease presents a high risk, recurrent or chronic sinus infection presents less of a risk if the Medical Inspector is satisfied that the seafarer can manage the condition with appropriate medication at sea.
4.16 Vestibular malfunction can occur suddenly and with sufficient severity to make safe operations of vessels and cranes impossible. It may be accompanied by nystagmus which compounds the disability. Meniere’s disease therefore presents a high risk.
4.17 Hay fever which responds to therapy (without side effects) presents a lower level of risk.
4.18 Frequently recurring tonsillitis presents a high risk until corrected.
with people of the same age and body build when walking on level ground or who has dyspnoea on one flight of stairs will have difficulty climbing stairs and ladders, climbing over plant and equipment, and walking reasonable distances on board ship. If in doubt, a practical test should be requested.
Tuberculosis
6.10 Untreated tuberculosis or other serious infection presents a high risk. Where the applicant has suffered tuberculosis or other serious lung infection, a letter from the treating physician should be obtained to certify that the seafarer is no longer infectious.
Chest X-rays
6.11 A chest X-ray is required at entry i.e. for pre-sea medicals and may be required where there is a history of tuberculosis, or pneumothorax and/or when clinically indicated. There is no requirement for routine chest X‑rays.
7 Gastrointestinal system
Teeth and gums
7.1 Seafarers must be dentally fit as, other than temporary pain relief, there is no dental treatment aboard ship. Dental abscesses or severe gingivitis presents a high risk. Seafarers with impacted wisdom teeth may need dental review.
Peptic ulcer
7.2 Acute peptic ulceration presents a high risk. However treated peptic ulceration is acceptable provided that the Medical Inspector is satisfied that the risk of recurrence, especially haemorrhage, is minimal. A letter from the treating physician, together with endoscopy report, may be required.
Liver and pancreas
7.3 A history of recurrent or chronic pancreatitis presents a high risk. Serious or progressive liver disease such as cirrhosis with complications of oesophageal varices presents a high risk.
Gall bladder disease
7.4 A person with a history of cholelithiasis and/or cholangitis should be carefully evaluated for the risk of recurrence before being accepted as fit for duty at sea.
Hernia
7.5 A hernia presents a high risk unless surgically corrected, with the exception that an applicant who has a small inguinal hernia where there is no risk of strangulation and where there is surgical opinion to state that there is no clinical indication for surgery may be determined as fit for lifting tasks.
7.6 A rectus divarification or large umbilical hernia should be surgically corrected before applicants can be accepted as fit for lifting tasks.
7.7 A diaphragmatic hernia without disabling reflux oesophagitis or other symptoms is acceptable.
Colostomies
7.8 A person with an uncomplicated stoma is acceptable provided that the underlying cause is compatible with work offshore and there are adequate facilities for changing colostomy bags on board ship.
Enteric diseases
7.9 Catering crew should be free of infectious enteric diseases, including hepatitis A.
A blood sample may be required for detection of antimicrobial antibodies to hepatitis A, unless the applicant produces evidence of a satisfactory immunisation. A blood test would only be required in a seafarer who is symptomatic and in whom there are clinical reasons to suspect hepatitis A.
7.10 Catering crew and those exposed to sewage (eg engineers maintaining sewage treatment plants) require hepatitis A immunisation on employment.
8 Genitourinary
8.1 Any person who has haematuria and/or protein on urinalysis should be carefully assessed to exclude any condition which may suddenly worsen and require urgent medical attention, eg renal calculi.
8.2 A history of renal calculi requires advice on fluid intake in hot weather. The presence of untreated renal calculi presents a high risk.
8.3 Urinary incontinence presents a high risk.
8.4 A large untreated hydrocele presents a high risk. A small symptomless hydrocele is acceptable.
13.4 If the person’s diabetes is currently uncontrolled eg due to change in therapy, it may be necessary to consider him or her as temporarily unfit and subject to re-examination in, say, three months.
Thyroid disease
13.5 Fitness for duties at sea will depend on the degree of control of thyroid disease, the absence of complications, especially cardiac, and the requirements for monitoring medication.
Adrenal disease
13.6 Disorders affecting adrenocortical hormone production such as Cushing’s syndrome or Addison’s disease present a high risk unless the underlying cause has been treated and the individual’s adrenal function is sufficient.
14 Skin disorders
Infections
14.1 Contagious skin disease presents a high risk unless the disease has been treated and is no longer contagious.
Dermatoses
14.2 Mild endogenous eczema is acceptable but the Medical Inspector should be satisfied that the condition will not be aggravated by exposure to oils, detergents or other substances at work to a degree sufficient to render the applicant unfit for duty at sea.
14.3 Psoriasis, not associated with polyarthritis, is acceptable.
15 Haemopoietic disease
15.1 Routine blood tests are not required for assessing medical fitness unless clinically indicated, for example there are clinical signs of anaemia, lymphadenopathy, haemarthroses.
15.2 Coagulation disorders such as Factor VIII deficiency present a high risk because it will not usually be possible to treat an acute traumatic haemorrhage at sea with replacement of clotting factors.
15.3 Leukaemias and myeloproliferative diseases present a high risk.
15.4 Chronic lymphatic leukaemia if mild and asymptomatic may be acceptable.
16 Infectious diseases
16.1 Active infectious disease presents a high risk. Tuberculosis and contagious skin diseases are mentioned in the relevant sections.
16.2 Catering staff must be free of enteric diseases, including hepatitis A.
16.3 HIV testing is not routinely required and should not be done unless there is a clinical indication. Whilst a positive HIV test is not a bar to employment, evidence of AIDS (Acquired Immunodeficiency Syndrome) presents a high risk. Of particular concern are neurological or neuropsychiatric and other complications which would compromise safety.
17 Neoplasms
17.1 Neoplasms of any type have the potential to disqualify an applicant or seafarer from duties at sea because of:
· acute symptoms, eg hemianopia with pituitary tumours
· complications eg pulmonary emboli
· side-effects of treatment/medication, eg immunosuppression, anaemia, nausea.
17.2 Frank malignant disease presents a high risk. Seafarers should be carefully reassessed after a diagnosis of cancer is confirmed and treatment instituted. The natural history and prognosis of the neoplasm should be taken into account. The progress and likelihood of complications of the disease or its treatment must also be carefully evaluated.
Annex 1
Job task analyses
Table 1 Master/Mate/Pilot
Table 2 Chief Engineer/Engineer/ Electrician/Fitter
Table 3 Chief Integrated Rating/Integrated Ratings
Table 4 Chief Cook/Cook/Steward
Table 5 Catering Attendant and Steward
Table 1: Master/Mate
| 1. Vision | 2. Hearing/speech | 3. Consciousness | 4. Physical | 5.Other |
| · read instructions · read instruction manuals · read charts · read weather maps · distinguish red/white/green navigation lights · distinguish coloured light alarms · observe aspect of other vessels · read radar, GPS and other monitors (digital, analogue and graphic) · read computer screens · identify navigation lights from beacons, buoys, lighthouse towers, other vessels · keep watch for obstacles to navigation · standing watch – night vision and depth perception | · give/take instructions · use 2-way radios and telephones · distinguish different auditory alarms | · alert to changes in machinery vibration eg engines · alert to movements of other vessels · alert to position of ship’s ancillary craft · interpret complex information from digital, analogue and graphic computerised monitoring equipment eg radar, GPS, computerised charts, compass · respond to alarms · alert to changes in weather · high level decision-making in emergencies · responsible for safety of ship’s crew and safety of vessel · alert to movements and position of crew | · climb narrow, steep stairs · climb 3 metre rope ladders at sea · climb mast* · climb steel rungs/ladders · lift hatch covers* · fine motor skills to plot courses on charts, use keyboards on computer, rotate knobs, pull levers, push buttons · assist with lifting, manual labour eg lifting cylinders, 25 litre drums etc* · cleaning/maintenance of the bridge (wheelhouse)* · place tags for safety checks* · clean own cabin, shower ie bending, reaching, scrubbing, and wiping (varies from ship to ship)* Additional for supply vessels · handle cargo on the back deck of a supply vessel* · handle wires, chains and ropes during anchor handling* · hook and unhook tows* | · work shiftwork (4 or 12 hour watches) · occasional long hours of work (18+) · write reports (log) · plan ship repairs* · plan work schedules* · away at sea for up to 6 months at a time* · fit through escape hatches* · work at high temperature, humidity and/or in extreme cold & in storms/cyclones etc · wear PPE–boots, overalls, hard hat, hearing protection and occasionally respirators · order deck stores* · use computers to write reports, keep chart catalogues* · check radio equipment, liferafts* · inspect oil, other cargo, ballast and water tanks and other confined spaces* · work with heavy seas on deck · work in conditions involving heavy rolling and pitching of vessel |
_____________________________________
* These duties are not normally required of a pilot
Table 2: Chief Engineer/Engineer/Electrician
| 1. Vision | 2. Hearing/speech | 3. Consciousness | 4. Physical | 5.Other |
· read gauges, dials · read instruction manuals, drawings · near vision for calipers and other instruments · near vision for identifying and using nuts, bolts, screws, pins etc · ability to distinguish basic colours to recognise coloured alarms and coloured wires | · communicate by 2-way radio · hear alarms and pager · give/take instructions | · alert to alarms (visual and auditory) · respond to emergencies · alert to position of ship’s ancillary craft · interpret complex information from monitors and gauges on instrument control panels in engine room | · lifting and carrying condenser coils, pipes, motors, pumps up to 35 kg – but can be carried by two persons · lifting and carrying 25 kg containers of chemicals · use lathes, circular saws, hand tools, grinders & pedestal drill · welding/oxy-cutting · fine manual dexterity in placing nuts, bolts, screws · turning valves, levers · pushing button controls · climbing steep stairways, steel rung ladders, rungs on masts and onto ship’s crane · standing and walking most of the shift · working in awkward postures · working in confined spaces · working overhead · clean own cabin, shower ie bending, reaching, scrubbing & wiping (varies from ship to ship) Additional for supply vessels · handle cargo on the back deck of a supply vessel · handle wires, chains and ropes during anchor handling · hook and unhook tows | · work shiftwork (4 hour watches) · write reports (log) · plan ship repairs · plan work schedules · away at sea for up to 6 months at a time · fit through escape hatches · work at high temperature, humidity and/or in extreme cold & in storms/cyclones etc · wear PPE–boots, overalls, hard hat, hearing protection and occasionally respirators · order engine room stores · exposure to heat and fumes · use computers to write reports, keep chart catalogues · safe handling of chemicals · check radio equipment, liferafts · inspect water tanks · work in conditions involving heavy rolling and pitching of vessel |
Table 3: Chief Integrated Rating/Integrated Rating
| 1. Vision | 2. Hearing/speech | 3. Consciousness | 4. Physical | 5.Other | |
· read instructions, procedures · read gauges, dials · read labels on chemicals · distance vision when operating small craft, crane, hoist · see navigation lights of other vessels, beacons, lighthouses etc · distinguish red/green coloured lights · distinguish coloured light alarms · stand watch – night vision and depth perception · near vision for identifying shackles, markings on slings, bolts, nuts, screws etc | · give/take instructions · hear whistles for crane/hoist movements · use 2-way radio · listen to machinery eg crane, LARC · hear warning signals/alarms · use hands free headsets to communicate by radio in rough seas | · alert to movements of other persons, operating machinery, ship’s small craft and helicopter · monitor equipment including radar, digital and analogue read outs on gauges, GPS, compass, and generally assist officer on watch | · manual dexterity to tie knots, splice rope, repair/use canvas tarpaulins, place slings, use pliers, spanners & other hand tools · pulling knobs, levers, pushing buttons to operate crane, machinery, incinerator · reaching and working overhead · shovel ash from incinerator and lift bags of rubbish into incinerator · lift stores · lifting from deck to overhead to load ship’s small craft · climbing ship’s rope ladders (3m) in rough seas, and steel rung ladders on towers (up to 30m) whilst carrying ropes, light tool bag · lifting weights up to 50 kg (two person lift) · lifting cables, boxes, batteries, winches, hoists up to 40 kg · use powered tools, saws, drills, rattleguns, chisels, sledgehammers · mooring/unmooring vessels · use air/electric chain hoists – pulling on ropes, chain, and pressing buttons on handheld control box · carpentry/shipwright duties · standing for long periods (3 hours) · clean own cabin, shower ie bending, reaching, scrubbing, and wiping Additional for supply vessels · handle cargo on the back deck of vessel · handle wires, chains and ropes during anchor handling · hook and unhook tows | · work at heights · work in high temperature, humidity and/or in extreme cold, and in storms, cyclones etc · long work hours (up to 10-12 hours per day · away at sea for up to 6 months at a time · fit through escape hatches · shiftwork when on 4-hourly watch · ship’s fire and safety rounds – inspect all areas regularly · plan work schedules · wear personal protective equipment eg safety boots, earplugs or earmuffs, hard hat, gloves, overalls, safety spectacles and occasionally respirators · exposure to paints, thinners, oils, antifoul, degreasers · use fire-fighting hoses, extinguishers · work in oil, other cargo, ballast and water tanks and other confined spaces · work in conditions involving heavy rolling and pitching of vessel | |
Table 4: Chief Cook/Cook/Steward
1. Vision | 2. Hearing/speech | 3. Consciousness | 4. Physical | 5. Other | |||||
| · near vision for reading labels, menus, recipes, computer, instructions, orders for stores, invoices, telexes, faxes · near vision for cutting, slicing, cooking | · give/take instructions · use telephones to contact providores, clients · communicate with ship’s crew · hear alarms | · alert to movements of persons in kitchen because of hot food in saucepans and trays · alert to position of deep fryers, cooking pots, pans especially in rough weather · alert to hazards on ship eg fire etc | · lifting, carrying, unpacking stores from gangway or forehead store space · unpack and place stores on shelves in fridges and freezers from floor height to shoulder height · unpack cartons each trip eg soft drinks, cans, foodstuffs, and cleaning gear · cleaning pots and utensils · wiping benches, stove tops · cleaning kitchen and laundries – mopping, scrubbing · scrub mats out of fridge · polish passageways · standing for long periods (3 hours) · fine manual dexterity to use kitchen utensils, knives and to turn knobs, flick switches on ovens, hot plates and appliances · clean own cabin, shower ie bending, reaching, scrubbing, and wiping · cleaning grease traps and tanks · cleaning ovens and deep freezers · narrow stairways | · order all food provisions · plan menus · cooking all meals for all persons on board · work split shifts with early starts plus additional hours for administration and other paperwork · away at sea for up to 6 months at a time although calling in at various ports during the voyage · fit through escape hatches · use a computer · wear safety footwear · work in conditions involving heavy rolling and pitching of vessel | |||||
Table 5: Catering Attendant and Steward
1. Vision | 2. Hearing/speech | 3. Consciousness | 4. Physical | 5. Other | |||||
· near vision for: · distinguish coloured light alarms/indicator lights on galley range | · give/take instructions · hear alarms · communicate with ship’s crew and passengers | · alert to movements of other persons in kitchen, pantry because of hot saucepans, food trays etc | · general interior cleaning of ship eg portholes · daily vacuum of mess room · polishing mess room twice weekly and other floors weekly (3 levels in all) · lifting, carrying, unpacking stores · carrying hot trays and stocking pantry · lifting floor polishing machines (24kg) up stairs (2 persons) · mopping, sweeping and/or vacuuming · wiping and scrubbing benches, deckheads, bulkheads · working overhead, above shoulder height to clean/wipe surfaces · washing dishes/pans in sink at waist height · load/empty dishwasher – bending required · washing/drying crew’s bed linen and towels on crew change day · occasional cleaning of cabins when passengers are on board · keeping washroom toilets clean on all levels · clean own cabin, shower ie bending, reaching, scrubbing, and wiping · vacuum all carpet areas | · assist Cook in food preparation as required · work split shifts with early morning starts · away at sea for up to 6 months at a time although calling in to various ports during the voyage · fit through escape hatches · wear safety footwear · work in conditions involving heavy rolling and pitching of vessel · take an active role in all vessel safety and emergency drills · take an active role in crisis management in emergencies | |||||
Annex 2
Guidance in screening for colour vision
1 Need for good colour vision
1.1 Deck officers need to be able to distinguish red, green and white navigation lights in order to be able to make correct decisions regarding the aspect of an approaching vessel, and regarding what action needs to be taken, if any, to avoid a collision. Confusion between such lights would lead to incorrect decisions being taken, with the potential for collision and resultant deaths, injuries and loss.
1.2 Ratings on lookout duty similarly need to be able to distinguish red, green and white navigation lights in order to provide correct advice to the officer of the watch.
1.3 Engineering officers and ratings on engine room duty need to be able to distinguish both warning lights (normally coloured red) from correct status lights (normally coloured white or green) and also need to be able to distinguish the colours of electrical wires when making connexions.
2 Tests
2.1 The Ishihara pseudoisochromatic tests should be used to screen seafarers in the deck and engine departments for colour vision impairment. If the tests indicate impaired colour vision, further testing should be carried out.
2.2 In the case of persons in the deck department who are required to keep watches, the further test should use the Holmes-Wright Type B lantern test. This test is conducted by some ophthalmologists and the Schools of Optometry in various Universities.
2.3 In the case of persons in the engine department whose duties may include making electrical connexions, the further test should be the UK Electricity Supply Industry Colour Vision Trade Test.
Note: For information on where to refer seafarers with colour vision deficiencies, contact the Manager, Ship Operations and Qualification at the Australian Maritime Safety Authority, on 1800 021 098.
3 Ishihara Test
3.1 The Ishihara pseudoisochromatic tests (using either the full set of 38 plates or the abridged version of 24 plates) should be used.
3.2 A satisfactory response on all plates on the first showing, or a single wrong response on first showing which is corrected on a second or third showing, should be considered to indicate ‘Normal’ colour vision. If the tests indicate impaired colour vision, further testing should be carried out.
4 Holmes Wright Type B Lantern Test
4.1 The lantern test is a practical test of a person's ability, in conditions simulated to represent a watchkeeping situation, to recognise and discriminate between navigation lights used at sea.
4.2 A lantern test is conducted by means of a Holmes/Wright type B lantern, which projects red, green and white lights viewed indirectly through a polished mirror at a virtual distance of 6 metres from the eyes. The large aperture of the lantern projects one coloured light at a time and the small apertures project 2 coloured lights side by side at a time. Each full circuit of the lantern contains 9 settings of single large apertures or 9 settings of small apertures. The small apertures of the lantern show any combination of 2 of the 3 colours.
4.3 A person who uses an aid to vision for a letter test is required to use the same aid to vision in the lantern test.
4.4 A person who does not use an aid to vision for a letter test is not permitted to use an aid to vision in the lantern test.
4.5 A person undergoing the lantern test must not wear a tinted aid to vision for the purpose of passing the test.
4.6 The lantern test must be conducted in a room from which daylight is excluded.
4.7 A person who requires to adapt to conditions of darkness is to be allowed up to 10 minutes complete or partial darkness in preparation for the lantern test.
4.8 A person is considered to have passed the lantern test if he or she correctly names the colours of one full circuit of large apertures, 4 full circuits of small apertures shown in sequence, and 9 sets of small apertures shown at random.
4.9 The procedures specified in 4.10 to 4.16 should be followed if a person undertaking the lantern test fails to achieve a pass in accordance with 4.8.
4.10 At the first mistake in naming a colour correctly, the examiner must inform the person being tested of the mistake and continue the test, adding a further circuit.
4.11 1f no further mistake is made in the test and the further circuit, the person being tested will be considered to have passed.
4.12 If a second mistake is made, the procedure under 4.10 and 4.11 of this Appendix is to be repeated.
4.13 If a third mistake is made, the test is to be repeated from the start after the person being tested has been given the opportunity to rest his or her eyes or regain composure.
4.14 In repeating the test under 4.13, the examiner is to record the result but not inform the person being tested of mistakes being made.
4.15 A person who in the repeated test under 4.13, correctly names all colours in accordance with 4.8 will be considered to have passed.
4.16 A mistake of red for green or green for red in the repeated test under 4.13 means failure of the lantern test.
4.17 A person who has failed the lantern test may request a further test.
5 Colour Vision Trade Test
5.1 When mistakes are made on the Ishihara pseudoisochromatic plates, this test should be used.
5.2 The applicant should sit opposite the Medical Inspector in good natural light. One at a time, each of the coloured wires should be placed in front of the applicant on a flat surface. The applicant should be asked to identify the colour of the wire. Slowness in answering indicates difficulties. Care must be taken that the applicant cannot compare the colour of one wire with others.
5.3 Applicants who wrongly identify a colour should be given an individual wire. The examiner should then present all nine wires to the applicant one at a time. The candidate should be asked to indicate when there is a match. All nine colours should be tested in this way.
5.4 Failure to find a correct match shows unreliable colour vision.
5.5 Matching colours correctly but wrongly identifying them singly, means mistakes will be made in identifying certain colours without comparing them with others.
5.6 The apparatus required is:
One centimetre of coloured plastic covered wire is exposed on a white card housed in a photographic colour transparency slide, size 5 x 5 cm, with a viewing window of 3.5 x 2.5 cm. Two complete sets of colours are made up (18 slides), these being housed in a slide magazine.
For matching purposes 9 individual wires are to be available, one in each colour, each 2.5 cm long.
Nine colours are to be used: white, black, yellow, red, grey, blue, orange, green and brown.
All wires used should have the same diameter, which should be in the range 0.8 to 1.1 mm. Wire of 0.89 mm diameter is preferred, if available.
* * * * * *
Appendix 3
Form of Certificate of Medical Fitness
| Certificate of Medical Fitness | ||||||||||||||||||||||||||||||||||||||||||||
| Name | Sex | PIN | ||||||||||||||||||||||||||||||||||||||||||
| Last name | First names | Male | ||||||||||||||||||||||||||||||||||||||||||
| Female | ||||||||||||||||||||||||||||||||||||||||||||
| Home address | ||||||||||||||||||||||||||||||||||||||||||||
| Proof of identity | ||||||||||||||||||||||||||||||||||||||||||||
| Photo driver’s licence | Passport | Other (specify) | ||||||||||||||||||||||||||||||||||||||||||
| I have evaluated the above-named applicant according to Marine Orders, Part 9, made under the Navigation Act 1912. On the basis of the applicant’s personal declaration, my clinical examination and diagnostic test results recorded on the medical examination form, I declare the applicant: | ||||||||||||||||||||||||||||||||||||||||||||
| Fit | Unfit* | Deck Department | * If found unfit, please provide details and action taken (eg referral or any practical tests required before fitness can be | |||||||||||||||||||||||||||||||||||||||||
| certified) | ||||||||||||||||||||||||||||||||||||||||||||
| Fit | Unfit* | Engine Department | ||||||||||||||||||||||||||||||||||||||||||
| Fit | Unfit* | Catering Department | ||||||||||||||||||||||||||||||||||||||||||
| Fit | Unfit* | Other services | ||||||||||||||||||||||||||||||||||||||||||
The applicant used aids to vision | Yes | No | ||||||||||||||||||||||||||||||||||||||||||
Colour vision test done | Yes | No | ||||||||||||||||||||||||||||||||||||||||||
Colour blind | Yes | No | ||||||||||||||||||||||||||||||||||||||||||
The applicant used aids to hearing | Yes | No | ||||||||||||||||||||||||||||||||||||||||||
| Describe any restrictions (eg specific position, type of ship, trade area) | ||||||||||||||||||||||||||||||||||||||||||||
| List any prescribed medications taken regularly | ||||||||||||||||
| Date of birth | Date of expiry | |||||||||||||||
| Under 18/over 55 | 1 year medical | |||||||||||||||
| / | / | / | / | |||||||||||||
| Day | Month | Year | 18 - 55 | 2 years medical | Day | Month | Year | |||||||||
| Date of examination | / / | Place of examination | ||||||||||||||
| Place of examination | ||||||||||||||||
| Official stamp | ||||||||||||||||
| Name of Medical Inspector | Signature of Medical Inspector | of Medical | ||||||||||||||
| Inspector | ||||||||||||||||
| I acknowledge that I have been advised of the content of the medical examination form. | Distribution of copies | |||||||||||||||
| Applicant’s signature | Original Applicant Duplicate AMSA Triplicate Medical Inspector | |||||||||||||||
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