Pre-sea and periodic medical fitness examinations form for 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling in your personal information, including your family name, given names, date of birth, sex, home address, seaman service book number, nationality, type of ship, and trade area.
3. In section A, provide a personal declaration regarding your medical history. Carefully indicate 'Yes' or 'No' for each condition listed. If you answer 'Yes' to any question, be prepared to provide additional details.
4. Proceed to the medical examination section. Mark whether this is a pre-sea or periodic examination and complete the required tests such as visual acuity and hearing assessments.
5. Fill out the results of any diagnostic tests performed and include comments from the medical examiner regarding your fitness for service at sea.
6. Finally, ensure that both you and a witness sign the document where indicated before saving or exporting your completed form.

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