(Cap 478 sections 96 and 134) [2 September 1996] (L.N. 605 of 1995) Cap 478O s 1 (Omitted as spent) (Omitted as spent) (Enacted 1995) Cap 478O s 2 Interpretation (1) In this Regulation, unless the context otherwise requires- "applicant" (申请人) means an applicant for a medical fitness certificate; "approved" (认可) means approved in writing by the Authority; "bulk chemical carrier" (散装化学品运载船) means a ship carrying in bulk any chemical listed in Chapter VI of the Code for the Construction and Equipment of Ships Carrying Dangerous Chemicals in Bulk (1993 edition) or Chapter 17 of the International Code for the Construction and Equipment of Ships Carrying Dangerous Chemicals in Bulk (1990 edition), published by the International Maritime Organization, together with any supplement thereto published by that Organization, as in force from time to time; "crew" (船员) means all seafarers employed on board a ship; "employer" (雇主) means the person for the time being employing the master; "GRT" (总注册吨位), in relation to a ship, means its gross register tonnage and the gross register tonnage of a ship having alternative gross register tonnages shall be taken to be the larger of those tonnages; "International Labour Office" (国际劳工局) means the office of that name established by the International Labour Organization; "medical fitness certificate" (健康证明书) means a certificate issued under section 6, or a certificate treated as equivalent thereto under section 5; "medical review panel" (医务覆核小组) means a medical review panel appointed by the Authority under section 10; "seagoing" (海域航行), in relation to a ship, means a ship other than one which navigates exclusively within inland waters or in areas where port regulations apply; "tons" (吨) and "tonnage" (吨位) mean "tons" and "tonnage" as calculated in accordance with the Merchant Shipping (Registration) (Tonnage) Regulations (Cap 415 sub. leg.); "valid medical fitness certificate" (有效健康证明书) means a medical fitness certificate which is in force and covers the type of sea service being performed by the holder. (2) Any approval given pursuant to this Regulation shall- (a) be in writing; and (b) specify- (i) the date on which it takes effect; and (ii) the conditions, if any, to which it is subject. (Enacted 1995) Cap 478O s 3 Application (1) Subject to subsections (2) and (3)- (a) this Regulation, except section 14, shall apply to all seagoing Hong Kong ships; and (b) sections 2 and 14 shall apply to all seagoing ships of 200 GRT and over- (i) which are not Hong Kong ships; (ii) while they are within the waters of Hong Kong; and (iii) if they have entered those waters in the normal course of business or for operational reasons.(2) This Regulation shall not apply to fishing vessels. (3) The Authority may grant exemptions from all or any of the provisions of this Regulation for classes of cases or individual cases on such conditions, if any, as he thinks fit and may, subject to giving reasonable notice, alter or cancel any such exemption. (Enacted 1995) Cap 478O s 4 Prohibition on employment (1) Subject to subsection (3), no person shall employ a seafarer on a ship unless that seafarer is the holder of a valid medical fitness certificate: Provided that- (a) any seafarer who has served at sea for a substantial period during the 2 years immediately preceding the date on which this Regulation comes into operation may continue his seagoing employment without such a certificate for a period of 2 years from that date; (b) any seafarer who is the holder of a medical fitness certificate which expires while he is in a place where medical examination in accordance with this Regulation is impracticable, may continue to be employed without such a certificate for a period not exceeding 3 months from the date of expiry of such certificate.(2) Subject to subsection (3), no person shall employ a seafarer on a type of ship, in a capacity or in a geographical area precluded by any restriction in the medical fitness certificate of that seafarer. (3) Subsections (1) and (2) shall not apply to the employment of- (a) a pilot, unless he is a member of the ship's crew; (b) a person employed on a ship solely in connection with- (i) the construction, alteration, repair or testing of the ship, its machinery or equipment; (ii) the exploration of the sea-bed or sub-soil or the exploitation of their natural resources; (iii) the storage of gas in or under the sea-bed or the recovery of gas so stored; (iv) the laying, inspection, testing, repair, alteration, renewal or removal of any submarine telegraph cable; (v) pipeline works, including assembling, inspecting, testing, maintaining, adjusting, repairing, altering, renewing, changing the position of, or dismantling a pipeline or length of pipeline; or (vi) the provision of goods, personal services or entertainment on board, unless such person is engaged in the normal working of the ship or has safety responsibilities in the event of an emergency on board ship; or(c) a person employed only while the ship is in port and who is not ordinarily employed at sea. (Enacted 1995) Cap 478O s 5 Certificates equivalent to a medical fitness certificate (1) A medical fitness certificate issued to a seafarer in accordance with the provisions of the Medical Examinations (Seafarers) Convention 1946 (International Labour Convention 73 of 1946) or of the Merchant Shipping (Minimum Standards) Convention 1976 (International Labour Convention 147 of 1976)- (a) by an authority empowered in that behalf by the laws of a country outside Hong Kong which has ratified either of those Conventions; or (b) by an approved authority empowered in that behalf by the laws of a country outside Hong Kong,shall be treated for the purposes of this Regulation as equivalent to a medical fitness certificate issued under section 6. (2) A certificate treated under subsection (1) as equivalent to a medical fitness certificate issued under section 6 shall continue to be so treated until the expiration of the period of validity specified in such certificate: Provided that any such certificate issued to a seafarer serving on a Hong Kong ship shall not be so treated for any longer period than would be permitted under section 8 in the case of a medical fitness certificate issued under section 6 to that seafarer. (Enacted 1995) Cap 478O s 6 Issue of medical fitness certificate (1) Every applicant for a medical fitness certificate shall be medically examined by an approved medical practitioner and if the practitioner considers that the applicant is fit for sea service, having regard to the medical and visual standards for serving seafarers specified in Schedule 1, he shall issue the applicant with a medical fitness certificate in the form specified in Schedule 2 and completed as to both Part A and Part B. (2) A certificate issued under this section may be restricted to such type of ship, such capacity or such geographical area as the approved medical practitioner thinks fit. (Enacted 1995) Cap 478O s 7 Special provision in respect of colour vision (1) If after a medical examination under section 6 an approved medical practitioner considers that an applicant is fit for sea service except in respect of colour visual standards he shall issue the applicant with a medical fitness certificate in the form specified in Schedule 2, but completed only as to Part A. (2) An applicant issued with a medical fitness certificate under subsection (1) may apply to the Superintendent for his colour vision to be tested, whereupon the Superintendent shall cause a suitable test to be administered to the applicant and, if satisfied by the results of such test that the applicant is fit for seagoing employment in respect of colour visual standards for any particular type of seagoing employment, shall complete Part B of the medical fitness certificate accordingly. (3) A medical fitness certificate completed in respect of Part A only shall not constitute a valid medical fitness certificate for the purpose of this Regulation other than for a type of seagoing employment in which colour visual standards do not require to be tested. (4) Where Part B of a medical fitness certificate is completed by the Superintendent under this section, the information contained in that Part shall remain valid for 6 years from the date thereof. (Enacted 1995) Cap 478O s 8 Period of validity of certificate An approved medical practitioner who issues a medical fitness certificate under section 6 shall specify the period, commencing with the date of the medical examination, for which the certificate shall remain valid, subject to the following maximum periods- (a) in respect of a seafarer under 18 years of age, 1 year; (b) in respect of a seafarer 18 years of age and under 55 years of age, 2 years; (c) in respect of a seafarer 55 years of age and over, 1 year; (d) in respect of a seafarer serving or intending to serve on bulk chemical carriers, 1 year. (Enacted 1995) Cap 478O s 9 Suspension or cancellation of medical certificate (1) If an approved medical practitioner has reasonable grounds for believing that- (a) there has been a significant change in the medical fitness of a seafarer during the period of validity of his medical fitness certificate; (b) when the medical fitness certificate was issued an approved medical practitioner, had he been in possession of full details of the seafarer's condition, could not reasonably have considered that the seafarer was fit, having regard to the medical standards referred to in section 6; or (c) the medical fitness certificate was issued otherwise than in accordance with this Regulation,he shall notify the seafarer concerned and may- (i) suspend the validity of that certificate until the seafarer has undergone a further medical examination; (ii) suspend the certificate for such period as he considers the seafarer will remain unfit to go to sea; or (iii) cancel the certificate if he considers that the seafarer is likely to remain permanently unfit to go to sea.(2) If an approved medical practitioner suspends a medical fitness certificate under subsection (1)(i) or (ii) or cancels a certificate under subsection (1)(iii), he shall notify the Superintendent in writing as soon as reasonably practicable. (Enacted 1995) Cap 478O s 10 Appointment of medical review panel (1) The Authority may in writing appoint any 3 approved medical practitioners to constitute a medical review panel for the purpose of hearing and determining one or more applications for medical review under this Regulation. (2) The Authority shall in writing appoint 1 member of a medical review panel appointed under subsection (1) to be chairman of the panel. (3) Subject to this Regulation, a medical review panel may determine its own procedure. (Enacted 1995) Cap 478O s 11 Application for a review (1) A seafarer who is aggrieved by- (a) the refusal of an approved medical practitioner to issue him with a medical fitness certificate; (b) the imposition of a restriction on a certificate under section 6(2); (c) the suspension of a certificate for more than 3 months under section 9(1)(i) or (ii); or (d) the cancellation of a certificate under section 9(1)(iii),may apply to the Superintendent for the decision to be reviewed by a medical review panel. (2) An application under this section shall- (a) be lodged with the Superintendent within 1 month of the date on which the seafarer is given notice of the decision which is the subject of the application for review, or, where delay is caused by the seafarer's employment on board a ship away from Hong Kong, within 1 month of the seafarer's return to Hong Kong; and (b) state the name and address of the approved medical practitioner whose decision is the subject of the application for review.(3) The Superintendent shall refer to the medical review panel, any application lodged with him pursuant to subsection (2), as soon as reasonably practicable. (4) Where an application is referred under subsection (3), the medical review panel shall- (a) if practicable, obtain a written report from the approved medical practitioner whose decision is the subject of the application for review; (b) medically examine the applicant; (c) if the applicant so requests, disclose to the applicant the written report of the approved medical practitioner and any other evidence not produced by the applicant himself, unless the medical review panel considers that such disclosure would be harmful to the applicant's health; (d) have regard to any relevant medical evidence produced to it, whether or not such evidence is disclosed to the applicant under paragraph (c).(5) In the light of its medical examination of the applicant and of all other medical evidence before it, the medical review panel shall- (a) where the decision which was the subject of the application for review was a refusal to issue a medical fitness certificate, the cancellation of a certificate or the suspension of a certificate for more than 3 months, and if it considers that the applicant is fit, having regard to the medical and visual standards specified in Schedule 1, issue to the applicant a medical fitness certificate in the form specified in Schedule 2, with or without restriction as to capacity or geographical area and valid for such period as the panel shall specify, subject to section 8; (b) where the decision which was the subject of the application for review was the imposition of a restriction as to type of ship, capacity or geographical area, and if it considers that restrictions other than those imposed on the medical fitness certificate issued to the applicant should be imposed, or that any restrictions so imposed should be deleted or varied, issue to the applicant a medical fitness certificate expressed accordingly and valid for such period as the panel shall specify, subject to section 8; (c) in a case other than those referred to in paragraphs (a) and (b), notify the applicant of its decision; and (d) in every case notify the Superintendent in writing of the result of the review.(6) Action under subsection (5) shall be taken not later than 2 months from the date on which the application for review is lodged with the Superintendent, or within such longer period as the Authority may determine in any particular case. (Enacted 1995) Cap 478O s 12 Records and annual returns An approved medical practitioner who conducts a medical examination under this Regulation shall- (a) make a record in an approved form of every such medical examination and retain the same for 3 years; and (b) send an annual return of all such medical examinations to the Superintendent in a form approved by him:Provided that such form, so far as the Superintendent considers practicable, shall not include medical information which can be identified as applying to a particular person. (Enacted 1995) Cap 478O s 13 Inspection and detention of Hong Kong ships (1) The Authority, or a person authorized by him for the purposes of this section, may inspect a ship and, if satisfied- (a) that any seafarer on board whose employer is required by this Regulation to ensure that he is the holder of a valid medical fitness certificate is unable to produce such a certificate; and (b) that the state of the seafarer's health is such that the ship could not sail without serious risk to the safety or health of others on board,may detain the ship. (2) The Authority and a person referred to in subsection (1) shall not in the exercise of his powers under this section unreasonably delay or detain a ship. (Enacted 1995) Cap 478O s 14 Inspection and detention of ships which are not Hong Kong ships (1) The Authority, or a person authorized by him for the purposes of this section, may inspect a ship and, if satisfied that any seafarer employed on board is unable to produce a valid medical fitness certificate, he may- (a) send a report to the government of the country in which the ship is registered, with a copy thereof to the Director General of the International Labour Office; (b) where, in his opinion, conditions on board are clearly hazardous to the safety or health of others on board, order the master to take such measures as are necessary to rectify those conditions and, if such measures are not taken in a reasonable time, detain the ship.(2) Where the Authority or a person referred to in subsection (1) exercises any of his powers under paragraph (a) or (b) of that subsection in respect of a ship, he shall notify that he has done so to the nearest maritime, consular or diplomatic representative of the country in which the ship is registered. (3) The Authority and a person referred to in subsection (1) shall not in the exercise of his powers under this section unreasonably delay or detain a ship. (Enacted 1995) Cap 478O s 15 Copies of Regulation to be kept on board The master of a ship shall keep on board a copy of this Regulation and make such copy temporarily available to any seafarer who so requests, and the employer shall ensure that the ship carries a copy of this Regulation. (Enacted 1995) Cap 478O s 16 Offences and penalties (1) An employer who contravenes section 4 commits an offence and is liable on conviction to a fine at level 4. (2) An employer or master who contravenes section 15 commits an offence and is liable on conviction to a fine at level 3. (3) In any proceedings for an offence under this Regulation it shall be a defence to show that all reasonable steps were taken to ensure compliance with the section concerned. (Enacted 1995) Cap 478O s 17 Amendment of Schedule 1 or 2 The Authority may, by notice in the Gazette, amend Schedule 1 or 2. (Enacted 1995) Cap 478O s 18 Authority to publish certain lists The Authority shall publish in the Gazette from time to time a list of approved medical practitioners and of persons appointed to constitute a medical review panel. (Enacted 1995) Cap 478O Sched 1 MEDICAL AND VISUAL STANDARDS FOR SERVING SEAFARERS [sections 6(1), 11(5) & 17] Introduction 1. Seafaring is a potentially hazardous occupation which calls for a high standard of health and fitness in those entering or re-entering the industry. A satisfactory standard of continuing good health is necessary for serving seafarers throughout their career. These medical and visual standards therefore give guidance on the health criteria to be met by a serving seafarer applying for a medical fitness certificate. 2. In setting the standards, allowance has been made for the inevitable impairment of health that time and chance bring, but firm recommendations have been made to exclude applicants suffering from medical conditions considered to be incompatible with continued seafaring. Such medical conditions include amongst others neoplasms, hypertension and other cardiac conditions where the uncertainty of prognosis makes the risks in continued seafaring unacceptable. 3. It is clearly impossible to encompass within the standards specific advice on every relevant medical condition. However, as a general rule an approved medical practitioner should be satisfied when examining an applicant for a medical fitness certificate that no disease or defect is present which could either be aggravated by working at sea or could represent an unacceptable health risk to the individual seafarer or to other crew members. 4. Apart from the purely medical aspects, the occupational background of seafaring should be considered especially in a case of doubt. It must be remembered that a ship is not only a place of work requiring attention throughout the day and night but also a temporary home in which the crew must eat, sleep and find recreation. While much can be done to ameliorate living and working conditions on board ship, certain inherent characteristics remain. A crew is a closed community living in a ship that is seldom quiet or still. Individual eating habits and tastes cannot easily be met; facilities for physical exercise are limited; forced ventilation systems are used; the tedium of routine can easily become oppressive in the absence of normal diversions enjoyed by those ashore. An inability to fit in, or unwillingness to take responsibility, or to accept a reasonable measure of necessary discipline, could impair the safe and efficient working of the ship. 5 Very few merchant ships carry doctors on board nowadays. Acute illness or injury is dealt with by designated ships' officers whose training is limited to first aid or medical aid treatment. It should also be borne in mind that the size of a crew complement is carefully adjusted. Sickness can throw a burden on other crew members or even impair the efficient working of a ship. An approved medical practitioner should therefore be satisfied that no condition is present in the applicant which is likely to cause trouble during a voyage and that no treatment is being followed which might cause worrying side effects. It would be unsafe practice to permit a seafarer to serve at sea suffering from a medical condition in which serious exacerbation requiring expert treatment could occur. 6. The absence of a doctor in most merchant ships also means that seafarers will not be able readily to consult a doctor or to obtain special treatment until the next port of call. Ship turnaround in ports is often very rapid, allowing no time for necessary investigation subsequent to consultation with a doctor. The standard of medical practice varies from port to port also and necessary medical facilities may not be available at the smaller, more remote ports. It is doubtful if it is ever wise to permit a seafarer to serve at sea if the loss of a necessary medicament could precipitate the rapid deterioration of a medical condition. 7. Special care should be taken when examining an applicant who- (a) has a doubtful medical history; (b) is likely to spend long periods in tropical climates; (c) is likely to join ships by air travel; or (d) has recently served or is intending to serve on bulk chemical carriers. Notes: (1) In addition to symptoms caused by acute conditions such as catarrh of the ear and sinuses (baratrauma), air transport sometimes leads to other disabilities such as breathlessness, dizziness, etc. becoming manifest. Such cases will require further investigation since the findings may well reflect on the applicant's suitability for further unrestricted sea service. (2) An applicant in category (d) above should be subjected to a blood test in addition to other medical examination procedures. 8. Physical requirements may vary between different types of ships, their departments and individual jobs in them. However, all seafaring jobs need an acceptable degree of fitness, in accordance with these standards, which is uniform for all shipping trades. The imposition of a restriction under section 6(2) of this Regulation may serve to avoid a particular type of trade or a prolonged voyage where there is some specified medical contra-indication, but careful consideration is necessary before any restriction is imposed. The type of restriction and the length of time for which it will operate should be made clear. The requirements of an advised treatment regime should never be set aside. 9. Despite the shortness of the voyage, even coastal work can be arduous and uncomfortable. A restriction to that type of work should be considered as an alternative to refusal of a certificate only if the shortness of voyage will permit adequate treatment of the medical condition causing concern. Examination Procedures 1. When it is necessary to consult with other doctors the usual professional ethical considerations will appertain, but it should be clearly understood that the final decision on fitness in accordance with the required medical and visual standards rests with the approved medical practitioner, subject to the provisions of section 9(2) of this Regulation. 2. An applicant for a medical fitness certificate shall be placed in one of the following categories by reference to the category letter ascribed in these Standards to any medical condition diagnosed in respect of him- A. Fit for sea service without restriction. B. Permanently unfit for sea service. C. Indefinitely unfit for sea service. D. Temporarily unfit for sea service. E. Fit for sea service subject to restriction.An applicant in respect of whom no adverse medical condition is diagnosed shall be placed in category A. 3. (1) An applicant placed in category A shall be granted a medical fitness certificate without restriction, but subject to the maximum period of validity specified in section 8 of this Regulation. (2) An applicant placed in category B shall be refused a medical fitness certificate. Any medical fitness certificate in his possession shall be cancelled. (3) An applicant placed in category C shall be refused a medical fitness certificate and informed that he may apply for a further examination after a specified number of months. Any medical fitness certificate in his possession shall be suspended until such further examination. (4) An applicant placed in category D shall be refused a medical fitness certificate and informed that he may apply for a further examination after a specified number of weeks. Any medical fitness certificate in his possession shall be suspended until such further examination. (5) An applicant placed in category E shall be granted a medical fitness certificate with specified restrictions operating for a specified length of time and subject to the maximum period of validity specified in section 8 of this Regulation. (6) An applicant who fails to satisfy an approved medical practitioner only in respect of colour visual standards shall be granted a certificate completed only as to Part A. Medical Standards 1. General Any infectious or contagious disease-D. Malignant Neoplasms-B. Note: Consideration can be given to passing cases of rodent ulcers which have responded satisfactorily to treatment. 2. Ear, Nose & Throat (a) Ear Acute and Chronic Otitis Externa-D. Should be completely healed before returning to sea. Care is required in passing fit for tropics. Acute Otitis Media-D. Chronic Otitis Media-D. May become A or E after satisfactory treatment or surgery. Special care is required in passing fit for tropics or where air travel is involved. Loss of hearing-A degree sufficient to interfere with efficiency-B. -Unilateral complete loss of hearing-B.Meniere's Disease-B. Notes: (1) No audio-metric standard has been set for the purposes of this Regulation. (2) Impaired hearing acuity should be referred for full investigation by an ENT surgeon. (3) The use of a satisfactory hearing aid at work by certain catering department personnel can be accepted where not hearing an instruction would not result in a danger to the seafarer or others. The hearing aid should be sufficiently effective to allow communication at normal conversational tones. (4) The use of a hearing aid by those working in, or associated with, the deck or engine room departments, including electricians and radio officers, should not be accepted. (b) Nose Nasal obstruction. Septal abnormality or polypus-D. Acute sinusitis-D. Chronic sinusitis-if disabling and frequently relapsing-B. (c) Throat A history of frequent sore throats or unhealthy tonsils with adenitis-D. (d) Speech Defects If likely to render seafarer inefficient-B. 3. Respiratory System The respiratory system should be free from acute or chronic disease causing disability. Chronic Bronchitis and/or Emphysema-Category depends on severity. Mild uncomplicated cases with good exercise tolerance may be A, but cases with recurring illness causing disability should be B. Bronchial Asthma-B. Pulmonary Tuberculosis-C. Most cases are unsuitable for further seafaring but if the approved medical practitioner is satisfied that the lesion is firmly healed, the radiological appearance is acceptable and the applicant has completed a full course of chemotherapy, further service can be considered. Cases where either one or both lungs have been seriously affected are never suitable for further service. All relapsed cases will be B. 4. Cardiovascular System The heart and blood vessels must be healthy. There should be no history, signs and/or symptoms of heart failure. There should be no significant abnormality of rate or rhythm or disorder of conduction. There must be no significant disease of the haemopoietic organs. A material degree of general arteriosclerosis-B. A history of coronary thrombosis or evidence of coronary artery disease-B. (All cases that have required coronary artery bypass surgery come within this category). A history of intermittent claudication, including any case where vascular surgery was required-B. Any cerebral vascular accident-B. Any cardiac valve replacement-B. Hypertension-all cases D for investigation. Notes: (1) There should be no evidence of left ventricular hypertrophy and/or strain on electrocardiography. The blood urea and chest X-ray should be normal. (2) The maximum acceptable level is 170 mm systolic, 100 mm diastolic, untreated. The diastolic pressure is to be measured at the fifth sound. Cases treated with hypotensive drugs or diuretics are unsuitable for further seafaring. The approved medical practitioner must establish that the use of these drugs is essential and alternative acceptable therapy is not possible. All cases should be kept under regular supervision. 5. Disease of Veins Varicocele-symptomless-A. With symptoms-D for surgical opinion. Haemorrhoids-not prolapsed, bleeding or causing symptoms-A. Other cases should be D until satisfactory treatment has been obtained. Varicose Veins-slight degree-A. Moderate degree without symptoms or oedema may be A, but with symptoms D for treatment. Recurrent after operation, with symptoms-B. Chronic varicose ulceration-B. Thin unhealthy scars of healed ulcers or unhealthy skin or varicose eczema may be B if breakdown is thought likely. Deep vein thrombosis or recurrent thrombophlebitis-B. 6. Gastro-Intestinal System Mouth or gum infection-D. Dental defects-D. Seafarers should be dentally fit. Gastro-intestinal Disease or Disorders-slight case-D. Severe or recurrent and those requiring special diet and/or regular supervision-B. Peptic Ulceration-D for investigation. Recurrent peptic ulceration or unsatisfactory operation result-B. Notes: (1) No seafarer with proved ulceration should return to seafaring until free from symptoms, and on an ordinary diet without treatment for at least 3 months following evidence of healing on gastroscopy. Whenever possible evidence of healing should be supported by endoscopic findings. (2) Cimetidine maintenance therapy. The duodenal ulceration relapse rate while on treatment is too high for safe seafaring. Cirrhosis of Liver-B. Pancreatitis-All cases where alcohol is an aetiological factor-B. Pancreatitis with associated gall bladder disease-after complete surgical cure of the gall bladder condition and resolution of the pancreatitis-A or E on case assessment. Recurrent pancreatitis-B. 7. Skin Special care is required in passing fit for service in the tropics if there is a history of skin trouble. Catering staff in particular should have no focus of skin sepsis. Any condition liable to be aggravated by heat, sea air, oil, caustics or detergents may have to be B. Fungus Infections-D. Acne-most cases-A, but severe cases and those with cystic acne-B. Psoriasis-most cases can be A, but some widespread or ulcerated cases should be D for treatment. Severe cases resistant to treatment or frequently relapsing-B. Sensitization Dermatosis-D. Refer for dermatological opinion. Acute Eczema-D. No man should return to duty until skin is completely healthy. Recurrent Eczema-B. Furunculosis-D. All other cases-D for investigation. Disposal will depend upon the nature of the condition, probability of recurrence or necessity for long term treatment. 8. Sexually Transmissible Diseases All cases of acute infection are D while under treatment. Cases under surveillance having finished treatment will usually be fit for normal service but restricted service may be necessary if facilities for supervision are inadequate. In all cases evidence of satisfactory tests of cure should be produced. 9. Genito-Urinary System Hypospadias-minor degree-A. Enlarged Prostate-D for investigation. Hydrocele-small and symptomless-A; large and/or recurrent-B; if operation desired-D. Abnormality of the Primary or Secondary Sexual Characteristics-D for investigation, upon which final decision will rest. Intra-abdominal or ectopic testis-D if treatment desired; otherwise B. Kidney and Bladder Diseases-All cases of proteinuria, glycosuria or other urinary abnormalities should be referred for investigation. Urinary Obstruction-from any cause-D for investigation. B if not remediable. Acute Urinary Infection-D. Recurrent cases should not be accepted unless full investigation has proved satisfactory. Acute Nephritis-D. Subacute or Chronic Nephritis or Nephrosis-B. Renal or Ureteric Calculus-D for investigation and any necessary treatment. An isolated attack of renal colic with passage of small calculus may be A after a period of observation, provided urine and renal functions remain normal and there is no clinical and radiological evidence of other calculi. Recurrent stone formation-B. Removal of Kidney-provided the remaining kidney is healthy with normal function-E. Such cases are unsuitable for service in the tropics or other conditions of high temperature. Renal Transplant-B. Incontinence of Urine-B. 10. Endocrine Disease or Metabolic Disorder Diabetes Mellitus- All cases requiring insulin-B. All gluiosuria cases should be considered diabetic unless proved to be otherwise.Maturity Onset Diabetic- Cases controlled by food restriction only and not requiring insulin or other drugs may be accepted. An initial period of 6 months to cover sick leave and later restricted service should be allowed to achieve this result. Thereafter, accepted cases should be subject to medical review at intervals of 6 months.All other cases of Endocrine Disease-D for investigation upon which decision will depend. A degree of obesity, with or without complications, adversely affecting exercise tolerance/mobility/general health-D for treatment. A set of height/weight tables should be used making allowance for up to 20% excess weight but none for age. Refractory or Relapsing Cases-B. 11. Central Nervous System Any type of Epilepsy-B. A single epileptic fit-provided that the past medical history is clear and investigation has shown no abnormality; re-entry could be considered after one year without any treatment. Fainting Attacks-D for assessment. Recurrent attacks with complete or partial loss of consciousness should be B. Organic Nervous Disease-usually B. Some minor localised disorders not causing symptoms or incapacity and unlikely to progress may be A. Migraine-slight infrequent attacks responding quickly to treatment-A. Frequent attacks causing incapacity-B. Psychosis-B. Psychoneurosis-D for assessment. Chronic or recurrent-B. 12. Alcohol Abuse If affecting health by causing physical disability or behavioural disorder-B. 13. Drug Dependence Dependence on dangerous drugs-B. 14. Musculo/Skeletal System It is essential that seafarers should have full use of sound upper and lower limbs throughout a career at sea. Balance, mobility and co-ordination should be unimpaired. Hernia-D until repaired. Osteo-arthritis-D for assessment. Advanced cases where disability is present-B. 15. Female Seafarers There should be no significant gynaecological disorder or disease likely to cause trouble during the voyage. Employment at sea shall not be permitted during the term of pregnancy. Visual Standards 1. No person should be accepted for sea service if any morbid condition of either eye, or of the lid of either eye, is present and liable to aggravation or recurrence. 2. New cases of monocular vision are unacceptable for any category of seafaring. However, monocular seafarers in the engine and catering departments with a satisfactory record of service prior to 1986 may be allowed to continue at sea in those departments. 3. Approved medical practitioners should use Ishihara plates to test for colour vision. 4. Distant vision and colour vision tests may be taken with or without visual aids (spectacles or contact lenses). However, an applicant who uses visual aid must reach the required visual standard for both aided and unaided vision. 5. Distant vision tests comprise a letter or shape test and are to be conducted on Snellen's principle at a virtual distance of 6 metres from the eye. 6. Unaided vision should be tested first and each eye must be tested separately. 7. In all cases where visual aids are required for the efficient performance of an applicant's duties, it shall be a condition of the validity of a medical fitness certificate that a spare pair is carried when seafaring. Where different visual aids are used for distant and near vision, a spare pair of each must be carried. Spare pairs of visual aids must be produced to the approved medical practitioner during the examination. 8. The following visual standards should be attained by an applicant intending to serve at sea in the departments specified- Department Standard (a) Deck Officers and Deck Ratings (including General Purpose Ratings) Age Below 22 years 22 years and above -Distant vision with or without visual aid Better eye 6/6 6/9* Other eye 6/9 6/12* -Distant vision without visual aid when visual aid necessary for above Better eye 6/36 6/60 Other eye 6/36 6/60 -Near, intermediate and colour vision, both eyes together, aided or unaided Vision required for ship's navigation (for example, chart and nautical publication reference, use of bridge instrumentation and equipment, and identification of navigational aids) -Visual fields Normal visual fields -Night blindness Vision required to perform all necessary functions in darkness without compromise -Diplopia (double vision) No significant condition evident* If the applicant marginally fails to meet this standard he should be referred to the Authority. The Authority may permit relaxation of the standard in particular causes. (b) Engineer officers, Radio, Electrical and Electronic Officers and ratings forming part of an engine room watch -Distant vision, aided if necessary Better eye Other eye 6/15 6/15 -Distant vision without visual aid when visual aid necessary for above Better eye Other eye 6/60 6/60 -Near, intermediate and colour vision, both eyes together, aided or unaided Vision required to read instruments in close proximity, to operate equipment, and to identify systems and components as necessary -Visual fields Sufficient visual fields -Night blindness Vision required to perform all necessary functions in darkness without compromise -Diplopia (double vision) No significant condition evident (c) Catering and Miscellaneous -Distant and near vision, aided if necessary (monocular vision will be B Visual acuity sufficient to carry out duties efficiently; but less than 6/60 in "other) eye" unacceptable -Colour vision need not be tested (Enacted 1995) Cap 478O Sched 2 MEDICAL FITNESS CERTIFICATE [sections 6(1), 7, 11(5) & 17] MERCHANT SHIPPING (SEAFARERS) (MEDICAL EXAMINATION) REGULATION PART A I, (doctor's name) .........................................................................................................., being a medical practitioner approved by the Seafarers' Authority for the medical examination of seafarers, have today examined (seafarer's name) ................................................................... Date of Birth ........................................... Place of Birth ........................................................ *Discharge Book/Seaman's Service Record Book/Seafarer's Employment Registration Book No. .............................OR (where Discharge Book or Seaman's Service Record Book or Seafarer's Employment Registration Book not held) Passport or other Travel Document No. ...................... and have found him fit for employment as (capacity) ................................................................ .............................................................................................................................................. on board (type of Ship) ........................................................................................................... to the medical and non-colour visual standards specified in Schedule 1 to the Merchant Shipping (Seafarers) (Medical Examination) Regulation, subject to the restriction detailed below* Restriction (if any) ................................................................................................................. .............................................................................................................................................. Period of restriction ................................................................................................................ Date of examination ............................................................................................................... Period of validity of certificate ................................................................................................ .................................................Approved medical practitioner. ...................................... Office Stamp PART B The above-named seafarer has satisfied the requirements of the Regulation in respect of colour visual standards, for the following type of sea service. ................................................ *Approved medical practitioner/ Superintendent, Mercantile Marine Office. ...................................... Office Stamp Dated ................................... * Delete if inapplicable. Note: Section 7(3) of the Merchant Shipping (Seafarers) (Medical Examination) Regulation reads as follows- "A medical fitness certificate completed in respect of Part A only shall not constitute a valid medical fitness certificate for the purpose of this Regulation other than for a type of seagoing employment in which colour visual standards do not require to be tested.". (Enacted 1995)
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