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.FORM/4104/AFORM / 4104/AMEDICAL REPORTReport No:ORIGINAL: TO MANAGERSCOPY TO: DOCTOR, CREW, CREW AGENT, SHIP'S FILEPORT : DATE:THE BEARER OF THIS LETTER MR:WHO SERVES AS:ON M/V:COMPLAINS OF:Dear Doctor kindly examine above seaman and let us have your report below:The MasterMEDICAL REPORTDIAGNOSIS :* MEDICATION GIVEN: YES NO* HOSPITALISATION: YES NO* REPATRIATION: YES NODoctor's Remarks :* FIT FOR HIS SERVICE : YES NO (FOR ABOUT DAYS )NOTES:( PLACE AND DATE )( SIGNATURE OF DOCTOR )NOTE TO THE DOCTOR : THIS FORM IS TO BE COMPLETED, AND ORIGINAL TO BE RETURNED TO THE VESSEL* = DELETE AS APPLICABLEATLANTIC UNITED MARINE INC.Safety Management System Manual - IMO Res.A.741 (18)Developed by: SMS Designated PersonAuthorised by: Managing DirectorDate of Initial Issue: 09 November 1998Revision No / Effective Date: 3 / 06-99Chapter: 6Page: 1 [ Pobierz całość w formacie PDF ]
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.FORM/4104/AFORM / 4104/AMEDICAL REPORTReport No:ORIGINAL: TO MANAGERSCOPY TO: DOCTOR, CREW, CREW AGENT, SHIP'S FILEPORT : DATE:THE BEARER OF THIS LETTER MR:WHO SERVES AS:ON M/V:COMPLAINS OF:Dear Doctor kindly examine above seaman and let us have your report below:The MasterMEDICAL REPORTDIAGNOSIS :* MEDICATION GIVEN: YES NO* HOSPITALISATION: YES NO* REPATRIATION: YES NODoctor's Remarks :* FIT FOR HIS SERVICE : YES NO (FOR ABOUT DAYS )NOTES:( PLACE AND DATE )( SIGNATURE OF DOCTOR )NOTE TO THE DOCTOR : THIS FORM IS TO BE COMPLETED, AND ORIGINAL TO BE RETURNED TO THE VESSEL* = DELETE AS APPLICABLEATLANTIC UNITED MARINE INC.Safety Management System Manual - IMO Res.A.741 (18)Developed by: SMS Designated PersonAuthorised by: Managing DirectorDate of Initial Issue: 09 November 1998Revision No / Effective Date: 3 / 06-99Chapter: 6Page: 1 [ Pobierz całość w formacie PDF ]