• Seafarer's Medicals - ENG1 | ML5

    This Pre Appointment Checklist is for ENG1 and ML5
  • NOTICE:
     THIS IS NOT A BOOKING FORM !

    Please fill this form only after you have made a booking on our website.

    You must fill this form prior to your appointment.

    Your clinician will review this form with you again on the day.

     

    If you require further guidance, please call +44 (0)20 4617 6186 or email us on yehs@yourexcellenthealth.org

  • When is your appointment?*
     - -
  • Would you like any vaccinations at your appointment?*
  • We are a Yellow Fever center and also provide other vaccines required by seafarers and other travellers.

    Please let us know if we can help you with any vaccines?

  • What vaccinations would you like?
  • Some Seafarers require a reciept for re-imbursenment. Would you like us to prepare a reciept for you on the day?*
  • For Government Guidance on the Seafarers Medical Certification,

    CLICK HERE

  • Seafarer Personal Details

  • Date of Birth*
     - -
  • Gender*
  • Seafarer works solely in the fishing industry*
  • Department*
  • When was your last dental check up?*
     - -
  • Have you had a hearing test (Audiometry) done in the past 10 years?
  • Have you had an ENG1 done in the past 10 years?
  • Please provide date of Hearing test (Audiometry) or ENG1
     - -
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  • Expiry date - Photographic ID Document*
     - -
  • Which Seafarer's Medical do you want to complete?*
  • Seafarer's Medicals - ENG1

    ENG1 Seafarers Medical Form
  • Important Information Before Your ENG1 Seafarer Medical

    Please read this notice in full before your appointment. It explains what to bring, what the examination involves, what it costs, and what happens if I cannot reach a decision on the day. Following it will give you the best chance of leaving with a certificate.


    1. What you must bring
    Photographic identification (mandatory). I am required to check your identity before I can examine you. You must bring one original, valid, in-date document from this list:

    • passport
    • photocard driving licence
    • national identity card or citizen card
    • seafarer's discharge book / seafarer identity document
    • Photocopies, photographs of documents and expired documents are not acceptable. Without acceptable ID I cannot carry out the examination.
    • Your previous ENG1 certificate, if this is not your first seafarer medical. Please bring the original paper certificate (or your equivalent overseas certificate). Superseded ENG1 certificates are withdrawn, scanned to the MCA's Approved Doctors Information System and then securely destroyed — so you should not expect it back. If you cannot produce it, tell me at the start of the appointment. I will normally still be able to proceed, but I am required to record the position and I may need to verify your history with the MCA, which can delay your certificate.

    Also bring:

    • all medication you are taking (or a current, printed repeat prescription list)
      your glasses or contact lenses, and your spares, plus your optical prescription if you have it
    • your hearing aids, if you use them
    • the name, address and telephone number of your GP
    • any letters, clinic notes, discharge summaries or test results from your GP, a hospital or a consultant — particularly anything from the last two years
    • any previous ENG3 (Notice of Failure/Restriction), restriction letter or CAD colour vision certificate you have been given

     

    2. You must tell me about your medical history — in full
    You will sign a declaration that the information you have given is correct.

    You must tell me if you have ever:

    • failed an ENG1 examination
    • been issued with an ENG1 carrying a restriction
    • started an ENG1 examination with another Approved Doctor and not completed it

    Withholding this is known as "doctor shopping". It can invalidate your certificate, and obtaining a certificate under false pretences is a criminal offence under fraud legislation.

    You must also tell me about any significant medical condition you have and any treatment you are currently receiving.


    3. What the examination involves
    Please note that I (Dr. Adeola Buluro) am a male doctor. I or a member of the clinical team will:

    • take your medical history
    • measure your height, weight and blood pressure
    • ask you to provide a urine sample
    • test your hearing, distance vision, near vision and colour vision
    • carry out a physical examination

    You will be asked to undress to your underwear for part of the examination. You will be given privacy to undress, you will only be undressed for as long as is necessary, and you are welcome to have a chaperone — please ask, and I will arrange one. You may also bring a friend or relative.

    Language. I cannot carry out the examination unless we can communicate directly in English. If that is not possible, you must bring an interpreter with you. Please tell us when booking.

    Fitness to be examined. If you attend in a state that makes examination unsafe or unreliable — for example under the influence of alcohol — I may have to refuse to proceed. I am required to record this and inform the MCA.

    Leaving part-way through. If you leave before the examination is complete, I am required to inform the MCA and to tell you that I have done so.


    4. Urine sample and menstruation
    A urine sample is a required part of the examination. Blood in the sample — including blood from menstruation — can produce an abnormal result that cannot be interpreted, and may lead to unnecessary further investigation or delay in issuing your certificate.

    If you are menstruating on the day of your appointment, you have two options:

    Attend as planned. Please tell me at the start. In most cases I can complete everything else and either repeat the urine test at the end of the visit at no extra charge.
    Rearrange. If you would prefer to move your appointment, contact us as far in advance as you can. Where the reason is menstruation, the appointment will be rearranged without charge, even inside the normal cancellation period.
    Please do not simply not turn up as the consultation will go ahead and be charged or stil be charged even if you are absent and do not contact us.


    5. Cost
    The examination fee is £115. It covers the consultation, the examination and the issue of your certificate.

    Additional tests. A small number of candidates need an extra test — for example an exercise/step test, or a CAD colour vision test at an MCA-approved test centre.

    Where an extra test is needed, I will tell you before it is carried out
    the cost will be agreed in advance with whoever is paying for your medical. CAD tests are booked and paid for directly with the test centre, not with this clinic.

    Payment is due on the day and is not dependent on the outcome. The fee pays for the examination, not for a particular result.

    Cancellations and missed appointments. Please give at least 48 hours notice if you need to cancel or rearrange. Refunds are available for services cancelled at least 24 hours before the scheduled appointment. Cancellations within 24 hours of your appointment will incur a £100 cancellation fee, except in cases of medical emergency or at our discretion. It will cost £50 to re-schedule an appointment on the day.


    6. Preparing well — why it matters
    I make my assessment on the evidence available at the appointment. If a relevant report is missing, I may not be able to complete your assessment that day.

    Before you attend, please:

    • request copies of any consultant letters, test results or GP summaries now — practices can take up to a month
    • bring paper copies or have them accessible on your phone
    • if you have a condition such as diabetes, epilepsy, a heart condition, a mental health condition, sleep apnoea, or you have had surgery in the last two years, bring the most recent specialist letter and evidence that your condition is stable and being monitored

    7. Your result
    At the end of the examination I will issue one of the following:

    Category 1 — fit for sea service, no restrictions
    Category 2 — fit, but with restrictions written on the certificate
    Category 3 — temporarily unfit, for a period I will specify
    Category 4 — permanently unfit
    Most candidates receive their certificate on the day. Certificates are valid for a maximum of two years (one year if you are under 18), or less if there is a medical reason.

    If I cannot complete my assessment on the day.
    If I have concerns about your fitness and need further medical information, a specialist opinion, or advice from the MCA's Chief Medical Adviser, I will not issue an ENG1 that day. Where a delay is likely, I will issue a Category 3 (temporarily unfit) certificate covering the period needed to obtain the information. This is a normal part of the process and is provided for in MCA guidance — it is not a failure.

    I will tell you clearly at the appointment:

    • exactly what information I need
    • how to send it to me
    • whether a further appointment is required and, if so, whether a further fee applies
    • Sending documents afterwards. Please send them by email to medsupport@yourexcellenthealth.org. Because of clinic demand I cannot guarantee to review unsolicited documents at short notice; I will tell you at your appointment what the arrangement will be in your case.

    If further review of additional documents or information is needed, you may email these to me, but you must also book an "ENG1 Follow Up Appointment" online. Due to clinic demand, I am unable to review documents sent by email unless time has been booked.

    If you are found unfit or restricted, I will issue an ENG3 (Notice of Failure/Restriction) and explain my reasons. You have the right to apply to the MCA for an independent review by a medical referee if you are found permanently unfit, temporarily unfit for more than three months, or fit only with restrictions. You must apply within one month of the date on your ENG3. The MCA pays for the review; you pay your own travel costs.

     

    8. Your certificate
    Your ENG1 is your property. You must carry it on the ship on which you work.

    Certificates are normally handed to you in person on the day. If you would like yours posted instead, we can send it by tracked post to a UK address for £17, payable prior to postage. This is optional.

    If your certificate is later lost or damaged, contact me — I may be able to issue a replacement for the remaining period of validity, for which an administrative charge of £20 applies. If a long time has passed, a fresh examination and the full statutory fee may be required.


    9. After your medical — your ongoing duty
    You must contact an Approved Doctor if, at any time while your certificate is valid:

    • you are absent from work for 30 days or more for a medical reason, or
    • you develop a medical condition that may affect your fitness to work at sea
    • Your certificate is suspended from that point until you have been assessed.


    This notice summarises MCA requirements set out in MSN 1886 (M+F) Amendment 3, MSN 1887 (M) Amendment 1, the Approved Doctor's Manual and the Merchant Shipping (Fees) Regulations 2018. Where this notice and MCA guidance differ, MCA guidance applies.

  • Seafarer's Medicals - ENG1

    ENG1 Seafarers Medical Form
  • Seafarer Family Medical History

  • Any Relevant Family History of Medical problems?*
  • Seafarer Medical History

  • Is this the first ENG 1 Seafarer Medical Examination?*
  • If No, tick previous fitness category:
  • Date of Examination
     - -
  • Will you be bringing your old ENG1 certificate with you to the appointment?*
  • Seafarer Medical History

  • Seafarer's Medicals - ENG1

    ENG1 Seafarers Medical Form
  • Seafarer's Medicals - ENG1

    ENG1 Seafarers Medical Form
  • MEDICAL EXAMINATION OF SEAFARERS CONSENT

    Privacy Notice
    Personal information collected as part of your medical will be entered into the Approved Doctors Information System. Your information is shared with the Maritime and Coastguard Agency (MCA), Chief Medical Advisor, any subsequent Approved Doctors you attend, and MCA administrators if required, for them to fulfil their statutory duties under the Merchant Shipping (Maritime Labour Convention) (Medical Certification) Regulations 2010 or the Merchant Shipping (Work in Fishing Convention (Medical Certification) Regulations 2018, which implement the UK’s international obligations under the Maritime Labour Convention, 2006 and the Work in Fishing Convention, 2007.


    For more information explaining how your information is used, please view our full privacy statement at www.gov.uk/mca


    Consent to examination
    Purpose of the examination: It is a legal requirement for a seafarer or fisherman to hold a valid medical certificate attesting to their medical fitness to perform their duties, taking into account the particular risks associated with working at sea. The medical examination is conducted in accordance with statutory medical standards set by the Secretary of State and overseen by the Maritime and Coastguard Agency. Further details, if required, may be found in MSN 1886 (M+F) and the Approved Doctor’s Manual.

    Nature of the examination:  The Approved Doctor will review your medical history and then examine you. The average duration of the assessment will be 30-45 minutes.

    The standard examination will at a minimum include:
    - Observation of posture, movement and gait
    - Pulse, blood pressure, height, weight, urine test
    - Examination of skin and also leg veins
    - Clinical test of ears and hearing if necessary
    - Clinical test of eyes and eyesight
    - Examination of teeth, gums, mouth and throat
    - Examination of heart, lungs and neurological system
    - Examination of abdomen including checking for hernias
    - Other tests that might be clinically indicated from the history will be explained

     

    It will be necessary for you to be partially undressed to conduct a full examination (down to bra and underpants for females and underpants for males). Privacy and dignity will be of paramount importance at all times and you will be offered a chaperone.

     

    Further information may be required from your GP or specialist prior to making a fitness decision.

     

  • I have read and understood all information above regarding my ENG medical examination. I have been given the opportunity to ask questions and any questions I have asked have been satisfactorily answered. I agree to proceed with the examination.*
  • Chaperone (Choose One Option only)*
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    You are about to submit your questionnaire!

  • Please confirm you have answered all ENG1 questions correctly.*
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  • Seafarer's Medicals - ML5

    ML5 Seafarers Medical Form
  • This form is for use by the following applicants only. Please tick why you need this form/certificate:*
  • 7. Current ML5 has expired, used for:
  • Date of first BML / RYA endorsement or last revalidation (if applicable)
     - -
  • Seafarer's Medicals - ML5

    ML5 Seafarers Medical Form
  • Seafarer Medical History

  • Section 1-Cardiac

  • a) Is the applicant having attacks of angina of effort, or receiving continuous treatment to prevent angina from manifesting itself?*
  • b) Has the applicant had myocardial infarction, unstable angina, or undergone coronary artery bypass surgery or coronary angioplasty?
  • If YES - please answer the following:
  • c) Has the applicant uncontrolled complete heart block?*
  • d) Has a cardiac pacemaker been implanted?*
  • e) Has a cardioverter / defibrillator device been implanted?*
  • f) Is there currently a serious or disabling disturbance of cardiac rhythm, such as atrial fibrillation?*
  • g) Is the applicant in need of medication to prevent paroxysmal arrhythmia?*
  • h) Is there evidence of serious congenital heart disease requiring continuing consultant cardiological review?*
  • i) Is there any history or evidence of heart failure or cardiomyopathy?*
  • j) Has the applicant undergone heart transplant or heart / lung transplant therapy?*
  • k) Has the applicant evidence of an aortic aneurysm that has not been successfully treated by surgery?*
  • n) Is there any history of stroke?*
  • o) Is there any history of Deep Vein Thrombosis?*
  • Seafarer's Medicals - ML5

    ML5 Seafarers Medical Form
  • Section 2 – Endocrine and Metabolic

  • Does the applicant have any of the following?:i) Endocrine disease (thyroid, adrenal including Addison's disease, pituitary, ovaries, testes)
  • ii) Diabetes – non insulin, treated by diet alone*
  • iii) Diabetes – non insulin, treated by oral medication*
  • iv) Diabetes – insulin using*
  • Seafarer's Medicals - ML5

    ML5 Seafarers Medical Form
  • Section 3 – Nervous System

  • a) Has the applicant had any form of epileptic attack?*
  • ii) Is the applicant still being treated?*
  • b) Is there a history of blackout or impaired consciousness within the last 5 years?*
  • c) Does the applicant have narcolepsy/cataplexy or any obstructive sleep apnoea?*
  • d) Is there a history of, or evidence of any of the conditions listed 1-8 below?.*
  • (1) TIA*
  • (2) Sudden and disabling dizziness/vertigo within the last year with a liability to recur*
  • (3) Subarachnoid haemorrhage*
  • (4) Serious head injury within the last 10 years*
  • (5) Brain tumour, either benign or malignant, primary or secondary*
  • (6) Other brain surgery*
  • (7) Chronic neurological disorders e.g. Parkinson's disease, Multiple Sclerosis*
  • (8) Dementia or cognitive impairment*
  • Seafarer's Medicals - ML5

    ML5 Seafarers Medical Form
  • Section 4 – Psychiatric Illness

  • a) Is there a history of, or evidence of any of the conditions listed in 1-6 below?*
  • (1) A psychotic illness in the past 5 years*
  • (2) A neurotic illness (anxiety/depression) in the past 5 years*
  • (3) Persistent alcohol misuse in the past 12 months*
  • (4) Alcohol dependency in the past 3 years*
  • (5) Persistent drug misuse in the past 12 months*
  • (6) Drug dependency in the past 3 years
  • (7) Disorder of personality (clinically recognised)
  • (8) Any other mental health and cognitive disorders
  • Seafarer's Medicals - ML5

    ML5 Seafarers Medical Form
  • Section 5 - Sensory

  • Is there deafness that significantly impairs communication by radio or telephone?*
  • Section 6-Malignant Disease

  • a) Does the applicant have any malignant disease likely to impair physical or mental fitness to undertake duties in the foreseeable future?*
  • b) Is there a history of bronchogenic carcinoma or any other malignant tumour (e.g. malignant melanoma) with a significant liability to metastasise cerebrally?*
  • Section 7-Musculoskeletal Limitations

  • a) Does the applicant lack the strength and flexibility needed to: i) perform their normal duties such as mooring and lock operations?*
  • ii) physically assist other people who have fallen overboard or who need to evacuate the vessel in an emergency?*
  • b) If the applicant works at sea, do they lack strength and flexibility to get in and out of a moving life raft? Leave blank if not applicable.*
  • d) Is there currently any disability of the spine, limbs or hands likely to limit duties or safety procedures while working?*
  • e) Has the applicant had a knee/hip replacement or other limb prosthesis?*
  • f) Does the applicant lack sufficient fitness to be responsible for the safety of fare paying passengers (if applicable)?*
  • Seafarer's Medicals - ML5

    ML5 Seafarers Medical Form
  • Section 8 – Respiratory System

    Is there a history of, or evidence of any of the following:
  • Sinusitis/Nasal Obstruction*
  • Chronic Bronchitis and/or Emphysema*
  • Pneumothorax*
  • History of severe childhood asthma with any symptoms at all present during the last five years?*
  • Exercise or cold induced asthma?*
  • Mild asthma that requires treatment with bronchodilator reliever inhalers (either alone or to supplement regular use of preventer inhalers) on more than two days a month?*
  • Moderate or severe asthma as an adult?*
  • Any hospital admissions over the last three years (due to asthma), or had oral steroid treatment for asthma during the last three years?*
  • Seafarer's Medicals - ML5

    ML5 Seafarers Medical Form
  • Section 9 - Other Medical Conditions/Additional Information

  • c) Is the applicant taking any medication that can impair safety duties?*
  • d) Is the applicant taking any medication with risk of acute complications?*
  • Seafarer's Medicals - ENG1 | ML5

    This form is for ENG1 and ML5
  • End of Form

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    Please note that after submission, you will not receive an email confirmation.

     

    If you still have further queries, please call and ask to speak to Nick or send us an email. 

     

    Your Excellent Health Service - YEHS 

    25 Harley Street, LONDON, W1G 9QW

    020 4617 6186 | yehs@yourexcellenthealth.org | www.yourexcellenthealth.org

    YEHS! TO EXCELLENT HEALTH Your Excellent Health Service (YEHS) is the trading name for Dr Charlie Easmon Limited (07537353). YEHS is registered with & has been inspected by the Care Quality Commission (CQC): 1-349138322

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