• YEHS - CRUISE LINES PEME FORM

    This PEME form is for Royal Caribbean and Virgin
  • When is your appointment? (Enter time in 12 hour mode)*
     - -
  • Do you want a reciept for this assessment?*

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

  • YEHS - CRUISE LINES PEME FORM

    YOUR DETAILS
  • Birth Date (day month year)*
     / /
  • Gender Assigned at Birth*
  • Format: 00000000000.

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

  • YEHS - CRUISE LINES PEME FORM

  • Which Cruise Line PEME are you having?*
  • Capacity that the Seafarer will serve on board (Virgin)*
  • Capacity that the Seafarer will serve on board (RCCL)*
  • Please tick all options that apply (Virgin Crew)
  • Please tick all options that apply (Royal Caribbean Crew)
  • Contract?*

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

  • YEHS - VIRGIN CRUISE LINE PEME FORM

    Section A - Personal Medical History

  • Ear, Nose & Throat (ENT)

  • 1.⁠ ⁠Do you have or had Frequent Ear Infection?
  • 2.⁠ ⁠Do you have or had Hearing Problems or lost?
  • 3.⁠ ⁠Do you have or had sinus trouble?
  • 4.⁠ ⁠Do you have or had frequent nosebleeds?
  • 5.⁠ ⁠Do you have or had Frequent Colds?
  • 6.⁠ ⁠Do you have or had Frequent Sore Throats?
  • 7.⁠ ⁠Do you have or had Balance Problems?
  • 8.⁠ ⁠Do you have or had Vertigo?
  • 9.⁠ ⁠Do you have or had Meniere’s Disease?
  • 10.⁠ ⁠Do you have or had Spinning Sensation?

  • Cardiology

  • 1. Do you have or had high blood pressure?
  • 2. Do you have or had low blood pressure?
  • 3. Do have or had a heart attack?
  • 4. Do you have or had angina?
  • 5. Do you have or had an irregular heartbeat?
  • 6. Do you have or had poor circulation?
  • 7. Have you had a stroke?
  • 8. Do you have or had paralysis?
  • 9. Other heart disease?

  • Psychiatric

  • 1. Do you have or had depression?
  • 2. Do you have or had anxiety?
  • 3. Do you have or had thoughts of harming self or others?
  • 4. Have you ever attempted suicide?
  • 5. Have you ever had a nervous breakdown?
  • 6. Do you have Attention Deficit Disorder? (ADD)
  • 7. Do you have Attention Deficit Hyperactivity Disorder(ADHD)?
  • 8 Have you received treatment from a mental health professional?
  • 9. Have you ever had psychological/psychiatric illness or disorder?
  • 10. Do you have or had trouble sleeping or staying asleep?
  • 11. Have you ever treated for drugs, alcohol or substance abuse?
  • 12. Have you ever taken antidepressant medication?
  • 13. Have you ever been diagnosed with bipolar disorder?
  • 14. Have you ever been diagnosed with Schizophrenia?
  • 15. Have you ever had Post Traumatic Stress Disorder (PTSD)?
  • 16. Do you have any pre-existing medical and/or mental health/psychological conditions that have not been covered in this questionnaire?
  • 17. Have you ever been declared or certified unfit for work for any reason, including but not limited to health, injuries, mental health, or psychological counselling?
  • 18. Have you ever been admitted to a hospital because of illness, injury or mental health/psychological episodes or conditions?
  • 19. Have you ever had obsessive compulsive disorder?

  • Vision/Ophthalmology

  • 1. Do you wear glasses or contact lenses?
  • 2. Do you have or had Eye Injury and/or illness?
  • 3. Do you have or had Conjunctivitis?
  • 4. Do you have or had Glaucoma?
  • 5. Do you have or had eye or vision problems?
  • 6. Do you have or had cataracts?
  • 7. Do you have or had eye surgery?
  • 8. Do you have or had color blindness?
  • 9. Do you have or had macular degeneration?
  • 10. Do you have or had Chalazion (eyelid cysts)?

  • Pulmonary

  • 1. Do you have or had Swollen Lymph Nodes?
  • 2. Do you have or had Asthma?
  • 3. Do you have or had Wheezing?
  • 4. Do you have or had Bronchitis?
  • 5. Do you have or had Tuberculosis?
  • 6. Do you have or had Pneumonia?
  • 7. Do you have or had Cough up Blood?
  • 8. Do you have or had Shortness of Breath?
  • 9. Do you have or had Pulmonary Embolism?
  • 10. Do you have or had Sleep Apnea?
  • 11. Do you have or ever had lung injury or illness?
  • 12. Do you have or ever had a collapsed lung?
  • 13. Do you have or ever had Pulmonary Fibrosis?

  • Endocrinology

  • 1. Do you have or had diabetes? Type 1 or Type 2
  • 2. Do you have or had osteoporosis?
  • 3. Do you have or had thyroid disorder or disease?
  • 4. Do you have or had problems with weight loss or gain?
  • 5. Have you had any other Endocrinology disease or disorder?
  • 6. Do you have or had hormone disease or disorder?
  • 7. Do you have or had prolong tiredness?
  • 8. Have you had sensitivity to temperatures (too cold or toohot)?
  • 9. Do you have or had any autoimmune diseases?
  • 10. Did you have or had Gestational Diabetes?

  • Dermatology

  • 1. Do you have or had skin problems and rash?
  • 2. Do you have or had dermatitis?
  • 3. Do you have or had psoriasis?
  • 4. Do you have or had eczema?
  • 5. Do you have or had latex gloves allergies?

  • Infectious Diseases

  • 1. Do you have or had Rheumatic Fever?
  • 2. Do you have or had infectious diseases?
  • 3. Do you have or had contagious diseases?
  • 4. Do you have or had syphilis?
  • 5. Do you have HIV?
  • 6. Do you have or had Gonorrhea?
  • 7. Do you have or had HPV?
  • 8. Do you have or had sexual transmitted diseases?
  • 9. Do you have or had any type of hepatitis?
  • 10. Have you had any type of tropical diseases?
  • 11. Do you have or had COVID-19?
  • 12. Do you have or had Dengue or Malaria?
  • 13. Do you have or had Mononucleosis?
  • 14. Do you have or had Chicken Pox?
  • 15. Do you have or had Measles?
  • 16. Do you have or had Mumps?
  • 17. Do you have or had Zika?

  • Oncology

  • 2. 1. Do you have or have you ever had cancer?
  • 2. Do you have or have you ever had tumors?
  • 3. Have you had treatment for cystic disease?
  • 4. Have you had treatment for colon/rectal cancer?
  • 5. Have you had treatment for myoma?
  • 6. Have you had treatment for skin lesions?
  • 7. Have you had tenderness, mass, lumps, cysts, tumours, or cancer in your breasts?
  • 8. Do you have or had fibroids, ovarian cysts, tumors or cancer?
  • 9. Have you had treatment for mixed cancers?
  • 10. Have you had treatment for prostate cancer?

  • Urology

  • 1. Do you have or had Kidney Stones?
  • 2. Do you have or had any type of kidney problem?
  • 3. Do you have or had kidney or bladder infections?
  • 4. Do you have or had kidney cysts?
  • 5. Do you have or had blood in urine?
  • 6. Do you have or had urinary tract infections?
  • 7. Do you have or had prostate diseases (Males)?
  • 8. Do you have or had bladder problems?

  • Gastroenterology

  • 9. 1. Do you now have or have you ever had Gastritis?
  • 2. Do you have or had Gallbladder stones or polyps?
  • 3. Do you have or had Gallbladder polyps?
  • 4. Have you ever had Anal Fissures?
  • 5. Do you have or had any type of Ulcers?
  • 6. Do you have or had Abdominal Pains?
  • 7. Do you have or had chronic diarrhea?
  • 8. Do you have or had episodes of prolong constipation?
  • 9. Do you have or had gluten intolerance?
  • 10. Do you have or had bleeding from stomach?
  • 11. Do you have or had bleeding from bowels?
  • 12. Do you have or had irritable bowel syndrome?
  • 13. Do you have or had Hemorrhoids?
  • 14. Do you have or had Jaundice?
  • 15. Do you have or had Liver Problems/Disease?
  • 16. Do you have or had any type of hernia?
  • 17. Do you have Crohn's disease?

  • Disability

  • 1. Have you ever been declared partially disabled?
  • 2. Have you ever been declared fully disabled?

  • Neurology

  • 1. Do you have or had headaches lasting more than 4 hours?
  • 2. Do you have or had migraines?
  • 3. Do you have or had loss of consciousness?
  • 4. Do you have or had episodes of dizziness?
  • 6. Do you have or had any type of head injury?
  • 7. Do you have or had concussions?
  • 8. Have you ever had fainting spells?
  • 9. Have you ever had seizures or epilepsy?
  • 10. Do you have or had any neurological disorder?
  • 11. Have ever had a stroke(s)? including mini-strokes?
  • 12. Do you have or had muscle weakness or loss of sensation?

  • Blood Disorders

  • 1. Do you have or had anemia including sickle cell anemia?
  • 2. Do you have or had hemophilia?
  • 3. Do you have or had Leukemia?
  • 4. Do you have orhad sickle cell anemia?
  • 5. Do you have or had sickle cell trait?
  • 6. Do you haveor had any other blood disorder?
  • 7. Do you have or had Polycythemia Vera?

  • Orthopedics

  • 1.Do you now have or have you ever had Bone pain?
  • 2. Do you now have or have you ever had Neck pain or injury?
  • 3. Do you now have or have you ever had Shoulder pain or injury?
  • 4. Do you now have or have you ever had Mid Back pain or injury?
  • 5. Do you now have or have you ever had Low Back pain or injury?
  • 6. Do you now haveor have you ever had Radiating pain?
  • 7. Do you now have or have you ever had Joint Pain?
  • 8. Do you now have or have you ever had Knee pain or injury?
  • 9. Do you have or ever had Feet and/or Toes pain or injury?
  • 10. Do you have or everhad Ankle pain or injury?
  • 11. Have you ever had any type of orthopedic injury?
  • 12. Have you ever had any type of fracture?
  • 13. Do you now have or have you ever had Elbow pain or injury?
  • 14. Have you ever had Hand/Fingers and/or Wrist pain or injury?
  • 15. Do you now have or have you ever had Arthritis?
  • 16. Have you ever had joint dislocations or surgeries?
  • 17. Do you now have or have you ever had Plantar Fasciitis?
  • 18. Do you now have or have you ever had Ganglion cyst?
  • 19. Do you now have or have you ever had Fibromyalgia?
  • 21. Have you ever received chiropractic treatment?
  • 20. Have you ever received physiotherapy?

  • Dental

  • 1. Do you have or had teeth decay?
  • 2. Do you have or had gingivitis?
  • 3. Do you have implants or fake teeth?
  • 4. Do you have or had teeth impacted?

  • Vascular

  • 1. Do you have or had varicose veins?
  • 2. Do you have or had poor circulation?
  • 3. Do you have or had Gout?
  • 4. Do you have or had Atherosclerosis?
  • 5. Do you have or had Peripheral Artery Disease?
  • 6. Do you have or had aneurysm(s)?
  • 7. Do you have or had deep vein thrombosis (DVT)?

  • Miscellaneous/General Questions

  • 1. Have you had an Accident or Illness in the last 10 years?
  • 2. Have you ever been hospitalized?
  • 3. Have you ever received a blood transfusion?
  • 4. Have you had an operation or surgery?
  • 5. Are you taking any type of medication (incl. vitamins)?
  • 6. Are you undergoing any type of treatment?
  • 7. Do you have any type of implants, including dental?
  • 8. Are you undergoing or need dental treatment?
  • 9. Do you drink alcoholic beverages? If yes, how much?
  • 10. Do you Smoke? If yes, then how much per day?
  • 11. Have you ever had an MRI and/or CTScan?
  • 12. Have you ever had any type of cosmetic surgery?
  • 13. Are you now getting dental or vision treatment?
  • 14. Have you participated or are you in a weight lost program?
  • 15. Have you taken or are you taking any weight loss medication?
  • 16. Have you had Gastric Surgery?
  • 17. Are you now or have been on a nutritional plans?
  • 18. Do you have, or have you ever had an Eating Disorder?
  • 19. Have you or are you currently undergoing hormone therapy?
  • 20. Have you or are you currently in Transgender therapy?
  • 21. Do you drink energy beverages? If yes, how often per day?

  • Allergies

  • 1. Do you have or had food allergies?
  • 2. Do you have or had anaphylaxis allergies?
  • 3. Do you have or had environmental allergies?
  • 4. Do you have or had seasonal allergies?
  • 5. Do you have or had chemical allergies?
  • 6. Do you have or had drug/medicine allergies?
  • 7. Do you have or had any other type of allergy?

  • Rheumatology

  • 1. Do you have or had lupus?
  • 2. Do you have or had sarcoid disease?
  • 3. Do you have or had rheumatoid arthritis?
  • 4. Do you have or had carpal tunnel syndrome?
  • 5. Do you have or had fibromyalgia?
  • 6. Do you have or had inflammatory myopathies?
  • 7. Do you have or had osteoarthritis?
  • 8. Do you have or had osteoporosis?
  • 9. Do you have or had tendinitis or bursitis?

  • Gynecology

  • 1. Are you now or do you think you are pregnant?
  • 2. Do you have or had gynecological problems?
  • 3. Do you have or had endometriosis?
  • Do you have any chronic diseases?
  • Diabetes Type 1 - Stable Condition?
  • Diabetes Type 1 - Restrictions?
  • Diabetes Type 2 - Stable Condition?
  • Diabetes Type 2 - Restrictions?
  • Hypertension - Stable Condition?
  • Hypertension - Restrictions?
  • Cardiovascular Disease - Stable Condition?
  • Cardiovascular Disease - Restrictions?
  • Chronic Kidney Disease - Stable Condition?
  • Chronic Kidney Disease - Restrictions?
  • Autoimmune Disease - Stable Condition?
  • Autoimmune Disease - Restrictions?
  • HIV - Stable Condition?
  • HIV - Restrictions?
  • Osteoarthritis (OA) - Stable Condition?
  • Osteoarthritis (OA) - Restrictions?
  • Asthma - Stable Condition?
  • Asthma - Restrictions?
  • Hypercholesterolaemia - Stable Condition?
  • Hypercholesterolaemia - Restrictions?
  • Hypertriglyceridemia - Stable Condition?
  • Hypertriglyceridemia - Restrictions?
  • Depression - Stable Condition?
  • Depression - Restrictions?
  • Anxiety - Stable Condition?
  • Anxiety - Restrictions?
  • Back Pain - Stable Condition?
  • Back Pain - Restrictions?
  • Scoliosis - Stable Condition?
  • Scoliosis - Restrictions?
  • Migraine Headache - Stable Condition?
  • Migraine Headache - Restrictions?
  • Otitis - Stable Condition?
  • Otitis - Restrictions?
  • Arthritis - Stable Condition?
  • Arthritis - Restrictions?
  • Varicose Veins - Stable Condition?
  • Varicose Veins - Restrictions?
  • Carpal Tunnel - Stable Condition?
  • Carpal Tunnel - Restrictions?
  • Suicidal Idealogy - Stable Condition?
  • Suicidal Idealogy - Restrictions?
  • Self Harm - Stable Condition?
  • Self Harm - Restrictions?
  • Bi-Polar - Stable Condition?
  • Bi-Polar - Restrictions?
  • Schizophrenia - Stable Condition?
  • Schizophrenia - Restrictions?
  • Panic Disorder - Stable Condition?
  • Panic Disorder - Restrictions?
  • Are there are other Chronic diseases not listed above?
  • Chronic Disease 1 - Stable Condition?
  • Chronic Disease 1 - Restrictions?
  • Chronic Disease 2 - Stable Condition?
  • Chronic Disease 2 - Restrictions?

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

  • YEHS - VIRGIN CRUISE LINE PEME FORM

    Declarations
  • Declarations

  • ROYAL CARIBBEAN GROUP PEME

    FORM

  • Hello,

    Before you go ahead with filling this form, you must have filled your FORM A on RiskConnect.

    FORM A: https://riskonnectrcl.my.site.com/EHR/s/peme

  • Are you a Perfect Destination employee (CocoCay, Labadee, and Perfect day Mexico) or Silverseas Crew Member?*
  • Perfect Destination and Regular Crews have different FORM As. Please confirm you have filled the right Form A for your category?*
  • When did you fill Form A?*
     - -
  • Please give the reason why you have not filled your FORM A.*

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

  • YEHS - CRUISE LINES PEME FORM

    Letter from GP / Specialists

  • If you have any current or historic medical problems, please try to get a recent letter from your GP or specilaist stating your current state of health and possibly giving you the all clear.

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

  • YEHS - CRUISE LINES PEME FORM

    Please provide Your Vaccination History
  • Measles, Mumps, Rubella - Date Recieved
     - -
  • Tetanus - Date Recieved
     - -
  • Yellow Fever - Date Recieved
     - -
  • Hepatitis B - Date Recieved
     - -
  • Hepatitis A - Date Recieved
     - -
  • Meningitis - Date Recieved
     - -
  • Polio - Date Recieved
     - -
  • Varicella - Date Recieved
     - -
  • Influenza - Date Recieved
     - -
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  • Cruise Lines - Vaccination Requirements

    Cruise Line / Vaccine Royal Caribbean Cruise Line Disney Cruise Line Norweigian Cruise Line Virgin Cruise Line
    MMR Mandatory  Mandatory (1st dose or proof of Immunity) Mandatory Mandatory for 1st dose
    Yellow Fever (Once a lifetime) Mandatory for TUI and Silversea crew members only  Not Required   Mandatory Mandatory (for all crew from epidemic areas)
    Tetanus (Once every 10 years) Mandatory  Not Required   Mandatory Mandatory Booster
    Polio Not Required    Not Required   Mandatory  Recommended 
    Varicella Not Required    Mandatory for Youth Activities / Nursery Counsellors only (1st dose or proof of Immunity) Mandatory for youth programme Recommended for others Mandatory (1st dose or proof of Immunity)
    Pneumococcal Not Required   Not Required    Recommended  Recommended 
    Influenza (Flu)  Not Required  Mandatory Recommended Recommended 
    COVID Not Required   Mandatory  Mandatory (if available) Recommended 
    Hepatitis B Not Required   Not Required    Not Required  Mandatory for Medical / Tattoo Artist (1st dose or proof of Immunity)
    Hepatitis A Not Required   Not Required    Not Required   Recommended
    Meningitis  Not Required  Not Required    Not Required Recommended
    Rubella  Mandatory for TUI crew members only  Not Required    Not Required  Not Required

     

    PROOF of MMR / Varicella

    If you do not have any evidence of Varicella or MMR vaccination, you will either need a blood test to check that you are immune or you get vaccinated with one dose (£90 per dose).

    Please let us know what you would like to do before your appointment.

  • Would you like any vaccinations at your appointment?*
  • What vaccinations would you like?

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

  • YEHS - CRUISE LINES PEME FORM

    END OF FORM
  • Fit Questions

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

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