Emergency Medical Incident Report for Seafarers
1. Vessel Details
Vessel Name
IMO Number
Flag
Position (Lat/Long)
2. Incident Details
Date
Time
Location on Board
Description of Incident
Witnesses (Names)
3. Injured/Ill Person Details
Name
Rank/Position
Nationality
Date of Birth
Gender
Male
Female
Other
4. Nature of Injury/Illness
Nature of Injury/Illness
Body Part(s) Affected
Symptoms
First Aid/Action Taken
5. Medical Assistance
Medical Assistance Contacted (e.g., Telemedical, Port, Hospital)
Evacuation Needed (Yes/No)
Yes
No
Additional Information
6. Reported By
Name
Rank/Position
Date
Time