Offshore Worker Pre-Sea Medical Assessment
Personal Information
Full Name
Date of Birth
Nationality
Passport Number
Position Applied For
Medical History
Chronic Diseases (if any)
Past Surgeries / Hospitalizations
Allergies
Current Medications
Vaccination Record
General Examination
Height (cm)
Weight (kg)
Blood Pressure (mmHg)
Pulse (per min)
Vision (Right/Left)
Hearing
Physical Findings
Laboratory & Diagnostic Tests
Blood Test
Urine Test
Chest X-Ray
ECG
Doctor's Assessment
Fit for Offshore Work
Fit
Unfit
Fit with Conditions
Remarks
Doctor's Name
Date of Assessment
Signature