Cruise Ship Staff Medical Fitness Declaration
Personal Information
Full Name
Date of Birth
Nationality
Position on Ship
Employee ID/Number
Medical Declaration
Do you currently have, or have you had in the past 12 months, any of the following conditions?
Fever, cough, or respiratory symptoms
Serious chronic illness (heart, diabetes, etc.)
Recent surgery or hospitalization
Contagious diseases
Other medical conditions (please specify):
Fitness to Work Declaration
I hereby declare that I am in good health and fit for work duties on board the cruise ship:
Yes
No
If "No", please provide details:
Signature & Date
Signature
Date