Ferry Crew Medical Fitness Self-Assessment

Crew Member Information

Full Name

Rank/Role

Date

Medical Fitness Checklist

I feel generally well today I do not have a fever I do not have a persistent cough I have no difficulty breathing I do not feel nausea or vomiting I do not have diarrhea I do not have any unusual rash or skin problem I have not had recent injury or surgery affecting work I am not currently taking new medication affecting alertness or performance

Other Health Concerns

Describe any other symptoms, concerns, or relevant details

Declaration

I confirm that the above information is accurate to the best of my knowledge.