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Run: Cruise Ship Crew Sign-On Medical Fitness Declaration

A sign-on medical fitness declaration for incoming cruise ship crew, with MLC certificate verification, current health status, medication disclosure, and fit...

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Declaration Overview

Submission date (required)

Full name (required)

Crew ID / employee number (required)

Position / job title (required)

Vessel name (required)

Planned sign-on date (required)

Medical Certificate Verification

Do you currently hold a valid MLC medical certificate? (required)

MLC certificate issue date (required)

MLC certificate expiry date (required)

Issuing authority / clinic

Upload a copy of your MLC medical certificate

Upload only if requested by your crewing team or if your certificate details need verification.

Current Health Status

Are you currently unwell or experiencing any symptoms that could affect safe work? (required)

Please describe the symptoms or condition (required)

Do you have any work restrictions, lifting limits, or duty limitations? (required)

Please describe your restrictions or limitations (required)

Have you received medical treatment, hospitalization, or emergency care in the last 30 days? (required)

Please provide brief details (required)

Medication and Health Disclosure

Are you currently taking any prescription medication that may affect alertness, mobility, or safe job performance? (required)

List the medication name and any relevant work impact (required)

Do you require secure storage or special handling for medication while onboard?

Do you have any allergies or sensitivities that may require onboard awareness? (required)

Please briefly describe the allergy or sensitivity (required)

Fitness for Duty Declaration

I confirm that, to the best of my knowledge, I am fit for duty and able to safely perform the essential functions of my role. (required)

Yes No N/A

I confirm that I have disclosed any current condition, restriction, or medication that may affect my ability to work safely. (required)

Yes No N/A

I consent to the review of this declaration by authorized crewing, HR, and ship medical personnel for sign-on clearance purposes. (required)

Yes No N/A

Additional comments

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