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(COMPANY LOGO) |
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| Preeployment medical check which has to be done by the doctor. The results must be not older |
| than 4 weeks before starting of contract. The examination has do be done before every embarkation. |
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| Die Voruntersuchungen des Bewerbers muessen von den jeweils zustaendigen Arzten durchgefuehrt |
| werden. Die Ergebnisse duerfen nicht aelter als 4 Wochen sein. |
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| Surename |
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| Familienname |
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| Firstname |
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| Vorname |
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| Sex |
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Male |
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Female |
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| Geschlecht |
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| Please checkmark/bitte ankreuzen |
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| The following checks have to be verify, wheter the crewmember is fit to work on a cruise ship and |
| can be employed in all areas of hotel services including food production and food & beverage |
| service area. |
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| In Nachfolgenden Punkten muss ueberprueft werden ob das Crew-Mitglied in den Bereichen des |
| Hotels mit inbegriffen Kueche und Restaurant eingesetzt werden darf. |
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| Type of Examination |
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Please checkmark below |
Results/Comment/Signature |
| Art der Untersuchung |
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Bitte unten ankreuzen |
Ergebnis/Bemerkung/Unters. |
| Blood Pressure |
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Done > Normal > Abnormal |
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| Blutdruck |
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| Visual Inspection Mouth/Face |
Done > Normal > Abnormal |
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| Visuelle Ueberpruefung v. Mund/Gesicht |
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| Eye Test |
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Done > Normal > Abnormal |
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| Augentest |
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| Visual iInspection Pupils |
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Done > Normal > Abnormal |
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| Visuelle Ueberpruefung d. Pupillen |
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| Hearing Test |
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Done > Normal > Abnormal |
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| Hoertest |
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| Reflexes |
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Done > Normal > Abnormal |
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| Reflexes |
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| Angle's Jerk |
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Done > Normal > Abnormal |
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| Gesichtsreflexe |
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| Heart |
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Done > Normal > Abnormal |
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| Herz |
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| Limbs |
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Done > Normal > Abnormal |
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| Glieder |
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| Type of Examination |
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Please checkmark below |
Results/Comment/Signature |
| Art der Untersuchung |
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Bitte unten ankreuzen |
Ergebnis/Bemerkung/Unters. |
| Hernia Examination |
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Done > Normal > Abnormal |
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| Leistenueberpruefung |
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| Skin |
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Done > Normal > Abnormal |
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| Haut |
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| Urine Analysis (sugar,albumine,blood) |
Done > Normal > Abnormal |
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| Urinanalyse (Zucker,Albumine,Blut) |
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| R>P>R> Serology (Viral Hepatitis) |
Done > Normal > Abnormal |
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| Blutanalyse (Hepatitis) |
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| Stool analysis |
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Done > Normal > Abnormal |
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| Stuhlanalyse |
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| Throat swab |
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Done > Normal > Abnormal |
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| Rachenabstrich |
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| H.I.V. Test |
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Done > Normal > Abnormal |
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| The result of X_RAY is valid for a period of 2 YEAR. |
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| Das Erbebnis des Roentgens behaelt seine Gueltigkeit fuer ein Jahr. |
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| Chest X_Ray done at this examination: |
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| Roentgenaufnahme vom: |
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| Chest X-Ray not Done, because the |
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| crewmeber has a valid X-Ray picture. |
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Date of X-Ray |
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| Roentgenbild war nicht erforderlich, |
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Datum des Roentgenbildes |
| da das Crewmember noch ein gueltiges |
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| besitzt. |
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| The crewmember is responsible to meet the requirements of proper vaccination in respect to the |
| ship's itinerary, as the requirements are subject to change depending on vessel's itinerary, employee |
| is required to have vaccination against Hepatitis A&B, Yellow Fever and Cholera. However employer. |
| The employee will try to submit employer information about any special requirements upon |
| notification by ship's Manager. The employee has to have these vaccination documented |
| and renewed, whenever necessary. |
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| Jedes Crewmitglied ist verpflichtet, die fuer die jeweilige Reiseroute des Schiffes notwendigen |
| Schutzimpfungen durfuehren zu lassen. Da die Vorschriften fuer Schutzimpfungen immer wieder |
| wechseln koennen, sind folgende Impfungen fuer jedes Crewmitglied Pflicht: Hebatitis A&B, |
| Gelbfieber, Cholera. Sollten aufgrund der Reiserouten des Schiffes zusaetzliche Impfungen |
| notwendig sein, so wird das Crewmitglied ueber den Arbeitgeber benachrichtigt. Diese Schutz- |
| impfungen muessen dokumentiert werden (Eintragung in den Impfpass) und wann immer notwendig |
| auch erneuert werden. |
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Date of Vaccation |
Next Vaccation requested |
| Hepatitis A&B |
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| Yellow Fever |
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| Cholera |
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