Certificate of medical fitness for a near coastal certificate
This form lets us know that you are medically fit for working at sea.
When do I need a certificate of medical fitness?
You will need a certificate of medical fitness if you are applying for:
- any high complexity domestic certificate of competency
- a low complexity certificate and you have answered yes to any of the questions in the medical declaration in your Certificate of competency application form 426.
How to complete this form
Section A of the form is for you to complete your details.
Sections B, D and E must be completed by a qualified medical practitioner.
Fill out your details in section A and take the form and the guidelines with you to your qualified medical practitioner. You must provide them with a proof of identity which may include a:
- driver’s licence
- other photo ID.
Give the medical practitioner the Guidelines for the medical assessment of near coastal seafarers. They will need to:
- read the guidelines
- check your identity
- examine you
- fill out the remaining information on the form
- sign it
- return the completed Certificate of medical fitness to you.
Submitting the form
Submit this form with your Certificate of competency application form 426.
Specific requirements for your certificate of competency can be found on the page for that certificate. Find your certificate of competency in Domestic certification.