Eyesight test certificate
This Eyesight test certificate form 542 lets us know that your eyesight meets the necessary standard for working at sea.
When do I need an eyesight test certificate?
You will need an eyesight test certificate if you are:
- applying for a new certificate of competency
- applying to revalidate your certificate, remove a restriction, add an endorsement, change your name, or replace your certificate for these certificates:
- Mate less than 80 metres near coastal
- Master less than 35 metres near coastal
- Marine engine driver grade 1 near coastal
- Master less than 80 metres near coastal
- Engineer class 3 near coastal
- operating under Marine Safety (Low complexity duties) Exemption.
How to complete this form
You can fill in this form online before downloading it as PDF document, or print a blank form.
You need to enter your details in Section A of this form. Sections B, C, and D must be completed by a qualified medical practitioner, optometrist or ophthalmologist.
You will need to print your partly completed form, and the Guidelines for the medical assessment of near coastal seafarers (the guidelines).
Take the form and the guidelines with you to your qualified medical practitioner, optometrist or ophthalmologist. You must provide them with a proof of identity which may include a:
- driver’s licence
- other photo ID.
Give the medical practitioner the form and the guidelines. They will need to:
- read the guidelines and the instructions on the form
- check your identity
- examine your eyes
- fill out the remaining information on the form
- sign it
- return the completed eyesight test certificate to you.
Submitting the form
For all certificate of competency application types, you should submit the 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.
For exemption 38, you do not have to submit the form but you must carry it with you at all times when you are working under the exemption.
- Read the eyesight and medical requirements for a domestic qualification.
- You will need to take these Guidelines for the medical assessment of near coastal seafarers to you medical practitioner, optometrist or ophthalmologist, with your partly completed application.
- Certificate of competency application form 426
- Find your certificate of competency in domestic certification