The 2012 ILO/IMO International Guidelines on the Medical Examination of Seafarers recommend criteria for taking decisions on the fitness of seafarers for work at sea

They also provide an internationally agreed basis for ensuring that the medical certification requirements in the ILO Maritime Labour Convention 2006 and the ILO Convention on Standards for Training, Certification and Watchkeeping 2012 are met. The Guidelines also include recommendations on the conduct of medical examinations and information for maritime authorities about appropriate national arrangements for seafarer medical examinations.

 The Guidelines reflect a shared view of what is good practice for medical examination prior to the issue of a statutory seafarer certificate of fitness. They have been agreed by national maritime authorities, by seafarer trade unions and by employer organisations with advice from maritime health professionals.

Some employers, insurers (P&I Clubs) and social insurance authorities require additional criteria to be used prior to acceptance of a seafarer for employment. These additional criteria are usually applied only in the lower-cost crewing countries and are often unacceptable in countries with well-developed laws on discrimination in employment. Such additional criteria do not necessarily represent a consensus of all the above groups, as their aim may be to reduce the costs to employers or insurers from illness in seafarers rather than safeguard maritime safety and the health of those working at sea. Such criteria are not considered in this handbook but the advice provided here may also assist doctors who are using these criteria, although these do tend to be more restrictive than statutory ones, are less accommodating to requirements for limitations to duties and sometimes lack the clarity of documentation found in the better statutory systems.

While some of the criteria in the Guidelines are self-explanatory, a number of those that apply to common conditions found in seafarers are concise summaries about complex conditions and their risks. The aim of this handbook is to provide additional detailed information for doctors conducting such examinations, both to guide them on decision taking and to provide theme with background information on the reasons for the criteria to enable them to explain the criteria to seafarers, employers, trade unions and others who may find additional information useful.

The material included is not static, changes in diagnostic and treatment methods and new results from population studies of disease will need to be considered in the future as they become relevant to maritime health practice.

This handbook had its origins in the work of the International Maritime Health Association working group on Evidence Based Medical Fitness Criteria. Much of this material was subsequently included in guidance for doctors approved by the United Kingdom Maritme and Coastguard Agency and it was then re-edited to be compatible with the ILO/IMO Guidelines. The author of this handbook was closely involved in all these stages.

Preparation of this Handbook has been made possible by a grant from the ITF Seafarers' Trust

made to the International Maritime Health Association.

It was prepared by the Norwegian Centre for Maritime Medicine

in association with Sixty AS.

This handbook provides information for maritime health professionals on what constitutes good practice for seafarer medical examinations and may help examining doctors to apply the Guidelines more fairly and consistently. It does not have any formal status. The Guidelines and the conventions on which they are based should be used as the definitive statements of international requirements and their interpretation. Where national standards are set that are compatible with the requirements and recommendations of the conventions and guidelines these should be followed, again this handbook may be used as a benchmark for good practice.