Form

ML5 medical report form and certificate (MSF 4112)

A report for your medical history and current health; lets your doctor decide on your fitness to work safely at sea.

From:
Maritime and Coastguard Agency
Published
17 April 2014
Last updated
13 February 2023 — See all updates

Documents

Seafarer medical report form ML5 and ML5 certificate (MSF 4112)

Ref: REV 02/23

PDF, 270 KB, 16 pages

View online

Details

Download and print these forms, and take them to your doctor to be filled in. It doesn’t have to be a Maritime and Coastguard Agency (MCA) approved doctor).

This form is for:

  • anyone applying for, revalidating, or changing their MCA Boatmaster’s Licence or certificate
  • anyone applying for a Royal Yacht Association (RYA) commercial endorsement for working on code vessels (see the form for more detail)
  • crew on a seagoing or domestic passenger vessel
  • working on a fishing vessel under 24m in length that is not subject to inspection in a foreign port, at sea for more than 72 hours or operating more than 200 miles from the coastline of the UK or beyond the continental shelf.
Published 17 April 2014
Last updated 13 February 2023 + show all updates

  1. Updated ML5 medical report and certificate 13th February 2023.

  2. Updated ML5 medical report form and certificate MSF 4112 February 2023.

  3. Updated with a revision of the seafarer medical report (ML5) and ML5 certificate (MSF 4112) November 2021.

  4. Most recent ML5 form added

  5. Latest ML5 medical form added

  6. September 2016 Revision Uploaded

  7. First published.

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