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.
Ref: REV 09/16 PDF, 122KB, 12 pages
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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