MEDICAL EXAMINATION for EMPLOYMENT

INSTRUCTIONS TO THE CREW MEMBER

Dear Crew Member, You are required to have a valid Medical Examination before joining your Crystal Cruises ship. Take time to read this instruction before going for your medical examination. 1. Take the Medical Examination Report to the doctor or clinic that has been recommended by your agent or ICMA. Alternatively, visit your licensed private physician only if agreed to with ICMA. 2. Attach a passport size photo to page 6, Medical Certificate. 3. Fill in the self declaration on pages 7 and 8 and sign it. 4. Fill in the self declaration Back and Spine on page 11 and sign it. 5. Fill in the self declaration Infectious Disease Immunity Verification on page 12 together with the Examining Doctor. 6. The doctor shall fill in all other information on pages 6, 7, 9 and 10. 7. When all of the test results are determined, the doctor shall complete page 6, stating whether you do/do not meet the medical requirements. The doctor shall also sign page 6 and affix his/her official stamp. 8. Once all of the pages (6 through 12) are completed, you need to forward all 7 pages and all lab tests to ICMA before you will be permitted to travel to your ship. You can forward them as follows: - Scan / email to medical@icma.no - Telefax to +47 2335 7901 9. ICMA will contact you with your travel instructions once our Company Medical Advisor has approved your medical examination. 10. Bring your copy of the Medical Examination with you to the ship. Thank you for carefully following these instructions. By doing so, you will help us to get you onboard your ship in the most timely manner, with your medical documentation in order. If you have any questions, do not hesitate to contact your Personnel Consultant at ICMA. Kind regards, The ICMA Team
November 2008

Page 1 Appendix (7) to Medical Management and Disease Prevention Manual, Rev. 4 (E) 26 March 2009

MEDICAL EXAMINATION for EMPLOYMENT

INSTRUCTIONS TO THE DOCTOR
Dear Doctor, The seafarer you are about to examine is seeking work onboard a cruise vessel operated by Crystal Cruises. Attached you will find a Medical Certificate and a Medical Examination Report that you need to complete. Please note the following important details: Medical Certificate The medical certificate is valid for a period of two years. Ensure that all information for the seafarer is completely filled in, including the ID (Passport and/or Discharge Book) number on page 6. Ensure that the attached photograph is the person to be examined. Place your official stamp partially on the photograph and the document. Upon completion of the medical examination, be sure to complete all details about your name, clinic or hospital, and address. Affix your stamp to the Medical Certificate (page 6). Medical Examination Report Ensure that the seafarer has completed all voluntary information correctly (pages 7, 8 and 11). Verify the MMR information on page 12 together with the seafarer, and sign when completed. Verify the Personal Medical History information carefully with them. You need to sign as a witness on page 8. Please note that no vaccinations are required or authorized, unless specifically requested by the Employer. See page 7. Conduct the complete Medical Examination and Summary on pages 9 and 10. We ask you to specifically check the seafarers back and spine for signs of injury or weakness. Any skeletal weaknesses or injuries will disqualify the seafarer from employment with us. We ask you to be thorough and honest in your evaluation of the seafarer. It is very important that all test results are determined before the Medical Certificate is completed. Please attach the analysis reports to the Medical Examination Report. Carefully read the attached Medical Guidelines for Hiring Crystal Shipboard Personnel. Thank you for your kind attention to this important medical examination for employment at sea. Sincerely, Thomas Carlson
General Manager International Cruise Management Agency AS Jernbanetorget 4B, 0154 Oslo, Norway medical@icma.no

Page 2 Appendix (7) to Medical Management and Disease Prevention Manual, Rev. 4 (E) 26 March 2009

MEDICAL GUIDELINES FOR HIRING CRYSTAL SHIPBOARD PERSONNEL The employment physical examination should establish that the applicant does not have any mental or physical disability or disease that interferes with his or her daily work or may in any way endanger the health of other persons onboard. It should also ensure that the applicants visual acuity, color vision and hearing fulfill the international regulation requirements for his or her type of work onboard. GENERAL DISQUALIFYING CONDITIONS (NOT FIT FOR SEAGOING EMPLOYMENT) Any mental, physical or medical condition that may interfere with the ability to function effectively in daily work onboard, in any emergency, or in any drill. Conditions that may endanger life or health of others onboard. Visual ability or hearing poorer than the international regulation requirements. (See page below) Conditions that require regular medical follow-up or medication.* Medical conditions that harbor risk of flare-ups or complications necessitating emergency evacuation from the ship. SPECIFIC DISQUALIFYING CONDITIONS (NOT FIT FOR SEAGOING EMPLOYMENT) 1. Communicable diseases, including venereal disease Venereal disease until adequately treated Active or incompletely treated tuberculosis Persons with radiological signs of pulmonary tuberculosis where previous treatment history cannot be verified. 2. Malignant neoplastic disease 3. Endocrine disease Diabetes mellitus Type I insulin dependent Diabetes mellitus Type II unstable * 4. Mental and psychological diseases Psychoses and severe depression requiring active psychotic drugs Neurotic disorders needing treatment and requiring the use of psychotropic drugs Behavioral disturbances, obvious adaptation difficulties Enuresis Alcoholism Drug addiction or abuse History of illicit drug use Any regular use of psychotropic drugs History of psychosis 5. Neurological disease Symptomatic neurologic disorders Epilepsy Severe migraine headaches Neuralgias
Page 3 Appendix (7) to Medical Management and Disease Prevention Manual, Rev. 4 (E) 26 March 2009

6. Cardiac disease Symptomatic or functionally significant heart disease Peripheral vascular disease Hypertension (individual assessment)* Conditions requiring continuous anticoagulant therapy 7. Respiratory disease Chronic bronchial conditions Asthma requiring treatment 8. GI disease Disease of the teeth and gums until adequately treated Recurring dyspepsia with or without ulcer Symptom-giving gallstones Chronic diseases of liver or pancreas Chronic enteritis or colitis Hernia (untreated or unsuccessfully treated). 9. GU disease Present calculi (stones) of urinary tract Chronic nephritis or nephrosis Prostatitis 10. Gynecological disease and conditions Recurring salpingitis Irregular menses (periods) with heavy blood loss Pregnancy 11. Dermatological disease Contagious skin diseases until adequately treated Severe skin diseases Allergies to substances commonly onboard (e.g. metals, petroleum products, detergents) 12. Musculoskeletal disease Recurring or chronic back pain with significant disability All musculoskeletal diseases, congenital malformations and sequelae after injuries which will interfere with the ability to function effectively in an emergency or drill. 13. Long term medications Person needing long term medication for reasons not mentioned above (e.g. transplant recipients). * * Persons with these conditions might be approved by CCIs Medical Consultant after his careful evaluation of the individuals history, symptoms and your objective findings. Examining physicians should mark the Medical Certificate DOES NOT meet physical requirements and describe the reason and notify ICMA who will arrange for further evaluation.

Page 4 Appendix (7) to Medical Management and Disease Prevention Manual, Rev. 4 (E) 26 March 2009

Standards for Visual Acuity, Color Vision and Hearing Minimum Standards (Ref: UK MSN 1765 (M) Appendix 1 to Annex B) Crew Position Vision Visual Field Color (distance) (Ishihara) Captain Unaided: Normal No Normal Vice Captain Both Eyes: 6/60 pathological 1st Officer field defect 2nd Officer Aided: Boatswain Better Eye: 6/6 Carpenter Other Eye: 6/12 Quartermaster Able Seaman Near Vision: N8 Ordinary Seaman Sailor Chief Engineer Unaided: 6/60 Sufficient for Normal Asst. Chief Engineer duties Electrical Engineers Aided: Electronic Engineers Better Eye: 6/18 Refrigeration Other Eye: 6/18 Engineers 1st Engineer Near Vision: N8 2nd Engineer 3rd Engineer Marine Storekeeper Oiler Wiper ALL Other Positions Sufficient to undertake duties efficiently

Hearing (USCG Std.) Unaided: Threshold 70 db or less each ear. 90% speech discrimination

Unaided: Threshold 70 db or less each ear. 90% speech discrimination.

Page 5 Appendix (7) to Medical Management and Disease Prevention Manual, Rev. 4 (E) 26 March 2009

MEDICAL CERTIFICATE
Photo Photo

Last Name

First and Other Names

Position applied for

Date of Birth
DD MM YYYY

Sex

Nationality

ID (Passport/Discharge book) No:

Ship Name

I have evaluated the above-named examinee according to the ICMA Medical Guidelines (Based on UK Medical Requirements for Seafarers MSN1765(M), and on the basis of the examinees personal declaration, my clinical examination, and the diagnostic test results obtained, and in consideration of the essential requirements of the position applied for, in my opinion this employee DOES / DOES NOT meet the physical requirement for this job. (circle one) Restrictions applied: None/ If unfit state reason Visual aid required (specify) Yes/No Informed spares necessary Yes/No Fit for lookout duty Yes/No

Signed:

Name: Clinic stamp:

Date:

DD

MM

YYYY

I acknowledge that I have been advised of the content of the medical examination form. Crew Members signature:

A copy of this page should be kept by the examining physician, and a copy sent to the ICMA. The entire original medical examination form should be given to the seafarer.

Page 6 Appendix (7) to Medical Management and Disease Prevention Manual, Rev. 4 (E) 26 March 2009

MEDICAL EXAMINATION REPORT - STRICTLY CONFIDENTIAL

This examination must be carried out by an authorized physician. The seafarer must meet the minimum standards set down by the authorizing body. Reference should also be made to the guidelines included. Last name First and Other Names

Date of Birth
DD MM YYYY

Sex

Position/Job Applied For

Home Address

Usual Medical Practitioner Name/Address

Date/result of last medical examination:

Date/result of last Employment Physical Exam (if any): DD MM YYYY

EMPLOYMENT PHYSICAL EXAM QUESTIONNAIRE - PERSONAL MEDICAL HISTORY To be completed by the Crew Member and given to the Examining Physician.
Vaccination status (This section is for information only. No vaccinations are required/authorised as part of this exam) State date of last vaccination/immunity (if not vaccinated, state N/A next to the item): Diphtheria: Tetanus: Pertussis: Polio: Hepatitis A: Typhoid : Hepatitis B: Yellow Fever: MMR: Varicella: To the best of your knowledge, have any of your family ever suffered from any of the following? Heart conditions/angina, Blood pressure problems, Stroke/vascular disease, Mental/nervous, disorder, Diabetes, Tuberculosis, Asthma/eczema, Glaucoma, Epilepsy/fits, Cancer, Anaemia If yes, please give details: Are you taking any non-prescription or prescription medications? Yes/No Please list with dosage, and reason for taking ___________________________________________________________________ Have you any allergies to medications, or to environmental allergens eg Hay Fever? Do you smoke? Yes/No Number of cigarettes per day Do you drink alcohol? Yes/No Number of units per week Do you feel healthy and fit to perform the duties of your designated position/occupation? Have you ever been declared unfit for sea duty, or had your medical certificate restricted or revoked? Yes/No

Yes/No Yes/No

Page 7 Appendix (7) to Medical Management and Disease Prevention Manual, Rev. 4 (E) 26 March 2009

EMPLOYMENT PHYSICAL EXAM QUESTIONNAIRE - PERSONAL MEDICAL HISTORY To be completed by the Crew Member and given to the Examining Physician.
Have you ever had any medical conditions affecting the systems below? Eye or vision problem: Glaucoma, Eye injury, Glasses/ contact lenses Dental problems Ear/nose/throat problems: Ear Infections, Hearing Problems, Sinus Trouble, Recurrent Nose Bleeding Heart problems: Rheumatic Fever, abnormal heart beat, Chest Pain, Heart Attack, Heart surgery Vascular disease: High blood pressure, Varicose veins, Poor Circulation Chest problems: Shortness of Breath, Coughing up Blood, Asthma/bronchitis, Wheezing, Pneumonia, Pleurisy, TB Endocrine or hormone disorders: Diabetes or blood sugar problems, Thyroid problem Malignant Diseases: Cancer or Tumour, Blood disorders Kidney problems: Urinary Infections, Blood in Urine, Kidney Stones Genital disorders: Sexually Transmitted Disease Males: Prostate Disease, Testicular lumps or swellings, Varicocele Females: Gynae problems, abnormal smears, painful periods, pregnancy problems, Breast lumps Date of last menstrual period: (exclude Pregnancy) Skin problems: Dermatitis, Rashes, Exzema, Psoriasis Infectious/contagious diseases: Malaria or other tropical diseases, HIV / AIDS Digestive disorder: Frequent Indigestion, Gastric/Duodenal Ulcer, Abdominal Pain Diarrhoea, Constipation, Bleeding from gut, Jaundice, hepatitis or Liver Complaints, Hernia, Haemorrhoids/piles Neurological problems: Epilepsy, seizures or Blackouts, Dizziness/fainting, Loss of consciousness, Frequent Severe headaches or Migraines, Muscular Weakness or Paralysis, Tingling or Numbness, Balance problems, Stroke, Head Injury or Concussion, loss of memory Psychiatric problems: Anxiety, Depression, Sleep problems, Nervous Breakdown, suicide attempt Restricted mobility: Back problems, Sciatica, Fractures, Dislocations, Severe Sprain, Arthritis, Rheumatism, Joint pain

If yes, give details:

Apart from conditions as above, have you had any other operations or surgery, serious accidents or injuries, medical problems, diseases or illnesses, visits to health care professionals or hospital admissions? Yes/No -------------------------------------------------------------------------------------------------------------------------------------------------------------I certify that the above medical information is true and any false information provided will be grounds for immediate dismissal. Any failure to disclose any pre-existing medical condition will be grounds to exclude claims for any illness/injury and other benefits to which I might otherwise be entitled. The details of my medical examination may be released to my own doctor and also the results may be communicated to the personnel department of the company/UK Club for whom this examination is carried out. I hereby authorize the release of all my previous medical records from any health professionals, health institutions and public authorities to this Examining Physician.

______________________
Signed: (Applicant)

___________________________
Examining Physician Date
DD MM YYYY

Page 8 Appendix (7) to Medical Management and Disease Prevention Manual, Rev. 4 (E) 26 March 2009

EMPLOYMENT PHYSICAL EXAMINATION

To be completed by the Examining Physician.

Height (cm)

Weight (kg)

BMI (kg/m2) Pulse

Rate

Rhythm Blood Pressure

Systolic

Diastolic

Vision Unaided Aided

Distance (Snellen chart) R 6/ R 6/ L 6/ L 6/ Both 6/ Both 6/

Audiogram Khz dB 500 1,000

right ear 2,000 4,000 6,000 8,000

Near (Sloan letters) Unaided Aided R N R N L N L N Both N Both N

Khz dB 500 1,000

left ear 2,000 4,000 6,000 8,000

Ishihara

Normal/Abnormal

Visual fields

Normal/Abnormal Glucose Protein

Blood Lung Function

PEFR

FEV1

FVC

Urinalysis (+/-)

Systems examination
Normal/Abnormal (give detail) General appearance Eyes, pupils External Ocular Movements Opthalmoscopy Ear, inc Tympanic Membrane Nose Throat Mouth, Teeth, speech Breast examination Chest and lungs Heart Vascular (inc. pedal pulses) Varicose veins Abdomen, inc Hernial orifices Genito-urinary(Not Pelvic Exam) Anus, (Not Rectal Exam) Musculo-skeletal Spine Cervical, thoracic and lumbar CNS inc general neuro exam Lymphatic system Skin Mental capacity Normal/Abnormal (give detail)

Page 9 Appendix (7) to Medical Management and Disease Prevention Manual, Rev. 4 (E) 26 March 2009

Test Results* See guidelines for requirements for each test Chest X-Ray (on initial employment and every
subsequent physical)

State whether applicable, Positive/Negative, Normal, or if abnormal give details

Electrocardiogram (only for individuals age 50

and above unless extenuating circumstances require it).

Full Blood Count Urea, electrolytes, Creatinine, Glucose, LFTs Hepatitis A Hepatitis B HBsAg, if positive other markers to establish infectivity Hepatitis C anti HCV Syphilis serology VDRL/RPR Other: Other: *Examining physician to attach lab test reports and x-ray reports separately. Based on the examination results above, I find this individual to be (circle one): Fit / Temporarily unfit / Permanently unfit

Name of Doctor:

Signature of Doctor:

Date of Examination:

DD MM YYYY

Name of examining Clinic/Hospital: Clinic Stamp:

The original of pages 6 to 12 should be given to the seafarer, a copy kept by the Examining Physician, and a copy sent to ICMA.

Page 10 Appendix (7) to Medical Management and Disease Prevention Manual, Rev. 4 (E) 26 March 2009

Self-declaration Back and Spine

Name: It is mandatory for all applicants to complete this form. False statements may lead to termination of employment. D.O.B. Yes No

Have you ever suffered from back pain in the past? (Circle one) If yes, 1. 2. When? (List year. If more than once, list all years)

What symptoms and signs did you have? (Please circle appropriate response) a. Pain all over? b. Low or high back pain? c. Pain also when resting? d. Pain radiating to buttocks, legs or arms? e. Other (please specify) What kind of investigations did you go through: (Please circle appropriate response) a. Examination by general practitioner or seamans doctor. If yes, who? Name, Address and Date of exam b. Examination by specialist? If yes, what type of specialist? Name, Address and Date of exam c. Examination by other health professionals If yes, please indicate type (chiropractor, physiotherapist, masseur, other) d. X-rays of back/spine e. Ultra sound/sonogram, Bone Scan, MRI or CT If yes, Type of exam? Name, Address and Date of exam Yes Yes Yes Yes No No No No

3.

Yes Yes

No No

Yes

No

Yes Yes

No No

4. 5.

What was the diagnosis (i.e. what were you told was wrong with your back?) What do you think was the cause: a. Overwork / Over-exertion? b. Acute injury? Did you receive any kind of treatment? If Yes, what kind of treatment? a. Medicine No Yes b. Massage c. Physiotherapy e. Chiropractic f. Surgery No No No No Yes Yes Yes Yes If yes. What type and how long? If yes. What type and how long? If yes. What type? Yes Yes No No c. Infection? d. Other Yes Yes No No

6.

If yes. What type and how long?

7.

Did your back pain lead to: a. Sick leave from work b. Medical Sign-Off No Yes If yes, how long? c. Disability pay No Yes If yes, where? When? How are you now? (Check one) Fully recovered Recovered, but must be careful with certain types of action State types: Still suffer from back pain (Describe)

8.

Name (print)

Signature

Date

Page 11 Appendix (7) to Medical Management and Disease Prevention Manual, Rev. 4 (E) 26 March 2009

INFECTIOUS DISEASE IMMUNITY VERIFICATION

To be completed by crew member:

Last name: First name:

_______________________________ _______________________________

Date of Birth: _______________________________

DD MM YYYY

IMPORTANT NOTE FOR COMPLETING THIS FORM: LIST THE DISEASE IMMUNITY BY PROVIDING THE DATES OF: THE DATES THAT YOU EXPERIENCED THE DISEASE (Varicella ONLY) or THE DATES THAT YOU WERE IMMUNIZED (VACCINATED) or THE DATES OF POSITIVE IMMUNITY BY TITER If you have been immunized or have positive immunity by Titer, you must present immunization records or titer results to the physician conducting your exam for verification. PREVIOUS IMMUNIZATION OR POSITIVE TITER IS ACCEPTABLE PROOF OF DISEASE IMMUNITY. A PAST HISTORY OF DISEASE IS ACCEPTABLE ONLY FOR VARICELLA. MUMPS, MEASLES & RUBELLA IMMUNITY VERIFICATION IS REQUIRED FOR ALL CREW! Immunization Date: or or or
DD MM YYYY DD MM YYYY DD MM YYYY DD MM YYYY DD MM YYYY

Disease Date: Mumps Measles Rubella Varicella (Chicken Pox)

Positive Disease Titer: or or or or

DD MM YYYY DD MM YYYY DD MM YYYY DD MM YYYY

Record Verified
(To be completed by Physician. Check as appropriate))

Y Y Y Y

N N N N

or

Signature of Completion and Accuracy: ` I certify that the above named person has presented me with records which indicate active immunity against each of the diseases above:

______________________ Name of Clinic or Physician (Official Stamp)

_______________________ Signature of Physician

_________________ Date DD MM YYYY

All employees reporting onboard must provide proof of vaccination against Rubella and Varicella. If proof cannot be provided, the crew member will be required to be vaccinated onboard against these diseases. If the crew member refuses to be vaccinated onboard, he/she will be sent home at their own expense and not rehired!

Page 12 Appendix (7) to Medical Management and Disease Prevention Manual, Rev. 4 (E) 26 March 2009