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Joining Instructions for STCW BST/BSTR
Thank you very much for applying to Nippon Survival Training Center (NSTC)
Please read this Joining Instructions carefully before joining the training.
◆ Registration
The training activities may include physically demanding and potentially stressful elements.
Please fill out the “Statement of Physical Fitness” and “Health self-declaration form and consentform”, submit the PDF data via email at least 15 days before the training in order to ensure yourgood health. (There is no need to submit the original. Please keep it until the end of the training.)*Note 1：If the procedure cannot be confirmed by 15 days before the start of training, according
to our cancellation policy, the training will be canceled and a cancellation fee will be charged.
*Note 2: Please keep yourself in good health for the training day. Also, drugs and alcohol areprohibited.
*Note 3: Please be sure to contact us if there are any changes to your declared health status(injury or illness) after submitting the documents.

◆ What to Bring
・Photo ID(My number card, Passport, Driver’s license ,Mariner’s pocket ledger, residence card, etc.)※Non-Japanese: passport only・Note pad & pen
Swimwear（For those participating in pool training） and eyeglasses and contact lens care set(contact lens solution and case, etc.).
・Motion sickness medicine if you experience seasickness (for lifeboat training)◆ Clothes, belongings
・Delegates are required to wear comfortable and suitable clothing for the training.
・Short pants, skirts, sleeveless tops, sandals and beach sandals are not allowed due tosafety concerns
・For your safety, accessories are not allowed during the training.
・For your safety, please remove your contact lenses before participating in training at the pooldue to the loss and/or the possibility of infection.
(Please bring your glasses so that you’ll be able to have clear visibility for pool-side explanation.)◆Provided
・Personal Protective Equipment (Helmet, gloves, etc.), shower towels, coveralls, boots, etc.
・Lunch (Provided a lunch box )・Refreshments such as water, tea, coffee, etc.

◆Registration

Please arrive at the center floor of the Nippon Suisan Building on the 4th floor at least 10 minutes
before the reception time listed on the timetable.
If there is any chance that you’ll be late, please call 093-884-2020.
* The registration room will be opened 30 minutes before the start.

◆Late Arrival Policy

A certificate of completion may not be issued to those who arrive late.

・NSTC will provide transportation to the firefighting training facility, but you will be asked to take a taxi
to the facility if you miss the departure time. Please note that you will be responsible for the actual
transportation cost in that case.

◆Use of parking lot

A parking permit is required to use the parking lot.
For parking lot usage, please email [delegate name] [training name] [training date] [carmodel/number] and let us know in advance.
*If you are using a rental car, [car model/number] is not required, but please write [rental car].

◆Training cancellation

Training may be canceled due to natural disasters (including infectious diseases).
In that case, the cancellation of the training will be announced on the news on the NSTC website by
7:00 a.m. on the day of the training.
If you determine that holding the training on that day is in doubt, please check the website on themorning of the training day
For those who have not completed the training due to the above reasons, please reschedule thetraining at a later date planned by NSTC. If you are unable to make up the course, we will refund thecourse fee. However, expenses other than the tuition fee (travel expenses, accommodation expenses,etc.) will not be refunded.
（Website Ｎｅｗｓ Article QR code）

◆Contentｓ of Training

The training includes the following content, make sure you are in a suitable state of health to participate
in the training.
訓 練 内 容Proficiency in

During offshore survival training, delegates will train

Personal

in a heated pool while wearing life vests andSurvival

immersion suits. The training includes entering theTechniqueswater from a height of about 1 meter, righting he life
raft, getting on the life raft, ensuring buoyancy without

STCW
BST

STCW
Refresher○○a life jacket, and responding to drifting underwater.
Delegates participate in the embarkation of a lifeboat
quay-side at our Lifeboat Facility. The lifeboat is anenclosed space.

EmergencyDelegatesFirst Aidresuscitation on a training mannequin and the use ofwill

betrainedincardiopulmonary○an AED.
FireDelegates will extinguish small to medium-sized

Prevention

training flames using a variety of portable fire

andextinguishers and hoses and nozzles. The maximum

Fire Fighting

weight of portable fire extinguishing equipment isapproximately 21 kg. The rescue training includes
extinguishing fires in the dark using self-contained
breathing apparatus and rescue (transportation)using on a training mannequin○○◆Directions
Address：Nippon Suisan Bldg. 4F, 2-6-27Ginza, Tobata-ku, Kitakyushu-shi, Fukuoka-ken, Japan
804-0076 (approx.10 minute walk from JR Tobata Station, North Exit)
TEL：093-884-2020（8：00～17：00weekdays） Mail: book@n-s-t-c.com

◆Handling of personal information
Nippon Survival Training Center (NSTC) will handle and protect the personal information of those who
apply training as follows. Please agree before applying.

1. Purpose of use of personal information
Name, address, telephone number, gender, and other personal information provided by the customer(hereinafter referred to as "Personal Information, etc.") will be used for the purpose of providing
training, and will not be used beyond the scope of the purpose without the customer's consent.

2. Regarding provision of personal information to third parties
We will provide personal information, etc. to the following third parties. The third party will use thepersonal information within the scope of the purpose.
・Training certification body・Insurance company
・Customer's affiliated company
・Medical institution (in case of emergency)

3. Regarding disclosure of personal information, etc.
If we receive a request to disclose, change, or delete personal information, etc., we will respondpromptly after confirming the identity of the customer

Ｄｅｌｅｇａｔe‘ｓ form
Statement of Physical Fitness
Delegate’s information
Course Title
Course date

20

YM

D～M

DCompany nameNameGender

Date of BirthY

Heightcm

Phone―M

D

Blood type

Weight―Shoes

WINDA ID(10digits）
NO

YES

F

A ・ B ・ O ・ AB ・ unknown

Kg

質問Mcm

※GWO delegate only

If 「ＹＥＳ」 in detail

Have had epilepsy, seizures, fainting, or “black out”
Have experienced chest pain
Feeling uncomfortable in your spine or joints(dislocation, knee pain, lower back pain, etc.)
Assigned to light work due to health condition
Have allergies to medicines, foods, etc.
Wearing glasses or contact lenses☐glasses☐contacts

Your ears become sensitive underwater. Or if you haveever had an abnormality in your ears while underwater.
Fear of heights, enclosed spaces, and water☐ heights ☐ closed spaces☐ Water

Not very good at swimming☐ can't swim

Have physical or mental symptoms other than those asked
above that may affect your ability to participate in training.
Have concerns about joining the training.
Indicate if you have been hospitalized or had any surgical treatment within the past 12 months.

Previous medical history

Current medical history※If you are taking medication, enter the name of the medication.

Health self-declaration form and consent form
The following conditions may pose a life-threatening risk to participating in training:
Asthma and other respiratory diseases
Epilepsy, fainting, and other similar conditions
Angina pectoris and other heart diseases
Dizziness and other inner ear disturbances (difficulty of equilibrium, etc.)
Claustrophobia, acrophobia (Fear of closed spaces and/or High Places)
Blood pressure disorders
Diabetes
Pacemaker or implantable defibrillator
Arthritis, osteoarthritis, and other muscular and bone disorders that limit movement
History of allergies (e.g. stings or bites by bees, wasps, spiders, etc.)
Under surgical intervention/Hospitalization now or recently
Other health conditions that may be affected by physical stresses due to climbing
I understand that the above conditions are health conditions which may pose life-threatening risks
during training and declare here that I am of a healthy body and that I can participate in the training at
my own risk. Our center will not be liable for any illnesses incurred during or after training.

Please check（Check☐☐☐☐）and sign after confirming the following items.

Please be sure to read the Joining Instructions before attending the training.
I have read the Joining Instructions and agree to the handling of personal information andcancellation of the training.
I agree that if I do not participate in the practical part of this training by my own choice, thecertificate of completion of the training will not be awarded.
If I have any doubts about my health condition during the training course, I agree to stop
training and seek medical advice. ＊We may refuse your participation in some cases.
I agree to follow the instructions of the instructor during the training period and not tointerfere with the progress of the training.

☐For your safety, keep nails cut short. If you have long nails, remove them before coming.

☐Accessories must be removed during the practical . Wearing accessories is not permitted.

Note1：If your health status has changed since the time of submission, please contact us immediately.
Please note that depending on the situation, it may be cancelled.
Note2：The training includes some activities that involve contact or physical close contact closenessbetween staff and delegates.

Date：

20 Y YM

DSignature