Translation: Only the Danish document has legal validity.
Order no. 1463 of 12 of December 2023
issued by the Danish Maritime Authority

Order on medical examinations of seafarers andfishermen1)

Pursuant to Sections 4(3), 70 and 75a of the Act on Seafarers' Employment Conditions,etc, cf. Consolidation Act no. 1662 of 17 December 2018, and Section 19(1)(3) and (4) of
the Act on the Crew of Ships, cf. Consolidation Act no. 74 of 17 January 2014, shall be

determined by authorisation pursuant to Section 1(1)(6) of Executive Order no. 261 of 23

March 2020 on the transfer of certain powers to the Danish Maritime Authority and on theright of appeal, etc, and after consultation with the shipowners' and seafarers'organisations:

Chapter 1
Scope

Section 1.The Executive Order applies to employees on board ships, cf. Section 1(1) andSection 49 of the Danish Seafarers' Employment Conditions, etc, except for employees on
cargo ships with a gross tonnage of less than 20, which are only used in traffic within
Danish ports, rivers, lakes or similar protected waters, and secondary commercial
fishermen.

Subsection 2. In cases where there is doubt as to whether the person in question is to be

regarded as an employee on board and thus covered by this Executive Order, the question

Translation: Only the Danish document has legal validity.
Order no. 1463 of 12 of December 2023
issued by the Danish Maritime Authority

shall be decided by the Danish Maritime Authority after prior consultation with theorganisations of shipowners and seafarers to which the question relates.

Subsection 3. This Executive Order shall also apply to the owner of the ship if they are on

duty on the ship.

Section 2. The Executive Order also applies to persons who must have a valid healthcertificate in connection with

1) Acquisition or renewal of a certificate of competency under the Danish Ship's Crew Act,

2) Admission as a student on an approved programme covered by the Maritime Education
Act, or3) Completion of training as a smoke diver as part of a training programme approved by
the Danish Maritime Authority.

Chapter 2

Health certificate requirements
Section 3. Employees serving on a ship must have a valid health certificate.

Subsection 2. Health certificates shall be issued to persons who have undergone medical

examination in accordance with the provisions of this Executive Order and have beenfound fit for service on board ship, possibly with restrictions, cf. Sections 6 and 9.

Subsection 3. Health certificates issued by a foreign authority that has implemented theInternational Convention on Standards of Training, Certification and Watchkeeping for
Seafarers (STCW Convention) and in accordance with the relevant provisions of theTranslation: Only the Danish document has legal validity.
Order no. 1463 of 12 of December 2023
issued by the Danish Maritime Authority

Maritime Labour Convention (MLC) are equivalent to health certificates issued inaccordance with this Executive Order.

Subsection 4. If there is documentation of a medical examination performed by a doctor

approved by the Danish Defence Medical Command who approves a conscript or otherdefence personnel on contract for service at sea, the Danish Maritime Authority may, after
a specific assessment, issue a health certificate to the person examined.

Subsection 5. The rule in Subsection 1 shall also apply to the owner of the ship if they areon duty on the ship.

Section 4. The purpose of the medical examination is to ensure the health of theindividual seafarer and fisherman and the safety of the ship.

Subsection 2. In the event of changes in the individual seafarer's or fisherman's state ofhealth, where it must be considered doubtful whether the person in question is still

suitable for their work on board or whether they are still fit for lookout duties, the person
must contact the Danish Maritime Authority in order to undergo a new medical
examination.

Chapter 3

The medical examination
Section 5. The medical examination shall be carried out by a ship's doctor authorised by

the Danish Maritime Authority, cf. Sections 12, 13, 14 and 15.

Subsection 2. The medical examination may also be carried out by a duly qualified doctor

in Greenland.

Translation: Only the Danish document has legal validity.
Order no. 1463 of 12 of December 2023
issued by the Danish Maritime Authority

Subsection 3. Persons who are to undergo a medical examination shall choose the ship's

doctor who is to carry out the examination, subject to Section 19(6).

Section 6. At the medical examination, the ship's doctor shall make an assessment of

whether the physical and mental condition of the person examined is generally such thatthe person in question is fit for service on board ship, possibly with restrictions, cf. Section
9.

Subsection 2. The doctor must use the medical certificate specified by the Danish

Maritime Authority on the Authority's website www.dma.dk.

Subsection 3. In their assessment, the ship's doctor shall consider

1) Whether the disease or condition carries an increased risk of acute complications

which cannot be treated by a layman on board a ship and which may therefore pose asignificant risk to the person concerned,

2) Whether an acute illness of the examined person poses a risk to the safety of the ship orplaces other crew members in an unnecessarily difficult situation; and

3) Whether the disease or condition means that the person examined would havedifficulty coping with an emergency situation on board.

Subsection 4. In assessing first-time discharges, the ship's doctor must consider whether

the disease or condition can be expected to worsen during the examined person's working
life.

Section 7. In connection with the examination, the ship's doctor shall use theappendices to this Executive Order.

Translation: Only the Danish document has legal validity.
Order no. 1463 of 12 of December 2023
issued by the Danish Maritime Authority

Section 8. The ship's doctor may obtain relevant information about the examinee,

including information on any medication consumption and any medical history, when it isdeemed necessary in connection with the performance of the medical examination andwith the express consent of the examinee, based on a specific, objective, medical

professional assessment. The ship's doctor must document why obtaining the above
information is deemed necessary.

Subsection 2. The ship's doctor shall include Appendix 4 in their assessment if theseafarer has a BMI above 40.

Section 9. In their assessment, the ship's doctor may limit the examinee's fitness forship service in relation to:1) Period of validity of the health certificate.
2) Workspace on board.

3) Trading limits, see Subsection 2.

Subsection 2. Appendix 5 lists the trading limit restrictions that should normally beapplied.

Subsection 3. When limitations in a trading limit are stated in a health certificate, theymust always be a geographical limitation of the health certificate, e.g. to an area, route orwaterway. The restriction must not specify a particular shipping company, employer orsimilar.

Subsection 4. The examinee's health information must not be included in any restriction.

Translation: Only the Danish document has legal validity.
Order no. 1463 of 12 of December 2023
issued by the Danish Maritime Authority

Section 10. The ship's doctor must report the result of the medical examination to theDanish Maritime Authority using the Danish Maritime Authority's digital reporting system,without disclosing health information.

Section 11. The ship's doctor shall document the examination, including noting theindividual measurements, judgements and objective reasons for their assessment.

Subsection 2. If, in their assessment, the ship's doctor deviates from the requirements

laid down in the appendices to the Executive Order, this must be stated in the
documentation in accordance with Subsection 1.

Subsection 3. The Danish Maritime Authority may, following a statement from a medical

specialist in eye diseases or ear, nose and throat diseases who assesses a specific seafarer'svisual and hearing ability, deviate from Annexes 1 and 2 of the Executive Order. On thisbasis, the Danish Maritime Authority can issue a new health certificate.
Chapter 4

Ship's doctors
Section 12. The Danish Maritime Authority approves ship's doctors upon application.

The Danish Maritime Authority continuously assesses the need to authorise new ship's
doctor so that access to a local ship's doctor throughout the country is ensured in asatisfactory manner as far as possible.

Subsection 2. It is a prerequisite for approval as a ship's doctor that the doctor holds anauthorisation in accordance with Chapter 8 of the Act on Authorisation of HealthcareTranslation: Only the Danish document has legal validity.
Order no. 1463 of 12 of December 2023
issued by the Danish Maritime Authority

Professionals and Healthcare Activities. A ship's doctor who loses or terminates thisauthorisation shall cease to act as a ship's doctor.

Section 13. In order to be approved as a ship's doctor, the doctor must undergo aqualification programme with a ship's doctor approved by the Danish Maritime Authority.
The programme is carried out as peer-to-peer training and consists of participation in atleast ten medical examinations in accordance with this Executive Order within a maximum
period of one year.

Section 14. Danish Maritime Authority supervises the authorised ship's doctors. The

Danish Maritime Authority may withdraw the authorisation of a ship's doctor in the eventof1) Dereliction of duty,2) Lack of impartiality,

3) Fewer than ten annual examinations,
4) Abusive behaviour; or

5) Repeated negligence in the performance of medical examinations pursuant to thisExecutive Order.

Subsection 2. Withdrawal of authorisation pursuant to Subsection 1 may, depending on

the circumstances, be made without prior consultation.

Section 15. If a doctor's authorisation to act as a ship's doctor is withdrawn, certificatesalready issued shall continue to be valid, subject to Section 19.

Translation: Only the Danish document has legal validity.
Order no. 1463 of 12 of December 2023
issued by the Danish Maritime Authority

Section 16. Ship's doctors and doctors in Greenland who carry out medical

examinations under this Executive Order shall be professionally independent in theexercise of their medical judgement when carrying out medical examinations under thisExecutive Order.

Chapter 5

Frequency of medical examinations
Section 17. Persons under 18 years of age shall at intervals of no more than one year beassessed by medical examination as fit for ship service, or fit with restrictions, cf. Sections
6 and 9.

Subsection 2. Persons aged 18 years or over shall, at intervals of not more than two

years, be assessed by medical examination as fit for ship service, or fit with restrictions, cf.
Sections 6 and 9.

Section 18. If a person has been assessed as unfit for ship service or fit with restrictions,a new medical examination under this Executive Order may only be carried out if theDanish Maritime Authority authorises it, subject to Subsection 4.

Subsection 2. The Danish Maritime Authority may grant the authorisation specified in

Subsection 1

1) When there is documentation that there has been a change in the person's state ofhealth, or2) When there are special circumstances which mean that a new medical examination
should be carried out.

Translation: Only the Danish document has legal validity.
Order no. 1463 of 12 of December 2023
issued by the Danish Maritime Authority

Subsection 3. The Danish Maritime Authority may also authorise a person who is deemed

unfit for ship service or fit with restrictions to obtain a specialist medical certificate. The

certificate is obtained for further clarification of the significance of a diagnosed illness orcondition for the person's fitness for ship service.

Subsection 4. Authorisation from the Danish Maritime Authority under Subsection 1 is

not necessary1) If more than two years have passed since the last medical examination, or2) If a person has been assessed fit with limitations at the last medical examination andthe validity period of their health certificate will expire within six months at the time of
the new medical examination.

Section 19. The Danish Maritime Authority may decide that a person who holds a valid

health certificate shall undergo a new medical examination or that a person's healthcertificate shall be cancelled when, on the basis of available information, it must be

considered doubtful whether the person in question is still suitable for their work on
board or whether they are still fit for lookout duties.

Subsection 2. When circumstances so require, the Danish Maritime Authority may decidethat a person may not serve on board when a new medical examination is required under
Subsection 1.

Subsection 3. If the person concerned is serving on board at the time when a new

medical examination is required under Subsection 1, the Danish Maritime Authority may
require the person concerned to be signed off or that the examination be carried out

within a specified period. If the Danish Maritime Authority requires the person concerned

Translation: Only the Danish document has legal validity.
Order no. 1463 of 12 of December 2023
issued by the Danish Maritime Authority

to be signed off, the Authority will pay the costs of free travel with subsistence to theperson's place of residence.

Subsection 4. If a person has previously been declared unfit for work on board ship, theDanish Maritime Authority may - irrespective of the result of the latest available medical

certificate - decide that the person in question shall be discharged at the first port the shipcalls at and from which the return journey can conveniently take place.

Subsection 5. The person concerned may not serve on board a ship after the deadline

notified in accordance with Subsection 3 unless it has been established by medical
examination that the person concerned is still fit for their area of work.

Subsection 6. The Danish Maritime Authority may instruct a ship's doctor to carry out a

new medical examination under Subsection 1.

Chapter 6

Health certificate content
Section 20. The form and content of the health certificate shall be determined by theDanish Maritime Authority.

Subsection 2. The health certificate is issued by automatic data processing based on the

result of the medical examination.

Subsection 3. Copies of lost or illegible health certificates may only be issued by theDanish Maritime Authority.

Translation: Only the Danish document has legal validity.
Order no. 1463 of 12 of December 2023
issued by the Danish Maritime Authority

Subsection 4. Health certificates issued on the basis of a medical examination carried out

in Greenland, cf. Section 5(2), shall be issued or endorsed by the master in accordance withthe medical certificate.

Section 21. The employee who takes up duty on a ship shall make their medical

certificate available to the master for the duration of their duty on board.

Subsection 2. The master shall provide health certificates if requested by the Danish

Maritime Authority.

Subsection 3. Persons who are in possession of a health certificate must submit

documentation if requested by the Danish Maritime Authority.

Section 22. If the period of validity of the health certificate expires during a voyage, thehealth certificate shall remain valid until the first call at a port where a medical
examination can take place without undue delay, subject to Subsection 2.

Subsection 2. However, the health certificate shall not remain valid for longer than threemonths after the expiry of the period of validity.

Chapter 7
AppealSection 23. The person examined, the shipping company or the Danish Maritime

Authority may appeal the result of a medical examination under Sections 6 and 9 to theDanish Shipping Appeals Board.

Translation: Only the Danish document has legal validity.
Order no. 1463 of 12 of December 2023
issued by the Danish Maritime Authority

Subsection 2. The Danish Shipping Appeals Board may decide that the seafarer is unfit,

wholly or partially fit with limitations, or that the limitations of the health certificate

pursuant to Section 9 shall be changed. The Danish Maritime Authority can issue a newhealth certificate if the Danish Shipping Appeals Board has made a decision on the fitness
or limitations of the health certificate.

Subsection 3. The Danish Shipping Appeals Board may decide that a seafarer shallundergo a new medical examination in accordance with Section 19(1) of this Executive
Order.

Subsection 4. Complaints about decisions made pursuant to Section 11(3) may not be

appealed to a higher authority.

Section 24. The ship's doctor is in all cases subject to the general complaint rules, cf. theDanish Act on Access to Complaints and Compensation within the Health Service. The ruleson possible withdrawal of authorisation, which are set out in the Danish Act on

Authorisation of Healthcare Professionals and Healthcare Activities, are enforced by theDanish Patient Safety Authority.

Section 25. Appeals about the content of the medical examination, payment for the

medical examination or non-compliance with Section 5(3) and the points listed in Section
14 may be brought before the Danish Maritime Authority.

Section 26. The examined party or the shipping company may appeal a decision madeunder Section 19(1) to the Danish Shipping Appeals Board.

Translation: Only the Danish document has legal validity.
Order no. 1463 of 12 of December 2023
issued by the Danish Maritime Authority

Section 27. The decisions of the Danish Shipping Appeals Board cannot be appealed toany other administrative authority.

Section 28. The Danish Maritime Authority's decision on approval of a ship's doctor

under Section 12(1) and on withdrawal of approval as a ship's doctor under Section 14(1)cannot be appealed to a higher administrative authority.

Section 29. Appeals to the Danish Shipping Appeals Board must be submitted in writing

to Nævnenes Hus, Toldboden 2, DK-8800 Viborg.

Subsection 2. The appeal period for decisions mentioned in Sections 23 and 26 is eightweeks. The Danish Shipping Appeals Board may waive the deadline if there are special
reasons for doing so.

Chapter 8General provisions
Section 30. Persons who use glasses, contact lenses, hearing aids or other aids to fulfil

the requirements set out in this Executive Order or the appendices must use the aid during
work and must at all times during ship service be in possession of an additional aid.

Section 31. Persons who are examined pursuant to this Executive Order must be able topresent photo identification if requested.

Chapter 9

Payment of medical examinations

Translation: Only the Danish document has legal validity.
Order no. 1463 of 12 of December 2023
issued by the Danish Maritime Authority

Section 32. Medical examinations and the Chester Step Test as listed in Appendix 4 inaccordance with this Executive Order shall be paid by the company, subject to Subsections
2, 4 and 5.

Subsection 2. If the person examined does not have a shipping company at the time of

the medical examination, the first shipping company that employs the person concerned ina position for which a valid health certificate is required shall reimburse the costs of the
medical examination, provided that the person examined can document the payment.

Subsection 3. Medical examinations, including the Chester Step Test, of maritime trainees

who have entered into a training agreement with an approved shipping company shall be
paid for by the shipping company in question.

Subsection 4. The Danish Maritime Authority shall pay for medical examinations,

including the Chester Step Test, which the Authority has required pursuant to Section
19(1), and for medical examinations of students on approved maritime education

programmes other than those mentioned in Subsection 3, where it is required as part ofthe education that the student has an approved health certificate.

Subsection 5. Payment for a medical examination under Subsection 4 requires that whenreporting a health certificate, it is stated that the seafarer is a student and that the Danish
Maritime Authority covers the costs of this examination.

Subsection 6. The Danish Maritime Authority may pay expenses for examinations carriedout by a specialist in eye diseases in accordance with Section 19(3).

Subsection 7. The Danish Maritime Authority may pay expenses for specialist

consultations under Section 11(3).

Translation: Only the Danish document has legal validity.
Order no. 1463 of 12 of December 2023
issued by the Danish Maritime Authority

Subsection 8. The Danish Shipping Appeals Board pays for medical examinations,

including necessary physical tests, which the Appeals Board has requested in connection
with Appeals Board proceedings and decisions.

Section 33. Students on approved maritime education programmes as mentioned in

Section 32(4) and (5), shall document to the ship's doctor that they have been admitted toan approved maritime education programme on condition that they obtain a healthcertificate that meets the admission requirements.

Section 34. Where the medical examination under Section 32(1) and (3) is to be paid forby a shipping company, the ship's doctor shall collect their fee from the person examined,
who shall be entitled to have the fee reimbursed by the shipping company.

Section 35. The ship's doctor shall receive a fee for examinations paid by the Danish

Maritime Authority in accordance with section 32(5) when the results of the examination
have been received by the Danish Maritime Authority.

Section 36. The fee for medical examinations carried out under this Executive Ordershall be determined by negotiation between the Danish Maritime Authority and theAttestation Committee of the General Danish Medical Association.
Chapter 10

Responsibilities of the ship's master
Section 37. The master shall be responsible for ensuring that the provisions of Section

5(2), Section 19(4) and (5) and Section 21(1) and (2) are complied with.

Translation: Only the Danish document has legal validity.
Order no. 1463 of 12 of December 2023
issued by the Danish Maritime Authority

Chapter 11

Penalty provisions
Section 38. Violation of Section 3(1) and (5), Section 21(3), Section 32(1)-(3) andSection 37 is punishable by a fine.

Subsection 2. Criminal liability may be imposed on companies, etc., (legal persons) inaccordance with the rules in Chapter 5 of the Danish Criminal Code.

Subsection 3. For the purpose of imposing criminal liability under Subsection 2, persons

employed to perform work on board the ship by persons other than the shipowner shallalso be deemed to be associated with the shipowner. Where a document of complianceunder the Safety Management Code or a certificate under the Seafarers' Employment

Convention has been issued to another organisation or person, the master and seafarers
shall also be deemed to be associated with the person to whom the document has been
issued.

Chapter 12

Entry into force and transitional provisions
Section 14. This Executive Order shall enter into force on 1 January 2024.

Subsection 2. Executive Order no. 933 of 23 June 2020 on medical examination ofseafarers and fishermen is repealed.

Section 40. Health certificates issued in accordance with the hitherto applicable rules

shall retain their validity with the conditions stated in the certificate.

Translation: Only the Danish document has legal validity.
Order no. 1463 of 12 of December 2023
issued by the Danish Maritime Authority

Section 41. The ship's doctors authorised under the hitherto applicable rules shallretain their authorisation to carry out medical examinations of seafarers and fishermen.
Section 42. The Order shall not apply to Greenland.

The Danish Maritime Authority, 5 December 2023
Rasmus Høy Thomsen/ Kristina Ravn

Translation: Only the Danish document has legal validity.
Order no. 1463 of 12 of December 2023
issued by the Danish Maritime Authority

Appendix 1
Vision requirements
Category of Distance Near/mid distance vision Visual
Colour Fields of Night
seafarers
vision withwithout vision 3vision 4 blindness 4
correction
correction

Diplopia (double vision) 4

1

Best Worst Binocular, with oreye eye without correction
Masters, deck 0.52 0.5
officers andratings withlookout duties

Sight required to navigate 0.1
the vessel (e.g. reference
to charts and nautical
publications, use of
instruments/equipment on
the bridge andidentification ofnavigational aids)

See
Normal Vision required Only in exceptional cases
note 6 fields of to perform all where all necessary functions
visionnecessarycan be performed without
functions in the compromising security
dark withoutcompromisingsafetyAll engine.45 .45
officers,
electrotechnicalofficers,
electrotechnicalratings andratings orothers who
are on duty inthe engine
room
GMDSS radio0.4 0.4
operators

Vision required to read 0.1
instruments at close range,
to operate equipment andto identify
systems/components, as
neededSee
Adequate Vision required Only in exceptional cases
note 7 fields of to perform all where all necessary functions
visionnecessarycan be performed without
functions in the compromising security
dark withoutcompromisingsafetyVision required to read 0.1
instruments at close range,
to operate equipment andto identify
systems/components, as
neededSee
Adequate Vision required Only in exceptional cases
note 7 fields of to perform all where all necessary functions
visionnecessarycan be performed without
functions in the compromising security
dark withoutcompromisingsafetyTranslation: Only the Danish document has legal validity.
Order no. 1463 of 12 of December 2023
issued by the Danish Maritime Authority

Notes:

Values are given in Snellen decimal notation.

A minimum of 0.7 is recommended in one eye to reduce the risk of undetected underlying
eye disease.

As defined in the "International Recommendation for Colour Vision Requirements forTransport" by the Commission Internationale de l'Eclairage (CIE-143-2001), including any
subsequent editions.

Subject to assessment by a clinical vision specialist where the results of the initial
examination indicate this.

Personnel in the machine department must have a minimum of 0.4 visual acuity.
CIE colour vision requirements 1 or 2.

CIE colour vision requirements 1, 2 or 3.

Appendix 2
Hearing requirements
Hearing tests
The hearing ability of seafarers and fishermen - with the exception of the seafarers

mentioned below - should average at least 30 dB (without hearing aids) in the better ear
and 40 dB (without hearing aids) in the less good ear within the frequencies 500, 1.000,

Translation: Only the Danish document has legal validity.
Order no. 1463 of 12 of December 2023
issued by the Danish Maritime Authority

2,000 and 3,000 Hz (which roughly corresponds to the ability to hear speech at 3 metresand 2 metres respectively).

Hearing tests using a pure-tone audiometer are recommended. Alternative assessment
methods that use validated and standardised tests to measure speech recognition

impairment are also acceptable. Speech and whisper tests can be used to make a quick
practical assessment.

Seafarers with deck or bridge duties must be able to hear whispered speech at a distanceof 4 metres.

The use of hearing aids by serving seafarers and fishermen can only be accepted if it isconfirmed that they can perform the specific routine and emergency tasks required ofthem on board in a safe and effective manner throughout the period of validity of thehealth certificate.

Appendix 3
Advice for common medical conditions
Introduction
The purpose of medical examinations is to ensure the health and safety of individualseafarers and fishermen on board. When assessing seafarers' and fishermen's fitness forTranslation: Only the Danish document has legal validity.
Order no. 1463 of 12 of December 2023
issued by the Danish Maritime Authority

service at sea, the factors set out in Section 6(2)(1)-(3) must always be taken into
consideration.

The medical examination must take into account whether the person is a first-time

seafarer 1) or a professional seafarer 2). In some cases, this is emphasised with a (NOTE).
It is not possible to create a complete list of fitness criteria that covers all medical

conditions and variations in severity, prognosis and treatment. The principles used in thetable can often be analogised to other diseases that are not mentioned.
The table of medical diseases is organised as follows:
1st column: Diagnosis code according to the "WHO International Classification of
Diseases", 10th edition (ICD-10).

Column 2: The common name of the disease or group of diseases with a brief description of
the relevance to work at sea.

Column 3: Description of diseases incompatible with seafaring work, temporary (M) or
permanent (P). This column should always be consulted first.

Column 4: Description of diseases that should lead to a health certificate with restrictions

on work area or time. This column should be consulted if the worker is not covered by thedescription in column 3.

Translation: Only the Danish document has legal validity.
Order no. 1463 of 12 of December 2023
issued by the Danish Maritime Authority

Column 5: Description of diseases that are compatible with an unrestricted healthcertificate. This column should only be consulted if the seafarer's illness is not covered bycolumns 3 and 4.

For some diseases, one or more columns are not relevant or not an appropriate healthcertificate for the disease. In such cases, "not possible" is indicated in the column.
ICD-10
code

Medi
cal
condi
tion

A00-B99
A00-09Infections
Infectious bowel
diseases
Contagious, relapsing.

A15-16

Pulmonarytuberculosis
Contagious, relapsing.

A50-64Sexually transmitted
diseases
Acute functional
impairment, relapse.

B15

Hepatitis A
Can be transmitted
through drinking waterand food.

Incompatible withreliable, safe andefficient performanceof routine andemergency tasks- expected to be
temporary (M)- expected to bepermanent (P)Able to perform
Able to perform all tasks
some, but not all,in all trade areas withintasks in some, but not the specified work area
all, trade areas (F)Increased monitoringneeded (T)M - Current symptoms
or awaiting culture
results. Carrier of
infection until it isdocumented that there is
no longer a risk ofinfection.

Not possible.

Non-catering staff: Whensatisfactorily treated or
cured.
Catering staff: Fitness
assessment depends on
individual medical
assessment. Bacteriologicaltesting may be required.

M - Positive screening
test or medical history until examined.
If infected - until
treatment is stabilised
and documented
infection-free.
P - Recurrence or severelung damage.
M - Until diagnosed,
treatment started andsymptom-free.
P - Late complications
that permanently impairfunctional ability.
M - Until liver function
is normalised.

Not possible.

Completed treatment.

F - Consider trade area
restriction if tablet
treatment has been
started and is
symptom-free.

Upon completion oftreatment.

Not possible.

Successfully treated andsymptom-free.

Translation: Only the Danish document has legal validity.
Order no. 1463 of 12 of December 2023
issued by the Danish Maritime Authority

B16-19B20-24Hepatitis B, C andmore
Transmitted throughcontact with blood orother body fluids.
Possibility of liver
damage and livercancer.
HIV positive
Transmitted throughcontact with blood orother body fluids.
Progression to HIVrelated disease or AIDS.

M - Until liver function
is normalised.
P - Persistent liver
damage with symptoms
that affect the reliable
and safe performance ofjob duties or risk ofcomplications.
M - Until stabilised andthe treatment is soeffective that the risk ofcomplications is low. If
the treatment changes
and the response to thenew medication is
uncertain.
P - Non-reversible,
functional impairing
HIV-related disease orfunctional impairing
medication side effects.
M - Until free of
infection and able toperform their duties.
P - If persistent
likelihood of relapse
with reduction infunctional ability or
disease recurrence.

A00-B99

Other infections
Functional impairment,risk of infection.

C00-D48

Cancer diseases
Malignant neoplasmsincluding lymphoma,
leukaemia and relateddiseases
Relapses, especiallyacute complications.

D50-89
D50-59Diseases of the blood and blood-forming organs
Anaemias/Haemoglobi P - Severe recurrent or
persistent anaemia or
nopathies

M - Until examined,
treated and the prognosis
is confirmed.
P - Persistent functional
impairment withsymptoms that affectsafety at sea or with ahigh probability ofrecurrence.

F, T - Uncertainty
about full recovery or
freedom from
infection. Individual
assessment based on
work tasks and tradeareas.

Successfully treated andsymptom-free.

F, T - Temporary
and/or trade area: HIV
positive and lowi
probability of
progression, without
treatment or on stable
medication without
side effects.

HIV positive, no current
functional impairment andvery lowi probability of
progression. No side effectsof treatment or need for
frequent monitoring.

Individual assessment
based on the nature of
the infection.

Successfully treated andsymptom-free, andconfirmed lowi probabilityof infection.

F - Restriction in the
trade area if persistentfunctional impairment
does not affectessential job tasks andrelapse is unlikely toresult in the need for
emergency medical
treatment.
T - Temporary to theinterval between
specialist
examinations if:- cancer is diagnosed <5 years ago, and- there is currently nofunctional impairmentthat affects the ability
to perform all duties atsea, and- there is a low
likelihood of relapse
or urgent need for
medical attention.

More than five years since
cancer diagnosis or if
specialist follow-up is nolonger required and nocurrent functional
impairment, and lowi
probability of recurrencewith functional impairment.
Must be confirmed by
specialist opinion.

F - Restriction inworkspace until

Normal haemoglobin levels.

Translation: Only the Danish document has legal validity.
Order no. 1463 of 12 of December 2023
issued by the Danish Maritime Authority

Decreased functional
ability, episodic red
blood cell depletion.

functional impairing
symptoms that cannot betreated.

D73

Splenectomy- condition M - After surgery until
without A spleen
the patient is fully
Increased susceptibility recovered.
to some infections.

D50-89Other diseases of theblood and bloodforming organs
Spontaneous bleeding,
reduced work capacity,
low resistance toinfections.
Coagulation disorderdue to anticoagulation
therapy (except
asetylsalicylic acid)
Increased risk ofspontaneous and, incase of injury, persistent
bleeding

D68

E00-90E10

M - Under investigation.
P - Chronic clotting
disorder.

M - Until examined andtreated and while shortterm anti-coagulation
therapy is ongoing.
P - Consider if recurrent
periodic treatment or if
on permanent anticoagulation therapy.

Endocrine, nutritional and metabolic diseases
M - From start ofDiabetes - insulintreatment until
treatedAcute functional
stabilised.
P - If poorly controlled,
impairment due toprevious severe
hypoglycaemia.
Complications due tohypoglycaemia, failure
inadequate blood sugar to recognise
hypoglycaemia or
control.
Increased likelihood of
without sufficienteye, nervous system and understanding of own
cardiovasculardisease. Functional
impairing diabetes
complications.
complications.
NOTE - For first-timehires, not in a position
listed in a ship's
manning determination
or in a training position
leading to such a
position. Not service on
fishing vessels.

haemoglobin is normal
and stable.
F, T - Consider a tradearea restriction andregular monitoring if
haemoglobin levels are
reduced but
asymptomatic.
F - Individual
Individual assessment.
assessment. May
likely be suitable forworking with a tradearea restriction and intemperate climates,
but may not be able towork in tropical areas.
Individual assessment. Individual assessment.

F, T - May be suitablefor work depending on
the type ofanticoagulation
treatment. Possible
restriction in domestic
trading limits once
stabilised on anticoagulation
medication withregular monitoring oftreatment levels.

Full recovery without
anticoagulation.

F, T - Documented
well-controlled
diabetes with thenecessary
understanding of own
disease and mastery ofblood glucose
monitoring. As well as
the ability to recognise
and respond to
hypoglycaemia.
Suitable for work witha limited trade areaand not on duty alone.
Temporary until thenext check-up.
Treatment must be
under regular medical
supervision. Wellregulated, no
hypoglycaemic cases

Not possible.

Translation: Only the Danish document has legal validity.
Order no. 1463 of 12 of December 2023
issued by the Danish Maritime Authority

E11-14

Diabetes - non-insulin
treated, on othermedication Progression
to insulin requirement,
increased likelihood ofeye, nervous system andcardiovascularcomplications.

Diabetes - non-insulin
treated, diet only
Progression to insulin
requirement, increased
likelihood of eye,nervous system andcardiovascularcomplications.
E65-68

Obesity or abnormal
body weight- high or
low
Risk to self, reduced
mobility, reduced work
capacity, increased
likelihood of diabetes,
cardiovascular disease
and osteoarthritis.

with impaired
consciousness in thelast two years. The
treatment should be
under
regular medical
supervision and theseafarer must have asufficientunderstanding of theirown illness and be
proficient in blood
glucose monitoring.
F - Restriction in work
area and restriction inwork area in the formof not being on duty
until stable ontreatment.
F - Restriction in a
trade area andrestriction in work
area and not on duty
alone.
T - Temporary, if lackof understanding of
own illness or if
treatment requires
frequent supervision.
F - Restriction in a
trade area andrestriction in work
area and not on duty
until stable.
T - Temporary whenstable but without
sufficientunderstanding of theirown illness.
M - If safety-critical
F, T - Temporary andtasks cannot be
trade area restriction
performed, physicalor task restriction if
capacity is significantly
not able to perform all
reduced.
tasks, but can perform
P - If safety-critical tasks routine and emergency
cannot be performed,
procedures related tophysical capacity is
the given safetysignificantly reduced
function.
and attempts to improve
the situation have failed.
Note: BMI is a usefulindicator of when to
perform physical tests.
BMI should not be thesole basis for an
unfitness decision. BMI
over 40 kg/m2 must

When stable without
functional impairing
complications.

When stable without
functional impairing
complications.

Physical functioning isaverage or better, weight isstable or decreasing, andthere is no co-morbidity.

Translation: Only the Danish document has legal validity.
Order no. 1463 of 12 of December 2023
issued by the Danish Maritime Authority

result in a specificassessment according toAppendix 4.
M - Until treatment isinitiated and stabilised
without side effects.
P - If persistentfunctional impairment,
need for frequent
medication adjustments
and increased likelihoodof serious complications.

E00-90

Other endocrine andmetabolicdiseases(diseases of the
thyroid, adrenal gland,
including Addison's
disease, pituitary gland,
ovaries, testicles)
Likelihood of relapse orcomplications.

F00-99
F10

Mental and behavioural disorders
M - Until treated andAlcohol
abuse(addiction)
fitness criteria are met.
Relapses, accidents,
To one year after
erratic/unpredictablediagnosis or one year
behaviour that threatens after a relapse.
safety.
P - If persistent or if
there is co-morbidity
with a likelihood of
exacerbation or relapse
at sea.
M - Until diagnosed,Drugtreated and fitness
addiction/persistentabuse Includes bothcriteria are met. To one
illegally acquired drugs year after diagnosis orand prescription drugs.
one year after a relapse.
Relapses, accidents,
P - If persistent or there
inappropriate
is co-morbidity withbehaviour/behaviour
likelihood ofaffecting safety.
exacerbation or relapse
at sea.

F11-19F, T - Individual
assessment based on
specialist opinion. The
likelihood offunctional impairing
complications of
illness or treatment
must be assessed,
including theconsequences ofinfection or injury atsea.

If the treatment is stable,disease control can be
infrequent, there is no
reduced ability to work, andthere is a very lowi
likelihood of complications.
Addison's disease: Due tosignificant risk ofcomplications and relapse,
unrestricted fitness is usually
not possible.

F, T - Temporary, not After three years without
as master or not master relapse. Without cowithout closemorbidity.
supervision andmedical supervision,
subject to documented
sustained abstinence.

F, T - Temporary,
restriction in work
area in the form of
non-master or nonmaster without close
supervision andmedical supervision,
provided that:- documented drugfree with a minimumof three negative,
unannounced drug
tests,- documented
successful
participation in arehabilitation
programme and- there is continuous
participation in drug
screening
programmes.

After three years with norecurrence after the last
episode and no comorbidities.

Translation: Only the Danish document has legal validity.
Order no. 1463 of 12 of December 2023
issued by the Danish Maritime Authority

F20-31

Psychosis(acute) organic, schizophrenicor other category
specified in ICD.
Bipolar (manic
depressive disorder).
Relapses that lead tochanges in perception,
cognition, accidents,
inappropriate
behaviour that threatens
safety.

F32-38

Mood/affective
disorders
Severe anxiety,depression or othermental conditions that
can affect functional
ability.
Relapses, reduced
performance, especiallyin emergencies.

Mood/affective
disordersMinor or reactive
symptoms of anxiety
and depression.
Relapses, reduced
performance, especiallyin emergencies.
F00-99Other disorders, e.g.
personality disorders,
ADHD, developmental
disorders (autism).

F, T - Temporary,trade area restriction,
restriction in work
area in the form of notmaster or not masterwithout close
supervision andmedical control
provided that:- the employee has
insight into their own
illness and- follows the treatment- has no side effects
from the medication.
F, T - Temporary,trade area restriction,
restriction in work
area in the form of notmaster or not masterwithout close
supervision andmedical control
provided that:- the employee has
insight into their own
illness and- follows the treatment- has no side effects
from the medication.
M - While acute, underF, T - Trade area
investigation, or if
restriction, restriction
functional impairingin work area in thesymptoms or side effects form of not master,of the medication. At
only master if:- good functional
least three months on
ability,stable medication.
P - Persistent or- insight into their own
recurring symptoms that illness,
affect functional ability. - follows the treatment
without side effects- probability of relapse
is lowi.
M - Until symptom-free. F, T - Temporary,
If treated withconsider a trade area
medication, then at a
restriction if on stablestable dose and without
medication dose andfunctional impairing side without functional
effects.
impairing symptoms
P - Persistent oror medication siderecurring symptoms that effects.
affect functional ability.
M - UndergoingF - If only able toassessment or testing of perform limited tasks.
medication until the final An individual risk
level of function isassessment is required
established.
(a) After a single
episode with known
triggers:
M - Until the conditionis examined and stable
and the healthrequirements are met. At
least three months after
the incident.
(b) After a single
episode with no known
triggers
or more than one
episode with or without
triggers:
M - Until the conditionis examined, stable andhealth requirements are
met. At least two years
after the last episode.
P - More than three
episodes or persistent
likelihood of relapse.
The health requirementswith or without
restrictions are not met.

Individual assessment atleast one year after theepisode, provided triggers
can always be avoided.
Individual assessment to ruleout the likelihood of relapse,
at least five years after thelast episode, no residual
symptoms and no
medication in the last two
years.

Individual assessment toeliminate the likelihood of
relapse. At least two years
relapse-free, off medicationor on stable medication
without functional impairingside effects.

Individual assessment one
year from the end of the last
episode, if symptom-free
and without medication or
on medication without
functional impairing side
effects.
No expected symptoms orside effects on board. There
have been no incidents
during previous periods atsea.

Translation: Only the Danish document has legal validity.
Order no. 1463 of 12 of December 2023
issued by the Danish Maritime Authority

P - If it is assumed tohave safety implications.
Individuals, especiallyfirst-time cancers, must
be assessed based on
their overall medical
history. Individuals withlong-term treatment
needs will generally not
be suitable for a position
listed in a ship's crew orin a training position
leading to such a
position.
Diseases of the nervous system
M - During theSingle seizure
Risk to the ship, otherassessment and one year
people on board orafter the seizure.
themselves.
Impaired attention andconcentration andreduced social skills.

G00-99G-40-41

Epilepsy - notriggering factors(multiple seizures)
Risk to the ship, otherpeople on board orthemselves.

Epilepsy triggered byalcohol, drugs, headtrauma(multiple
seizures)
Risk to the ship, otherpeople on board orthemselves.

G43

G47

Migraines(frequentattacks resulting inincapacity to work)
Likelihood of recurringfunctional impairment.
Sleep apnoea
Fatigue and episodes
where the worker falls
asleep while working.

M - During theassessment and two
years after the lastseizure. First-time onset:
Without seizure
phenomena for at least
10 years, of which atleast five years without
medical treatment
P - Recurrent seizuresthat cannot be controlledwith medication.
M - Under investigationand for two years after
the last seizure.
P - Recurrent seizuresthat cannot be controlledwith medication.

P - Frequent seizures
leading to functional
impairment.
M - Until treatment has
started and has beensuccessful for threemonths.
P - Treatment has notbeen successful or there
is poor compliance.

based on specialist
opinion.

F - One year after the
seizure and on stable
medication.
Restriction in the workarea, possibly not on
duty.
F - With seizure
phenomena within thelast 10 years, but notwithin the last two
years with or without
treatment: Absoluterejection for a position
mentioned in a ship'screw determination or
in a training position
leading to such a
position.
F - Individual
assessment after two
years with no known
triggers, seizure-free
without medication orwith medication andgood compliance;
restriction in the work
area and not on duty
and restriction in thework area.
F - If only able toperform limited tasks.

T - Documented
efficacy of treatment
for three months,
compliance with
continuous positive
airway pressure(CPAP) machine
confirmed. Semi-

One year after the seizure
and one year after the end oftreatment. If there aretriggers, these should not beable to reoccur.
No seizures in the last ten
years, no epilepsy
medication in the same 10year period and nolikelihood of new seizures.

No seizures, without
medication, for at least five
years, provided there is no
continued exposure to
triggers.

No anticipated functional
impairment at sea. No
incidents have occurred
during previous periods at
sea.
Individual assessment basedon work tasks and safetyfunctions, as well as theopinion of a specialist.

Translation: Only the Danish document has legal validity.
Order no. 1463 of 12 of December 2023
issued by the Danish Maritime Authority

Narcolepsy
Fatigue and episodes
where the worker falls
asleep at work

M - Until controlledwith treatment for atleast two years.
P - Treatment isineffective or there ispoor compliance.

G00-99Other organic nerve
disorders, e.g. multiple
sclerosis, Parkinson's
disease
Relapse/progression;
limited muscle strength,balance, coordinationand mobility.

R55

Syncope and other lossof consciousness
Relapses can lead to
injury and loss ofcontrol.
(a) Common fainting

M - Until diagnosed andstable.
P - If the limitations
affect the ability toperform the work in a
reliable and safe manner,
or if the seafarer's
physical functioning is
too poor for the work.
M - Until investigated,the cause is identified
and control of theunderlying condition is
ensured.

(b) Not common
fainting; without known
cause, not recurrent,
without provenunderlying cardiac,
metabolic orneurological disease(c) Recurrent syncope
or syncope withpossible underlying
cardiac, metabolic orneurological cause

T90(d) Disturbance of
consciousness
suggestive of seizures.
Go to G-40-41
Intracranial
surgery/head trauma,including treatment for
vascular anomalies orsevere head trauma withbrain injury.

annual compliancechecks based on CPAP
records.
F, T - Trade area
restriction andrestriction in work
area and not on duty if
a medical specialist
confirms full controlof the treatment for atleast two years.
Annual checks.
F, T - Individual
assessment based on
work tasks, safetyfunction and specialist
medical opinion.

Not possible.

Individual assessment basedon work tasks, safetyfunction and the opinion of a
medical specialist.

If a single incident.

M - Four weeks.

F, T - Individual
assessment, trade area
restriction andworkspace restriction
and not on duty alone.

Three months after theincident if there are no newcases.

M - For a possible
underlying cause that isundiagnosed or
untreatable; six months
after the event if no new
seizures occur.
M - For possible
underlying cause orcause identified andtreated; for one monthafter successfultreatment.
P - If the recurrent
seizures continue despite
a full examination andappropriate treatment.
M - For one year or
longer until thelikelihood of seizures islowi based on a
specialist opinion.

F, T - Individual
assessment, trade area
restriction andworkspace restriction
and not on duty alone.

With possible underlying
cause, but no treatable cause
found - one year after theincident, if no new cases
occur.
With possible underlying
cause found and treated;
three months after successfultreatment.

Not possible if there aresigns of seizures.
F - After at least one
year, trade area
restriction, restriction
in work area and noton duty alone, if thelikelihood of epileptic

No functional impairment
due to underlying illness or
injury, not on epilepsy
medication. Probability of
seizures very lowi.

Translation: Only the Danish document has legal validity.
Order no. 1463 of 12 of December 2023
issued by the Danish Maritime Authority

Risk to the ship, otheroccupants and self due
to seizures. Impaired
cognitive, sensory or
motor function. Relapse
or complication ofunderlying disease.

H00-99H00-59

H65-67

H68-95

H81

P - Persistent functional
impairment due tounderlying condition orrecurrent epileptic
seizures.

Diseases of the eye and ear
M - Transient, failure to
Eye diseases:
Progressive or recurrent fulfil relevant vision(e.g. glaucoma,requirements, seemaculopathy, diabetic
Appendix 1, and lowi
probability ofretinopathy, retinitis
progressive visual
pigmentosa,
impairment or relapse
keratoconus, diplopia,
blepharospasm, uveitis, once the condition istreated or cured.
corneal ulceration or
P - Inability to fulfil
retinal detachment)
Probability that vision
relevant vision
requirements cannot be requirements, see
met in the future,
Appendix 1, or - ifprobability of relapse.
treated - increased
likelihood of subsequentvisual impairment or
relapse.
M - Until treated.
Otitis externa; otitis
P - If there is chronic ear
media
Relapse, risk ofdischarge from people
infection for people who who handle food.
handle food.
Problem with wearing
hearing protection.
M - Transient failure to
Ear diseases:
Progressive (e.g.
meet hearing
otosclerosis)
requirements, see
Appendix 2 lowi
probability ofsubsequent functional
impairment or relapse
after the condition istreated.
P - Persistent inability tofulfil the hearing
requirements, see
Appendix 2, or if treatedsubsequently, increased
likelihood of further
deterioration.
Ménière's disease and
M - In the acute phase.
other forms of chronic
P - Frequent seizuresor recurrent dizziness.
leading to functional
Balance disturbances
impairment.
leading to movement
impairment and nausea.

seizures is lowi andthere is no functional
impairment due tounderlying illness or
injury. Provided thereis good compliance totreatment and regularcheck-ups asprescribed by aspecialist.

Provided there is goodcompliance to treatment andregular check-ups asprescribed by a specialist.

F - Trade area
restriction if relapse isunlikely, albeit
possible, and treatment
is possible with early
medical intervention.
T - If relapse ispossible but unlikely
and can be detected byregular medical checkups.

Very lowi likelihood of
relapse. Progression so thatvision requirements are notmet, cf. Appendix 1, is not
likely during the validity
period of the certificate.

Individual assessment.
Assess the effect ofheat, humidity andhearing protection on
otitis externa.

Effectively treated and nolikelihood of relapse.

T - If relapse ispossible but unlikely
and can be detectedwith regular checkups.

Very lowi likelihood of
relapse. Progression to alevel where hearing
requirements, see Appendix
2, are not met is unlikely
during the validity period of
the certificate.

F - Individual
Lowi probability ofassessment if only able functional impairment at
to perform limitedsea.
tasks.

Translation: Only the Danish document has legal validity.
Order no. 1463 of 12 of December 2023
issued by the Danish Maritime Authority

I00-99
I05-08

I10-15

I20-25

Heart and vasculardiseases
Congenital heartdisease and valve
disease(incl. surgery for these
diseases)
Heart murmurs thathave not beenpreviously investigated.
Likelihood ofprogression and limited
functional ability.

M - Until diagnosedand- if necessary - treated.
P - If work capacity is
reduced or there are
episodes of reduced
work capacity or if on
anticoagulation
medication or if
permanently highprobability of afunctional impairing
event.
M - Usually if >160
Blood pressure
systolic or >100
elevation
Increased likelihood ofdiastolic mm Hg, until
ischaemic heart disease, diagnosed and treated
eye and kidney damage according to nationalor brain haemorrhage.
guidelines.
P - If persistently >160
Possibility of acutesystolic or >100
hypertensive episode.
diastolic mm Hg with orwithout treatment.
Heart attack, e.g.
M - For three months
myocardial infarction,
after initial investigation
previous myocardial
and treatment isinfarction or newly
initiated; longer if
discovered left-sided
symptoms are notbundle branch block,controlled.
P - If the criteria forangina, cardiac arrest,
issuing a healthcoronary bypass orcertificate are notangioplasty.
Acute functionalpresent andimpairment or reduced
improvement of thework capacity.
condition cannot be
Problems dealing withexpected.
cardiac emergencies at
sea.

F, T - If frequent
specialist monitoringis required.
F - Trade area
restriction if individual
assessment indicates alikelihood of acutecomplications or rapid
progression.
T - If frequentmonitoring is required.

Heart murmurs - If benign
after specialist assessment.
Other - Individual
assessment based on
specialist opinion, but notpossible with
anticoagulation (except
acetylsalicylic acid).

T - If additional
monitoring is required
to ensure that levels
remain withinrecommended limits.

If treated according tonational guidelines, without
functional impairing side
effects.

T - If the probability
Not possible.
of recurrence is very
lowi and the worker isfully compliant withrisk reduction
recommendations, norelevant comorbidities: Issue
initial six-month
health certificate andsubsequent annual
health certificate.
F, T - If the probabilityof relapse is lowi,
limited to:- work area in the formof not working alone
or not on duty alone;and- trade area restriction.
Initially issue a sixmonth healthcertificate and then an
annual healthcertificate.
F, T - If the likelihoodof relapse is moderate andthe seafarer is
asymptomatic.
Sufficient physicalTranslation: Only the Danish document has legal validity.
Order no. 1463 of 12 of December 2023
issued by the Danish Maritime Authority

I44-49Heart rhythm andconduction
disorders(incl.
pacemakers and ICDs).
Likelihood of functional
impairing relapse andsudden functional
impairment and limited
work capacity.
Pacemaker/ICD can beaffected by strong
electrical fields.

I61-69G46

Ischaemic
cerebrovasculardisorder(apoplexy or
TCI).
Increased likelihood of
relapse, acutefunctional ability. Riskof developing othercirculatory disordersthat may lead to acutefunctional ability.

I73

Arterial claudication
Likelihood of othercirculatory disease thatcan cause a sudden loss

fitness to performroutine work andsafety functions:- Restriction in thework area in the formof not working alone
or not on duty alone;and- trade area restriction
or only work on board
a ship with a doctor on
board.
Individual assessmentof limitations.
Annual checks.
M - Until examined and T - If needing checktreated, and satisfactory
ups at shorter
efficacy of the treatment intervals, there are nois documented.
functional impairing
P - If there are functional symptoms and very
impairing symptoms
lowi likelihood of
relapse, based on apresent or increased
specialist opinion.
likelihood of functional
F - Work area
impairment at relapse,
restriction and not on
and if treated with an
duty alone and/or
ICD implant.
restriction in the tradearea if lowi probabilityof acute functional
impairment due to a
relapse.
The follow-up regime
must be specified. If
treated with apacemaker, theduration of the healthcertificate mustcoincide with the needfor pacemaker control.
M - Until treated, stable F, T - Individualand for three months
assessment of fitness,after the incident.
restriction in scope of
P - If residual symptoms work and not on duty
interfere with job
alone.
performance or there is a The assessment should
include the likelihood
significantly increasedof future
likelihood of a relapse.
cardiovascular events.
No physical functional
impairment in relation
to the work area.
Annual assessment.
M - Until assessed.
F, T - Consider
P - If unable to perform
restriction of work
the work.
area and not on duty
provided symptoms
are mild and do not

Checks not required or atintervals of more than two
years. No symptoms andvery low likelihood of
relapse based on a specialist
opinion.

Not possible.

Not possible.

Translation: Only the Danish document has legal validity.
Order no. 1463 of 12 of December 2023
issued by the Danish Maritime Authorityof ability to work.
Limited ability to work.

I83

I80. 2-3

I00-99J00-99J02-04
J30-39J40-44

J45-46

Varicose veins
Possibility of bleedingfrom an injury, skinchanges and ulceration.
Deep veinthrombosis/pulmonary
embolism
Likelihood ofrecurrence or severe
pulmonary embolism.
Likelihood of bleeding
due to anti-coagulation
treatment.

M - Until treated forfunctional impairing
symptoms. Up to one
month after surgery.
M - Until investigated
and treated, and while on
short-term anticoagulation treatment.
P - Consider if recurrent
or on permanent anticoagulation treatment.

M - Until the patient has
been examined andtreated and a satisfactory
effect of the treatment isconfirmed.
P - If recurrent
functional impairing
symptoms or likelihoodof recurrence due torelapse.
Diseases of the respiratory system
Nose, throat and sinus M - Until treated.
P - If there is a recurring
conditions
Reduced ability tofunctional impairment.
work; relapses may
occur. Transmission of
infection to food and/or
other crew members.
M - If an acute episode.
Chronic bronchitis
P - If recurrent severe
and/or emphysema
Reduced work capacity episodes, or if physicaland symptoms offunctional impairment,functional impairment.
or if functional
impairing dyspnoea.
Other heart
conditions, e.g.
cardiomyopathy,
pericarditis, heart
failure.
Likelihood of relapse,
acute loss of ability towork and limited work
capacity.

Asthma (detailed
specialist report for all
first-time hires)
Unpredictable episodesof breathlessness.

M - As long as theepisode lasts until
diagnosed (including thepossibility ofoccupational asthma)interfere with essential
job duties, or if
surgically treated andno physical functional
impairment to work.
Individual assessmentof the likelihood of
future heart disease(criteria in I20-25).
Reassess at least
annually.
Not possible.

No symptoms orcomplications.

F, T - May be suitablefor work where lowi
probability of injury,
restriction in work
area to domestic travel
when stabilised onanti-coagulation
medication withregular monitoring oftreatment levels.
Individual assessment
based on a specialist
opinion.

Full recovery without
anticoagulation.

Individual assessment.

Once treatment is complete,
relapse is not expected.

F, T - Individual
assessment. Morestringent, if not tradearea restriction. Assess
functional ability inemergency situations
and physical fitness inrelation to work.
Annual reassessment.
F, T - Trade area
restriction if moderate
adult asthma, wellcontrolled, treatedwith inhaled

Not possible.

Individual assessment.
Very lowi likelihood of
relapse.

Under 20 years old:If mild or moderate paediatricasthma, but without
hospitalisation or oral
steroids in the last threeTranslation: Only the Danish document has legal validity.
Order no. 1463 of 12 of December 2023
issued by the Danish Maritime Authority

J93

K00-93
K01-06

K25-28

K40-41

K42-43

K44

K50, 51,
57, 58, 90

and treatment isinitiated.
In people under 20 yearsof age withhospitalisation or use oforal steroids within thelast three years.
P - If likelihood of acutelife-threatening asthma
attack at sea or history of
uncontrolled asthma, e.g.
multiple hospitalisations.
M - 12 months after the
Pneumothorax(spontaneous or
first episode or shorter if
traumatic)
advised by a specialist.
P - After repeated
Acute functional
episodes, unless
impairment uponpleurectomy orrelapsepleurodesis has been
performed.
Diseases of the digestive system
Dental health and oral M - If visibly untreateddental or oral disease.
diseasesP - If there is an
Acute toothache,increased likelihood ofrecurrent infections ofsevere dental problems
the mouth and gums.
persisting after treatment
has been completed; orif the seafarer does notfollow recommended
dental treatment.
M - Until healed, cured
Peptic ulcer
Relapse with pain,
or with helicobacter
bleeding or perforation. control and on a normal
diet for three months.
P - If the ulcer persists
despite treatment.
Hernias - inguinal and M - Until diagnosed by asurgeon and entrapment
femoralis unlikely or - if
Probability ofentrapment.
necessary - treated.
Umbilical and ventral Individual assessment
depending on theherniasInstability of thesymptoms andabdominal wall duringfunctional impairment.
bending and lifting.
Assess the importance ofregular heavy physicalexertion.
Individual assessment
Hiatus hernia
Reflux of stomach
based on the severity ofcontents and stomach
symptoms.
acid, which can cause
heartburn/upper
dyspepsia.
M - Until the patient is
Non-infectious
assessed and treated.
enteritis, colitis,

medication andwithout episodes
requiring
hospitalisation or oral
steroids in the last two
years or mild or
exercise-induced
asthma requiring
regular treatment.

years and without the needfor regular treatment
Over 20 years old:If mild or exertion triggering andwithout the need for regulartreatment.

F - Duty only in port
areas when recovered.

Possible 12 months after the
first episode or shorter
duration on specialist
advice.
After surgery - on the adviceof the treating specialist.

F - Trade area
Teeth and/or dentures in
restriction if thegood condition.
criteria are not met andthe ship's operation
allows for dental
treatment withoutcompromising thesafety of the ship'screw.
F - Individual
assessment forpossible service earlier
with a trade area
restriction.

Once cured and on a regular
diet for at least threemonths.

F - Untreated:
Individual assessmentwith a trade area
restriction.
Individual assessment
depending on thesymptoms andfunctional impairment.
Assess the importanceof regular heavy
physical exertion.
Individual assessment
based on the severityof symptoms.

When satisfactorily treated,or exceptionally, when thesurgeon deems strangulation
unlikely.
Individual assessment
depending on the symptoms
and functional impairment.
Assess the importance ofregular heavy physicalexertion.

F - Does not fulfil theconditions for anunrestricted health

Individual assessment basedon a specialist report. Under

Individual assessment basedon the severity of symptoms.

Translation: Only the Danish document has legal validity.
Order no. 1463 of 12 of December 2023
issued by the Danish Maritime Authority

K60, I84

Crohn's disease,
diverticulitis, etc.
Functional impairment
and pain.
Anal diseases:
Haemorrhoids,
fissures, fistulas
Likelihood of episodesof pain andfunctionality.

P - If severe orrecurring.
M - If external
haemorrhoids withrepeated bleeding or
symptoms.
If painful fissure or
fistula or infected,
recurrent bleeding or
faecal incontinence.
P - Individual
assessment if treatment
not possible or recurrent.
M - Until satisfactorily
investigated.
P - If severe orcomplicated with ascites
or oesophageal varices.
M - Biliary colic until
cured.
P - Advanced liverdisease, recurrent or
persistent functional
impairing symptoms.

K70, 72

Cirrhosis of the liver
Liver failure,
haemorrhagic
oesophageal varices.

K80-83Biliary tract disorder
Gallstone colic andliver impact.

K85-86

Pancreatitis
Probability ofrecurrence.

Y83

Stoma (ileostomy orcolestomy)
Functional impairment
due to loss of control,
need for bags, etc.
Potential problem inprolonged emergency
situations.
Skin and subcutaneous diseases
M - Until satisfactorily
Skin infections
Recurrent transmission treated.
of infection to others.
P - Individual
assessment if thecatering employee hasrecurring issues.
Other skin diseases,
T - Until diagnosed ande.g. eczema, dermatitis, satisfactorily treated.
psoriasis
Recurrence, possible
occupational disease.
Diseases of the musculoskeletal system andconnective tissueL00-99L00-08

L10-99M00-99

M - Until cured.
P - If repeated or
alcohol-related, unlessabstinence isdocumented.
M - Until stable.
P - Poorly controlled.

certificate, but acute
deterioration isunlikely: Trade area
restriction.
Individual assessment
for untreatedconditions trade area
restriction.

full control with a lowi
likelihood of relapse.

F, T - Individual
assessment based on a
specialist report.

Not possible.

F, T - Individual
assessment based on a
specialist report. Does
not fulfil therequirements for theunlimited healthcertificate. Acutebiliary colic unlikely.
Individual assessment
based on a specialist
report.

Individual assessment basedon a specialist report. Verylowi probability of relapse
within the next two years.

F - Individual
assessment.

Individual assessment basedon a specialist report.

F, T - Based on thenature and severity of
the infection.

Cured with a low likelihoodof relapse.

Individual assessment
F - If aggravation due
to heat or workplace
influences.

Stable with no impact on
ability to work.

When satisfactorily treated.

Individual assessment basedon a specialist report. Verylowi likelihood of relapse.

Translation: Only the Danish document has legal validity.
Order no. 1463 of 12 of December 2023
issued by the Danish Maritime Authority

M10-23

M24. 4

M54. 5

Y83. 4
Z97. 1

N00-99N00, N17
N03-05,
N18-19Osteoarthritis, otherjoint diseases, possiblywith joint replacements
Pain and reduced
mobility affecting ability
to work and safetyfunction. Prosthetics:
Likelihood of infection
and dislocation. Limited
service life of
prosthetics.
Recurrent instabilityof the shoulder or kneejoint
Acute limitation of
movement with pain.
Back pain
Pain and movement
restriction affecting theability to work andsafety function. Acuteexacerbation.
Prosthetic limbs
Mobility impairment
affecting the ability towork and safetyfunction .

M - Full recovery ofphysical function andspecialist report before
resuming work after hipor knee replacement.
P - Advanced and severecases.

F - Individual
assessment based on
job requirements andmedical history.
Assess tasks inemergency situations
and evacuation from aship. Not physicalfunctional impairment.

Individual assessment. Can
perform routine and safetyfunctions. Very low
likelihood of deteriorationthat results in these tasks not
being able to be performed.

M - Until satisfactorily
treated.

F - Individual
assessment of possible
joint instability.

Treated; very low risk of
relapse.

M - In the acute phase.
P - If recurring or
permanently reduced
ability to work.

Individual assessment.

Individual assessment.

P - If essential worktasks cannot be
performed.

F - If work and safetyfunction can be
performed, but
specific limitations in
non-essential work
functions.

Not physical functional
impairment.
The planning of how to fit
the prosthesis in emergency
situations must be
confirmed.

Individual assessmentof residual condition.

Healthy with normal kidney
function.

F, T - Individual
assessment based on
specialist report,
kidney function andlikelihood ofcomplications.
F - Assess whether
there is uncertainty
about the ability towork in tropicalconditions or in hightemperatures.
Individual assessment
in relation to a tradearea restriction.
F - Individual
assessment in relation
to a trade area
restriction.
F - Individual
assessment if it islikely that thecondition may require
treatment at sea or

Individual assessment basedon a specialist report, kidney
function and likelihood ofcomplications.

Diseases of the urinary and genital organs
P - Until healthy.
Acute nephritis
Kidney failure,
hypertension.
M - Until diagnosed.
Sub-acute or chronic
nephritis or nephrosis
Kidney failure,
hypertension.

N20-23Kidney or urinary
tract stones
Pain attacks.

M - Until diagnosed andtreated.
P - Recurrent stone
formations.

N33, N40

Prostate
enlargement/urinary
tract obstruction
Acute urinary retention
Gynaecologicaldiseases- severe vaginal
bleeding, severe
menstrual pain,
endometriosis, prolapse

M - Until diagnosed andtreated.
P - If the condition isuntreatable.
M - If reduced ability towork or assessment isnecessary.

N70-98

Individual assessment basedon a specialist report, withnormal urinary function andlow likelihood of relapse.

Successful treatment with alowi likelihood of relapse.
Fully recovered with a low
likelihood of relapse.

Translation: Only the Danish document has legal validity.
Order no. 1463 of 12 of December 2023
issued by the Danish Maritime Authority

R31, 80,
81, 82

Z90. 5

O00-99O00-99R47, F80

Functional impairment
due to bleeding or pain
Proteinuria,
haematuria,
glucosuria or abnormal
findings in urine
Indicator of kidneydisease or other illness.
Kidney removal or a
non-functioning
kidney.
Impaired fluid
regulation in extreme
conditions if theremaining kidney is not
functioning optimally.
Pregnancy
Pregnancy
Complications, limited
mobility. Possibility of
injury to mother andbaby in pre-term birthat sea.
GeneralSpeech disorders
Limited communication
skills.

M - If clinicallysignificant.
P - Severe anduntreatable underlying
cause, e.g. renal
impairment.
P - Renal impairment in
the remaining kidney ofthe first-time discharged
patient. Significantly
reduced renal function in
the remaining kidney ofthe previously
discharged patient.

affect the ability towork.
T - When regular
Very lowi probability ofmonitoring is required. underlying serious illness.
F, T - When uncertainof the cause, but not anacute problem.
F - No sailing in thetropics or exposure tohigh temperatures.
Previously discharged
with minor functional
impairment of theremaining kidney.

Normal function in theremaining kidney, no
progressive kidney disease.
Based on a specialist
opinion.

M - Late pregnancy andearly postnatal.
Complicated pregnancy
that requires increased
monitoring.

F, T - Individual
assessment. May beable to work later inpregnancy with alimited work area.

Uncomplicated pregnancy
until 24 weeks of pregnancy.
Recommendations for
pregnancy prophylaxis
should be followed.

P - If incompatible withthe reliable and efficientperformance of worktasks and tasks inemergency situations.

F - If assistive
technology forcommunication isrequired to ensure
reliable and efficientperformance of worktasks in normal andemergency situations.
Individual assessmentof seizure likelihood,severity and treatment
options, access toemergency medicalcare.
F - When the reaction
impairs the ability towork but is not lifethreatening and thelikelihood ofrecurrence can be
reduced by simple
measures.
F, T - Individual
assessment based on a
specialist report.

No issues with essential
speech communication.

T78, Z88

Allergies (other thanallergic dermatitis andasthma)Likelihood of relapse
and more severe
seizures. Reduced
ability to reliably
perform work tasks.

M - Until fully
diagnosed by aspecialist.
P - If life-threatening
reactions are likely.

Z94

Transplants -kidney,
heart, lung, liver.
(For prosthetic joints,
lenses, ears, heart
valves, etc., see therelevant section).
Likelihood of rejection,side effects of the
medication.

M - Until the effects ofsurgery and medication
have stabilised.
P - Individual
assessment based on a
specialist opinion.

When the reaction impairs
the ability to work but is not
life-threatening and can becontrolled with non-steroidal
medication or lifestylechanges without the risk ofsafety-critical side effects.

Not possible.
.

Translation: Only the Danish document has legal validity.
Order no. 1463 of 12 of December 2023
issued by the Danish Maritime Authority

Classify by
diseaseProgressive diseases
that currently fulfil therequirements, e.g.
Huntington's chorea andkeratoconus.

M - Until the patient is
examined and possibly
treated.
P - Assess on a first-time
deployment.

Classify by
disease

Diseases that are notlistedM - Until examined andtreated if indicated.
P - If permanently
reduced ability to work.

Individual assessmentwith a specialist
opinion.
Acceptable if
progression of thedisease with functional
impairment is unlikely
within the validity
period of the healthcertificate.
Use an analogy basedon the listed
conditions as a
guideline.
Assess the likelihoodof an acute functional
ability, relapse orprogression, andlimitations in theperformance of normal
and tasks inemergency situations.

Individual assessment with a
specialist opinion.
Acceptable if progression of
the disease with functional
impairment is unlikely
within the validity period of
the health certificate.

Use an analogy based on thelisted conditions as a
guideline.
Assess the likelihood of anacute functional ability,
relapse or progression, andlimitations in theperformance of normal andtasks in emergency
situations.

Translation: Only the Danish document has legal validity.
Order no. 1463 of 12 of December 2023
issued by the Danish Maritime Authority

Note:
i. Incidence/frequency: When the terms very low, low and moderate are used in relation

to the likelihood of a medical event, this is based on clinical judgement, but in some cases
quantitative evidence of the likelihood of a medical event is available. When quantitative

evidence is available, e.g. for epilepsy or cardiovascular disease, additional examinations
may be required to determine the individual likelihood of deterioration of the healthcondition.

- The quantitative probability limits are set to:- Very low: < 2% per year
- Low: 2-5% per year

- Moderate: 5-10% per year

ii. Asthma; definition of severity levels
Paediatric asthma:- Mild: Onset after age 10, few or no hospitalisations, normal activity level between

episodes, treated with inhaled therapy alone, remission by age 16, normal lung function.

- Moderate: Few hospitalisations, regular use of inhaled therapy, affected functional level,
remission at age 16, normal lung function.

- Severe: Frequent episodes, with hospitalisations, oral steroid treatment, affected lungfunction.

Adult onset asthma:Translation: Only the Danish document has legal validity.
Order no. 1463 of 12 of December 2023
issued by the Danish Maritime Authority

Asthma that persists from childhood or onset after the age of 16. In people with adultonset asthma, the relationship to specific allergens should be investigated, including

occupational asthma. Less specific agents such as cold, workload and respiratory infection
should also be identified.

- Mild intermittent asthma: Episodes of mild breathing difficulties occurring lessfrequently than one-two weeks apart and with good response to inhaled beta2-agonists.
- Mild asthma: Frequent episodes of breathing difficulties requiring the use of beta2agonist or steroid inhalation.

- Exercise-induced asthma: Episodes of breathing difficulties and breathlessness triggeredby physical exertion, especially in the cold. The episodes can be effectively treated withinhaled therapy (steroid or long-acting beta2-agonists) or other oral treatment.

- Moderate asthma: Frequent episodes of breathing difficulties despite treatment withinhaled steroids or other medication, sometimes requiring oral steroids.

- Severe asthma: Frequent episodes of breathing difficulties. Frequent hospitalisation.
Frequent use of oral steroids.

Appendix 4
Use of tests for obesity

Translation: Only the Danish document has legal validity.
Order no. 1463 of 12 of December 2023
issued by the Danish Maritime Authority

In cases where a seafarer's BMI exceeds 40, a specific assessment must be made ofwhether the person in question is able to perform routine and safety-critical tasks onboard. To support this assessment, physical tests can be carried out.

Physical tests, including the Chester Step Test, cannot be the sole basis for rejection or
restriction of the seafarer's fitness for ship service, but must be part of an overall

assessment. It must also be assessed whether the person's fat distribution and muscle
density are severely hampering mobility.

The physical tests should allow the seafarer to demonstrate that they are able to handle
the physical demands and stresses associated with working at sea.

For this purpose, the Chester Step Test can be used, which is a reproducible method toprovide insight into a person's cardiovascular capacity, physical ability and endurance.
Alternatively, informal tests can be used, such as having the seafarer walk three to six

flights of stairs and assessing the seafarer's condition accordingly. The informal tests are
not a reproducible test, but can give the ship's doctor an immediate assessment ofstrength, mobility, motor skills, etc.

The ship's doctor can use the following parameters in informal tests to assess theseafarer's ability to cope with everyday life and emergencies on a ship.

Translation: Only the Danish document has legal validity.
Order no. 1463 of 12 of December 2023
issued by the Danish Maritime Authority

Routine movement around the ship

Is the seafarer, without assistance from others,
able to:- Climb ladders and stairs- Step over high door frames- Operate heavy fire and watertight doors.

Perform routine tasks on board aship

Is the seafarer able to:- Work with raised arms
- Bend down and pick up objects from floor
level- Stand and walk for longer periods- Move into tight spaces and areas- Maintain a normal conversation with anormal workload

Obligations in case of emergencies
on a ship

Is the seafarer able to:- Wear a life jacket or survival suit
- Escape from a smoke-filled room
- Assist in the evacuation of people- Crawl- Handle firefighting equipment

Appendix 5
Overview of commonly used trade area restrictions
Coastal vessels:
Sail in the North Sea east of 3 degrees E. longitude and south of 62 degrees N. latitude,
speed in the Baltic Sea south of 58 degrees N. latitude and sail along the coasts ofGreenland at a distance of not more than 30 nautical miles from the coast (baseline).
Individual assessment of whether to exempt Greenland's coasts.

Translation: Only the Danish document has legal validity.
Order no. 1463 of 12 of December 2023
issued by the Danish Maritime Authority

Local trade:
Coastal vessels and sailing south of 62 degrees N. latitude, north of 48 degrees N. latitude

and east of 12 degrees W. longitude, sailing in the Baltic Sea north of 58 degrees N. latitude,
sailing in the Faroe Islands and sailing along the coasts of Greenland at a distance of not
more than 200 nautical miles from the coast (baseline).

Individual assessment of whether sailing in the Faroe Islands and sailing along the coastsof Greenland should be exempt.
Defined sailing route:
After individual assessment, fitness can be limited to a specific shipping route, usually aferry crossing or similar.
Defined area:
After individual assessment, fitness can be limited to a specific lake, harbour or fjord.

1)

Official notes

The Executive Order contains provisions implementing parts of Council Directive 2009/13/EC of 16

February 2009 implementing the Agreement entered into by the European Community Shipowners'

Associations (ECSA) and the European Transport Workers' Federation (ETF) on the Maritime Labour

Convention, 2006 and amending Directive 1999/63/EC, Official Journal of the European Union 2009, L 124, p.
30-50, parts of Council Directive 2003/88/EC of 4 November 2003 concerning certain aspects of theorganisation of working time, Official Journal 2003, L 299, p. 9-19, parts of Council Directive 2017/159/EU of
19 December 2016 implementing the Agreement on the implementation of the International Labour

Translation: Only the Danish document has legal validity.
Order no. 1463 of 12 of December 2023
issued by the Danish Maritime Authority

Organisation's Working Conditions in the Fishing Sector Convention, 2007, entered into on 21 May 2012 by
the Confederation of Agricultural Trade Unions in the European Union (Cogeca), the European Transport

Workers' Federation (ETF) and the Association of National Fishermen's Organisations in the European Union(Europêche), Official Journal 2017, No. L 25, page 12, and parts of Directive 2008/106/EC of the European

Parliament and of the Council of 19 November 2008 on the minimum level of training of seafarers (reworked),
Official Journal 2008, No. L 323, p. 33, as amended by Directive 2012/35/EU of the European Parliament andof the Council of 21 November 2012, amending Directive 2008/106/EC on the minimum level of training of

seafarers, Official Journal 2012, No. L 343, page 78, and Directive (EU) 2019/1159 of the European Parliamentand of the Council of 20 June 2019 amending Directive 2008/106/EC on the minimum level of training of

seafarers and repealing Directive 2005/45/EC on the mutual recognition of certificates of competency issued
by the Member States, Official Journal 2019, No. L 188, page 94.
1)

First-time hires, i.e. anyone going to sea for the first time, who has not worked in a ship within the last five

years and all seafarers and fishermen under the age of 18.
2)

Professional seafarers, i.e. seafarers and fishermen over the age of 18 who have worked on a ship within thelast five years and for whom the seafaring or fishing profession must be considered their main occupation.