Form

Occupational disease report form for UK registered merchant ships

Employers of seafarers on UK ships to submit this form when seafarers are diagnosed by a medical practitioner with an occupational disease.

• From: Maritime and Coastguard Agency
• Published: 19 March 2015

Documents

Occupational disease report form for UK registered merchant ships (MSF 4159 rev 0714)

PDF, 633 KB, 4 pages

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Details

The Merchant Shipping (Maritime Labour Convention) (Health and Safety) Regulations 2014 require employers of seafarers on UK ships to complete and submit this form to the MCA when seafarers are diagnosed by a medical practitioner with an occupational disease listed in Annex 1 of Merchant Shipping Notice MSN 1850(M) and where the seafarers have been engaged in the corresponding type of work specified for that disease in that Notice.

One form should be completed for each disease

Please submit the completed form to

Maritime and Coastguard Agency
Seafarer Safety and Health Branch
Bay 2/17, Spring Place
105 Commercial Road
Southampton
SO15 1EG

Email: mlc@mcga.gov.uk

This form must be completed by the employer or, if the affected person is self-employed, by the affected person.

Completing and signing this form does not constitute an admission of liability of any kind, either by the person making the report or any other person.

Published 19 March 2015