Jamaica Crew Change Advice Form

Vessel Details

Vessel Name:
Port:
Flag:
Location:
Berth/Anchorage Name:

Operating Company

Name:
Address:
Email:
Telephone:

Local Agent

Name:
Address:
Email:
Telephone:

Seafarer Details

Name:
Seafarer Number:
Passport Number:
Date of Birth:  
Onboard Rank:
Country of Issue:
Telephone:
Email Address:
Have you been provided appropriate PPE for the travel?
Transit Option:
 
Are you the holder of any other Seafarer identity document?

Health Questions


Has a company Pre-departure medical/Health Check been conducted for COVID-19?
Has the seafarer tested positive for the antibodies for COVID-19?
Does the seafarer have any COVID-19 symptoms or is unwell?
Has the seafarer been in contact with anyone testing positive to COVID-19?
Details of contact with COVID-19 positive individual (date/location):
Has twice daily temperature testing been conducted for the last 14 days and temperature been normal?
(Normal temperature is considered to be less than 37.6oC)

Travel Arrangements


Please provide us with your travel arrangement details.

! Date of Travel ! Departure Location
Transportation Phase ! Arrival Location
Transportation Method Transportation Number
Accommodation Details Self Isolation/PPE Requirements

Date of TravelDeparture LocationTransportation PhaseArrival LocationTransportation MethodTransportation NumberAccommodation DetailsSelf Isolation/ PPE Requirements 
No travel arrangements have been added

Has the seafarer visited any other countries in the last 30 days?:

Shipboard Information

Confirm the ship has implemented self-isolation protocols for joining seafarers - including
non-essential personnel not to fill bridge berthing/departure duties?
Confirm Master has been advised of requirements to disinfect joining/leaving seafarers
baggage and clothes following/prior to travel?
Confirm Master has been advised that for 14-days after crew-change if any persons onboard
exhibit high temperature or COVID-19 like symptoms they are to immediately notify last Jamaican
agent to alert Ministry of Health and Wellness (888-754-7792) to allow commencement of contact tracing

Lodging Agent

Are you, the seafarer, leaving Jamaica?
Has the Maritime Authority of Jamaica agreed to a crew change?
Please provide any additional measures stipulated or if crew change refused outline reasons:
Is the terminal notified?
Please provide any additional measures stipulated or if crew change refused outline reasons:


Declaration

I (Name) of (Agency)
advise that the information provided in this form is to the best of my knowledge correct and the crew member to whom this form relates has consented that the personal information it contains is being collected in connection with the risks presented by COVID-19, and may be passed onto appropriate stakeholders, health professionals & Commonwealth, State and local officials for the purpose of facilitating a crew change.



Seafarer Documents

Please upload the documents marked as required (!).

Crew Health Self-Declaration and Daily Temperature Records: ( ! )
Seafarer's Employment Agreement (Signed and Dated): ( ! )
Certificate of Competency/Proficiency: ( ! )
Copy of COVID-19 management plan/staff procedures:
COVID Test Result:
Masters Declaration:
Travel Itinerary: ( ! )



We kindly ask that you review the information that you have provided for your application. If you have already reviewed the information provided then please proceed.


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Disaster Risk Management Solution


Address: Office Centre building, 12 Ocean Boulevard, Kingston

Phone: 876 9671060-7

Fax: 876 9225765