PEME — Pre-Employment Medical Examination

A seafarer's PEME is the medical gate before joining a ship. It is mandatory under STCW Section A-I/9 (medical fitness standards) and MLC 2006 Standard A1.2 (medical certificate). The result — fit, fit with restrictions, or unfit — determines whether a seafarer may legally sign on a crew agreement. Failure to hold a valid medical certificate while serving at sea is a deficiency that can result in port state control action against the vessel.

The applicable standard depends on the flag state of the vessel and the seafarer's nationality. A Filipino seafarer on a Liberian-flagged ship must meet both MSMS (Philippines) and Liberian/STCW A-I/9 requirements, whichever is the more demanding. Where a CBA (Collective Bargaining Agreement) imposes additional requirements (e.g. certain company-specific tests), those are additional contractual obligations on top of the statutory minimum.

Standards by flag / authority

ENG1UK MCA (Maritime and Coastguard Agency)
Standard seafarer medical fitness certificate for all seafarers serving on UK-flagged ships or UK nationals on any flag. Issued by an MCA-approved medical examiner (AME).
Validity: 2 years (1 year if the seafarer is under 18 or over 65, or if the examiner certifies reduced period on medical grounds).
ML5UK MCA
Restricted fitness certificate for seafarers who fail the full ENG1 standard but are fit for restricted service (e.g. coastal or near-coastal waters only, specific medical exclusions). Equivalent to ENG2 in older terminology.
Validity: 2 years, with same age-related reductions as ENG1. The ML5 restricts service — it does not allow unrestricted deep-sea service.
STCW Section A-I/9IMO (implemented by each flag state)
Sets the minimum medical fitness standards all seafarers must meet under STCW. Requires vision, colour vision (deck officers), hearing, physical fitness, and freedom from conditions that may cause sudden incapacity. Each flag state implements via national rules that must be at least as demanding as A-I/9.
Validity: 2 years generally. Flag states may impose shorter validity for seafarers with specific conditions.
ILO/WHO Guidelines (2013)International Labour Organization / World Health Organization
Medical Examinations of Seafarers — a 234-page joint guidance document providing a common framework for medical examiners worldwide. Sets vision, hearing, cardiovascular, psychiatric, and other criteria. Forms the basis for many national PEME standards including Manila Standard Medical Standards (MSMS).
Validity: Framework document — validity periods set by flag/national rules.
Philippines DOH-AOA (MSMS)Philippines Department of Health — Accredited Organizations (AOA)
Philippine seafarers (the world's largest national supply) must be medically examined by a DOH-AOA accredited clinic. The Manila Standard Medical Standards (MSMS) set the criteria. Required for MARINA-issued CoCs and for compliance with ITF/IBF JNG CBAs.
Validity: 2 years standard; CBA-specific validity may differ.
India DG Shipping formatDirectorate General of Shipping, India
Indian seafarers must hold a medical fitness certificate from a DG Shipping-approved medical practitioner. Follows ILO/WHO 2013 guidelines with some India-specific additions (tropical disease screening).
Validity: 2 years.
USCG NVIC 04-08United States Coast Guard
Medical and physical evaluation guidelines for US Merchant Mariner Credentials. Sets vision, hearing, neurological, cardiovascular criteria for USCG licence holders. More detailed than STCW A-I/9 in several areas (e.g. diabetes management requirements).
Validity: 5 years for most credential holders (coincides with credential validity).

Common conditions leading to rejection or restriction

Cardiovascular
Uncontrolled hypertension (consistently > 160/100 mmHg); recent myocardial infarction (typically within 6 months); significant cardiac arrhythmia (untreated); symptomatic coronary artery disease; poorly controlled heart failure. Well-controlled hypertension on medication is often certifiable at examiner discretion.
Diabetes mellitus
Insulin-dependent diabetes is frequently a basis for restricted or refused certification under most flag standards, due to hypoglycaemia risk at sea. Well-controlled diet or oral medication-only diabetes is often certifiable. Individual assessment required; USCG NVIC 04-08 provides detailed insulin-dependent guidance for restricted service.
Epilepsy
Active epilepsy (any seizure within past 2–10 years, depending on flag standard) is generally a bar to sea service. Extended seizure-free periods on anti-epileptic medication may be certifiable under restricted service provisions (ML5/equivalent) in some flags.
Psychiatric disorders
Severe or unstable psychiatric illness (schizophrenia, active mania, major depressive disorder with suicidality). Stable, treated minor depression is not necessarily a bar. Psychiatric medication side effects (sedation, impaired reaction time) are considered.
Vision
Deck officers (OOW): minimum 6/12 in each eye (corrected), no worse than 6/60 uncorrected; night blindness prohibited. Engineering officers: 6/18 corrected, 6/60 uncorrected minimum. Standards are flag-specific — ILO/WHO 2013 tables give the reference.
Colour vision (deck)
Deck officers and ratings on bridge watchkeeping duty must pass the Ishihara or equivalent colour perception test. Failure may be grounds for restriction from deck watchkeeping duty (not from all sea service). Lantern test (Farnsworth or equivalent) may allow restricted certification under some flags.
Hearing
Conversational hearing (with or without aids, typically 2 m in quiet room per ILO/WHO). Audiometry required for USCG and recommended by ILO/WHO for seafarers over 40. Total deafness is a bar to all watchkeeping functions.

PEME-specific tests beyond the standard clinical examination

ECG (electrocardiogram)
When required: Required for seafarers aged 40 and over in most PEME standards; may be required for younger seafarers where cardiovascular risk factors are identified.
Resting 12-lead ECG. Abnormal results (significant arrhythmia, ischaemic changes) trigger further evaluation or fail the examination.
Chest X-ray
When required: Required by many flag and national standards (particularly Philippines DOH-AOA, India DG Shipping). Frequency varies: some require for every PEME, others only on first examination.
Screens for tuberculosis, significant lung pathology. CXR policy has been debated due to radiation dose; some flags have moved to tuberculin testing where infection rates are lower.
Audiometry
When required: USCG — required for all. ILO/WHO recommends for all; many national standards apply it to seafarers over 40 or those in high-noise engine ratings.
Identifies noise-induced hearing loss common in engineering ratings. Results may trigger referral or restrict ratings from high-noise spaces without hearing protection.
Ishihara / colour vision
When required: Required for all deck officers and deck ratings expected to keep navigational watch. Usually tested at every PEME renewal.
Plate test (24 or 38 plates). Failure triggers lantern or Farnsworth D-15 secondary test. Engine officers are generally not required to pass colour vision tests.
HepB / HepC / HIV serology
When required: Required by Philippines DOH-AOA, some Middle East/Gulf flag states, and several large cruise line operators as a CBA requirement.
Not universally required under IMO/ILO standards. Positive results create complex situations — MLC 2006 prohibits discrimination but flag/port-state law may restrict entry. HIV-positive seafarers may be restricted from some flag states' waters.
Drug and alcohol screening
When required: Most PEME standards include urine drug screening (typical 5-panel: cannabis, cocaine, amphetamines, opiates, phencyclidine). Alcohol by breath/blood may be added. Some CBAs (e.g. cruise industry) require hair follicle testing for a longer detection window.
A positive result is typically an automatic fail. Prescribed medications (opioid pain management, psychiatric drugs) must be declared and assessed for fitness-for-duty impact.

Appeal rights

A seafarer who fails a PEME does not necessarily lose all right to serve at sea. Appeal procedures differ by flag:

UK (ENG1) — Failed seafarers may request a review by an MCA-appointed Medical Referee. The referee can overturn or modify the approved examiner's decision. A second medical opinion from a specialist may be submitted in support. Cost is borne by the seafarer.
Philippines (DOH-AOA) — Appeal to the DOH through the accredited clinic or directly. A second opinion from an independent DOH-AOA clinic is the standard route. CBA-specific appeals may be routed through the union (AMOSUP, NUSI, etc.).
India (DG Shipping) — Disputed results can be referred to the Senior Medical Inspector of the DG Shipping. Further appeal via the DG Shipping medical board.
USCG (NVIC 04-08) — Individual waivers may be applied for through the NMC (National Maritime Center) for certain conditions (e.g. controlled diabetes, history of cancer in remission). Waiver requires specialist documentation.
MLC 2006 protection — MLC Standard A4.1 requires that seafarers have reasonable access to onboard medical care; A1.2 sets the certificate framework. MLC does not guarantee employment of an unfit seafarer, but it does require that flag states have a fair and documented process for fitness determination.