‘Occupational Health Issued in accordance with | MEDICAL FITNESS CERTIFICATE MEDICAL REPORT (this document was adopted from Saipem company and used only for Salpern ‘client/subcontractor ) MEDICAL FITNESS CERTIFICATE 11 & Gas UK Guidelines, Saipem Corporate Standards OPR-COR-HE-H.T-001 IMO and STCW Guidelines on medicel examination £, STO-CORHLTCU-001-1, Specify prescrip| Full mame (in dlock letters) Date of Birth Occupation M fairer (1-7 -1g83 weiner. This Health Certificate is valid until: 7.3 AUG 2073 it © offshore &énshore ~ Fit with presctiotions and/or restrictions permanent © temporary fer months. a Unfit permanent 1 temporary for months —— [FIT TO WORK| iM ‘Apoiicant’s signature in the Doctor's presence i pplicant’s signature in the Doctor's pr a p DILAB Place 7G, BALATKARIMUN Day, Month, Year 2 4 AUG 2022 Employer must provide the personal protective equipment specific to the activity