Sailing Crew Member Medical History Checklist

Imagine that you have a guest or crew member on your sailboat, yacht or motorboat and an accident happens. Perhaps they get hit by the boom and are knocked out or pass-out for no logical reason? If the crew member needs medical attention will you be able to talk to a doctor about their medical history? Will you be able to tell paramedics that the crew member has an allergy to a particular medication?

Or can you imagine going out for a day sail and a crew member has an epileptic fit. You send out a MAYDAY and get a helicopter evacuation set up only to find out that the crew member is an epileptic. If you don’t ask, people are often reluctant to talk about illnesses and disease. Rather than take a ‘head in the sand’ approach, set up a policy for every crew member, guest and visitor to fill out your sailing crew member medical history checklist.

Sailing Crew Member Medical History

Crew Member Details

• Full Name:
• Date of Birth:
• Address:
• Emergency Contact Name:
• Emergency Contact Phone:

Medical History – Tick if your answer is ‘Yes’ to any that apply

• I am allergic to medication(s) (aspirin, penicillin).
• I am allergic to foods/substances.
• I take prescribed medication on a permanent or semi-permanent basis.
• (anti-inflammatories, antibiotics, insulin).
• I have asthma.
• I have suffered from anaphylactic shock.
• I have had an epileptic seizure.
• I have epilepsy.
• I have been treated for diabetes.
• I am anemic.
• I have sickle cell anemia.
• I had high blood pressure.
• I have heart disease (heart murmur, rheumatic fever).
• I have lung disease (pneumonia, other).
• I have kidney disease (infections, other).
• I have liver disease (mononucleosis, hepatitis).
• I have other disease.
• I have had a hernia or “rupture”.
• I have had a concussion, or become unconscious recently.
• I have broken a bone (fracture) in the past 2 years.
• I have required medical attention for injuries in the past 2 years.
• I have had a surgery in the past 2 years.
• I have back problems.
• I have a pin, screw, or plate in my body.
• I wear contacts.
• I am not up to date with my tetanus and polio shots.
• I have suffered from sea sickness.
• I have other conditions that need to be known by the crew.

To be filled in by the Skipper

• Name of vessel:
• Vessel contact:
• Contact number: