Application for Inclusion on the Registered Doctors List

General Notes:
1. Admission to the registered doctors list is administered by RS Occupational Health on behalf of Oil & Gas UK. 2. Completed forms to be returned to:R S Occupational Health 8 Craigshaw Road West Tullos Aberdeen AB12 3AR OR: email to: oguk.dr.enquiries@rsoh.co.uk OR: fax: + 44 (0) 1224 899005

3. Medical Practitioners admitted to the Registered Examining Doctors List are expected to medically assess offshore workers in accordance with the current issue of the Oil & Gas UK Guidelines for Medical Aspects of Fitness for Offshore Work. This application form is to ensure that applicants will likely be suitable to perform medical assessments under the requirements of the Guidelines and therefore only doctors who have adequately completed all sections will be considered for admission to the list. From 1st January 2011, applicants thought suitable to join the list will be required to undertake an initial one-day training course. The course is presently run in Aberdeen, UK, and costs 500. Applicants progressing to the training course will be sent a copy of the guidelines with the course joining instructions. 4. Applicants will be issued with a PIN number on successful completion of the initial training course. Operating Companies will normally allow individuals to mobilise offshore only if the worker is in possession of a medical certificate signed by a doctor on the registered examining doctors list and bearing a valid PIN number.
5. Doctors on the registered list will be required to renew their place on the list

annually, by submission of a statistical return of numbers of medicals undertaken and payment of an annual administration fee, on 1 st November each year.
6. An annual examining doctors conference takes place in Aberdeen in March.

Examining Doctors are encouraged to attend if at all possible.

Please now complete sections 1 to 4 following:

RSOH/UKOOA/Drs Application Forms.doc

Section 1A. Personal Details (all applicants) Name Year of Qualification Post Graduate Degrees/Diplomas

Section 1B. GMC Details (UK applicants) GMC Registration No. Do you hold a licence to practice from the GMC?

Section 1C. Professional Body Details (non-UK applicants) National and/or State Medical Licensing Body (include address)

Medical Licence Number/Code/Reference

Section 1D. Address Details (all applicants) Name of Practice/Organisation FULL Clinic Address:

Tel No: Fax No: Email: (Must be provided)

RSOH/UKOOA/Drs Application Forms.doc

Section 2. Relevant Experience For entry to the Registered Examining Doctors List applicants should show: a) experience of offshore oil and gas (or remote) medicine or b) other relevant/transferable experience in occupational medicine or c) that they will commence working under the direct supervision of a doctor already on the registered doctors list or d) other relevant applicable experience 2A. Please indicate which option best describes your practice in occupational medicine: 1. An occupational physician working principally in the oil industry 2. An occupational physician, working partly in the oil industry and partly in other industries 3. A physician whose primary substantial clinical work is in another medical speciality, but with a part-time occupational medicine element 4. None of the above

For 3 or 4, please state your main area of clinical practice:

Note: All doctors joining the examining doctors list, regardless of previous experience, will be required to undertake a one-day preparation course, entitled Oil&Gas UK Doctors Training Workshop. Courses can be booked on-line at: http://www.oilandgasuk.co.uk/events/index.cfm
2B. Your personal relevant experience:

Please describe your experience, past and present, in offshore oil and gas medicine:

RSOH/UKOOA/Drs Application Forms.doc

Please describe your experience, past and present, in any other form of remote medicine:

Please describe your present activities in occupational medicine:

Please describe your reason(s) for requesting entry to the examining doctor list (i.e. what are the circumstances which require you to undertake Oil and Gas UK medicals?)

2C. The organisation you work in:

Please describe the nature of the organisation you work in (e.g. oil and gas operating company, other oil and gas related contractor company, group occupational health services provider, general practice or other medical clinic, self-employed business etc):

Please give the name(s) and Oil and Gas UK PIN number(s) of the senior colleague(s), if any, you report to:

RSOH/UKOOA/Drs Application Forms.doc

Section 3. Facilities The Guidelines for Medical Aspects of Fitness for Offshore Work require the following assessments to be carried out:1. 2. 3. 4. A full clinical examination, to include an assessment of dental health. Urinalysis Audiometry, to standards defined in BS 6655 and MS 26 Pulmonary function testing, with a minimum of FEV1/FVC and peak flow measurement. 5. Visual acuity & colour perception. 6. Height / weight and BMI determination

Please provide the following details:Audiometer make and model, acoustic booth details, other relevant information relating to meeting the requirements of BS 6655 and MS 26

Attach a copy of your most recent audiometer calibration certificate.

Respiratory function testing equipment, make and model, calibration procedures.

Give details of your methods for testing visual acuity and colour vision

Confirm that you have available an accurate set of weighing scales. Give details of make and model.

Certain offshore workers may be designated as emergency response team members and require a higher level of physical fitness than standard offshore workers. The Medical Guidelines require these workers to undergo further evaluation including a fitness test and determination of VO2 max. This may be by Chester Step Test or any other suitable testing method.

RSOH/UKOOA/Drs Application Forms.doc

Provide details of test to be used :-

Section 4. Declaration I certify that the above information is correct. If included on the Registered Examining Doctors List I agree to adhere to the Oil & Gas UK Guidelines for Medical Aspects of Fitness for Offshore Work and to have my services audited by Oil & Gas UK. Signed: Date:

For Official Use Only: Application Approved By: Date:

PIN No.:

RSOH/UKOOA/Drs Application Forms.doc