The document is a medical examination form for commercial divers. It includes sections for personal information of the diver, medical history, physical examination results, certifications and qualifications. The examining doctor found the diver medically fit to dive with no restrictions.

1. -E
HSE Health and Safety
Executive
The Medical Examination and Assessment of Divers
. An HSE AMED should complete this form.
. Please place the card provided between carbonised pages before application.
. Please complete all relevant sections and tick box(es) where appropriate.
. Please retain pink copy for your records and give white copy to diver.
. PIease return the blue copies within 7 days to: HSE, Corporate Medical Unit, Redgrave Court, Merton Road, Bootle,
Merseyside, L20 7HS
THIS IS A MEDICAL CERTIFICATE OF FITNESS TO DIVE FOR THE PERSON BELOW
Surname
Date of birth
Permanent
address
Diver's signature
Date of examination
N; ,r{*l*- Forename(s)
7- 7- -5/s rvrare
[q I Female
tr Nationality yi l-iEL
et lt
n hort
: (Medical reasons on next page)
ls the diver medically fit to dive? Yes tr
lf diving activities are RESTRICTED, please give clear advice
No
to the
Date of e
[tlt
diver below
Ltl 3* 6^r,a
"T /1_ t
avw
3.vd.
Examining doctor (AMED) details
Name
Address
F*urv* HSE Pin No Clt*o6*.3
LI o"rt[o**.- 5 *tfD F*{',-. *.*{*
Telephone No
Email
Fax No
I
I confirm that I have performed the medical examination in accordance with the guidance in the current version of MA1
AMED signature e3"3- t5-
i*4"-?rr*"
Medical ln Confidence - Retain for 7 years
MA2 (o4.ii) ., terial number: 1,74240

2. Details of the diver's work history
& **o*,--f* |
vr^Jh fl ",t
"ld. t/t*"t- I &r
ca t* yt
tu t .i <"-a.
Diving Certificate number, most recent qualification Commencement date of commercial diving
ao j
6 /tr9 r+{
Type of breathing equipment used at work
fi
Diving activity in last year:
Number of dives at work Days in saturation
Principal type of diving at work activity: (rick one box onty)
Recreational
Otfshore (non-sat)
Has there been any
tr
tr
DIVING
tr
Miritary
[l Inshore
tr
tr
Police
Media
tr
tr
Archeological/Scientific
tr
Offshore saturation Hyperbaric chamber
ves [-.1 No
RELATED ILLNESS in the last 12 months (eg decompression illness)?
lf Yes, please give details below @ontinue overleaf if necessary)
NumberofdaysduetoiIlnessorinjurysinceIastmedicalexamination
Has the diver been given information about the RIGHT OF APPEAL?
Did you see the diver's immediately previous MA2, or receive a completed
questionnaire from the diver's GP, or receive any information from any other doctor?
ves F;l No
tr
trv". E No
lf UNFIT or RESTRICTED decision given, give medical reasons @ontinue overteaf if necessary)
Medical ln Confidence - Retain for 7 years
rr424ASerial number:

3. Details of the diver's work history
& **o*,--f* |
vr^Jh fl ",t
"ld. t/t*"t- I &r
ca t* yt
tu t .i <"-a.
Diving Certificate number, most recent qualification Commencement date of commercial diving
ao j
6 /tr9 r+{
Type of breathing equipment used at work
fi
Diving activity in last year:
Number of dives at work Days in saturation
Principal type of diving at work activity: (rick one box onty)
Recreational
Otfshore (non-sat)
Has there been any
tr
tr
DIVING
tr
Miritary
[l Inshore
tr
tr
Police
Media
tr
tr
Archeological/Scientific
tr
Offshore saturation Hyperbaric chamber
ves [-.1 No
RELATED ILLNESS in the last 12 months (eg decompression illness)?
lf Yes, please give details below @ontinue overleaf if necessary)
NumberofdaysduetoiIlnessorinjurysinceIastmedicalexamination
Has the diver been given information about the RIGHT OF APPEAL?
Did you see the diver's immediately previous MA2, or receive a completed
questionnaire from the diver's GP, or receive any information from any other doctor?
ves F;l No
tr
trv". E No
lf UNFIT or RESTRICTED decision given, give medical reasons @ontinue overteaf if necessary)
Medical ln Confidence - Retain for 7 years
rr424ASerial number:

4. EXERCISE TESTING
Risk assessment satisfactory? ves
@ *oE
Results
y''t "r
CENTRAL NERVOUS SYSTEM
Normat
tr Abnormat
tr If abnormal, please give details below
PERIPHERAL NERVOUS
Normal
tr
:RVOUS SYSTEM
Abnormal
tr lf abnormal, please give details below
Normal
tr
.ETAL SYSTEM
Abnormal
tr lf abnormal, please give details below
EARS
Normal
tr Abnormat
tr If abnormal, please give details below
Audiogram performed? Please attach audiogram or write results below lretain copy for AMED records)
// //4
VISION
Examination of eyes, fundus Normal
tr Abnormat
tr lf abnormal, please give details below
rVg N_r
Yes tr Notr
gLi*. ta
MUSCULO-SKELETAL
ls colour vision normal?
Medical ln Confidence - Retain for 7 years
r'1,4240Serial number:

5. DENTAL
Does the diver have regular dental assessments in line with current DOH guidelines?
(ln case of doubt about dental health, a dental certificate is required)
ABDOMINAL EXAMINATION
Yes
B *o []
Abdominal and genito-urinary examination Normal
tr Abnormal
I lf abnormal, please give details below
Protein
SKIN
susar Fl Blood
tr
Examination of skin Normat
tr Abnormat
tr lf abnormal, please give details below
+^Jl-cc 4G.€^e Sl**! &*r'
(NB: Sickle cell testing is not required)
URINALYSIS
HAEMATOLOGY (initial examination only)
Please note any additional findings below for future reference
INVESTIGATION SUMMARY
lnitial Annual
Spirometry Yes (e
Exercise Test Yes G"
Urinalysis Yes
'tgAudiology Yes lf clinically indicated JI ft
Hb/FBC Yes If clinically indicated d ,r
Resting ECG Yes 5 yearly from age 40 or, if clinically indicated # [
Routine Radiology No No
Medical ln Confidence - Retain for 7 years
1,1,4240Serial number:

6. vUKAS
PERSONNEL
CERTIFICATION
025
Certificate
of Proficiency
CSWIP CERT NO 100482
This is to certify that:
Nicholas Johns
Date of birth 7 February 1985
has demonstrated proficiency as an Undenruater lnspector Grade 3.1U in
accordance with the CSWIP requirements published in Document CSWIP-
DIV-7-95-Part 1, sth Edition, June 2015 and amendments in force on the
examination date.
Date of issue 17 August 2015
Date of expiry 2 July 2020
Signed :,uA,{UV V
(For CSWIP)
NEW EMPL.YERS sHouLD orfrh"Aol
TWI CERTIFICATTON r-rO IOerrrnfv C
iK TO SEE THE CERTIFICATE HOLDER'S
D, AND VERIFY CERTIFICATE VALIDITYAT WWW.CSWIP.COM
PLEASE READ THE NOTES OVERLEAF
Photocopies are unauthorised by
TWlCertification Ltd
lssued by:
TWI Certification Ltd, Granta Park, GreatAbington, Cambridge CB21 6AL, UK
The use of the UKAS Accreditation Mark indicates accreditation in respect of those activities covered by Accreditation Certificate No. 025
This certificate is the property of TWl Certification Ltd and must be surrendered on request

7. ,,,-iii+'t
-
CSWIP
I--^&-__l
t7tI uxns I
lcEflrrFrGFo |
025
'..)i1^,.C
TWI Certification Ltd
Granta Park, Gt Abington
Cambridge, CB21 6AL UK
Tel: +44 (0) 1223 899000
UNDERWATER INSPECTOR 3.1 U
Expiry Date:0207 2020
fhis card is the Nopetty ol TW Ceililicanon Ltd and must be swendered on demild.
tr is not vafid without he officid CSWP cfficete.

8. Heallh and Safety at Work elc Act 1974
Diving at Work Regulalions '1997
Surface Supplied
ss/559675/14
Nicholas W Johns
Date of Birth: 0710211985
Sird on behaf of the Card lssue Date
roalh and Satety Executive: 2O-Aug-2014
,lt
l"vv'^4- =EI-ISE
'€'. /g'

9. Health and Safety at Work elc Acl 1974
Diving al Work Regulations 1997
Surface Supplied (Top Up)
TU/559675/14
Nicholas W Johns
Date o, Birth 07 l02l 1985
Sgred m behaf o, the Card lssue Dale
Healh and Safetv Fxecdive )o-il6-A1A
(-l"! -,&^4 -{Ji.
-E
HSE
T' d'

10. Health and Salety al Work elc Acl 1974
Diving al Work Regulalions 1997
SCUBA
sc/559675/14
Nicholas W Johns
Date o, Birth: 07 lOZl1985
sigred o behaf of the Card lssue Date
Healh ad Safely Executive: 20 Auo_2O14
t-
r-v.i-,e{-
tt- -E .g- '.
::II:, -
HSE

11. CERTIFICATE OF FIRST-AID TRAINING
lssued by: Certificate Number:
lNT207-34025
Date of issue:
28t08t2015
lssued to:
Date of Birth: 07t02t85
A satisfactory standard of competence in first aid has been attained appropriate to:
Category of First Aid
Training; FIRST AID at WORK + OXycEN ADMTN
Previous First Aid training
Certificate Number:
Date on which certificate ceases to be valid unless further
training is undertaken: 27t08t2018
John T. Rabone
Managing Director
InterMedie
3 Stoke Damerel Business Cenlre
5 Church Sfreef, Sfoke Tet: (01752) SSBOAO
Plymouth, Devon, pL3 4DT Fax: (0175i) S6gOgO
Great Britain. Mobite: 0774b 694339
E-mail : ad min@inte rdive.co. uk
We b s ite : v,rww. inte rdive. co. u k
Nicholas Johns

12. CERTIFICATE OF DIVER MEDIC QUALIFICATIONS
RECOGNISED BY IMCA
Interdive'* Services Ltd
3 Sfoke Damerel Business Cenfre
5 Church Sfreel Stoke Tet: (01752) SSSOBO
Plymouth, Devon, PL3 4DT Fax: (01752) 569090
Great Britain. Mobile: 07748 694339
E-mail : ad min@interdive.co. uk
We b s ite: vrvrw. i nterdi ve. co. u k
lNT201-34025
28t08t2015
Nicholas Johns
lssued to:
07t02t85
Date of Birth:
Date on which certificate ceases to be valid
unless further training is undertaken:
27t08t2017
John T. Rabone
Seal of issuing body Managing Director
IMGA
Members

13. ffinrte4edic
Tbis is to certfy tbat
NICHOLAS JOHNS
b as suc c e ssful ly comp le te d
a training course beld between
17.08 and 28.08 2015
and bas been trained in accordance
ruitb tbe syllabus and standards
required by
INTERMEDIC'" SERY'CES
in the folloruing subjects
EMT. REMOTE CARE
Tbis Certificate is ualid for tbree years -from
tbe date of issue.
Training Director
./obn Rabone
Certificate No. rNT210-3401s
Healtb 6 Safety Executiue Registration Number 1613/95
InterMedic Seruices 3 Stoke Damerel Business Centre,
5 Cburcb Street Stoke Plymoutb Deuon PL3 4DT Grectt Britctin
Tel, *14 (0) 1752 55 80 80 Fax: +44 (0) 1752 56 90 90

14. EmergentrU First Flesptrnse'
This is to certify that
Nicholas W. Johns
has satisfactori ly completed
Emergency First Response
First Aid at Work
Nick Reeves EFR637478
lnstructor
The Underwater Centre # 23568
Centre
valid for three years from the date of issue
Course completion date: 29 May 2014
Expires: 28 May 2017
gt/r-5
Mark Caney
Director, Emergency First Response Ltd.
Certificate number: 1 406UL9795
ln compliance with Health & Safety (FirstAid) Regulations 1981
Emergency First Response Ltd provides training and
assessment for first aid at work, in accordance with currently
accepted first aid practice.
EMEFIEENEY'
first response
Creating fonfidence to Eare"

15. F=JH
_ _ a
dtE
-E E==p .
=
Erl Oi_.; Fl /A r-.
Gi (J -.I F
-E F roc:
i- -=2.
=E
H; =Hi
=2#Ffi E=3
=ts817(
=
A
r{J
i
z
!-)
V) ,f
€HE3HL'I'fA
(') -) a .:- Y
8 {rFEd, +':'>=
=
E N.g::j
A =S;UHvw
":r.t tJ '. ) 4
=
t1 a7-LL-srir
a cri FlEl
H B 3=?: r c-- F(-) iEgr1aW
-v-H
* :os:=;;i a) tTI rI1 'lJ r-r
X dF l:Il;-
2 H q aqB
* ii2F== z# ct'l ct': (, t^'
=
Fi
> -lv=< c-)
.= rcE=u X
i 5<k=,4
=
E
=====
h-f v14?q E{
= *,2Eo"l O
=
e==EE 2
H Y=:A; A
F >SenrlE
E il Zu- E
=H -EF==
; E=EE
E EFSEAaFet
H EeqE-4-J z'c;z
= 38 =3=
U?c);=P
> ?o#c
5 =EP3#E=F-'6rrtz
LTI Z
-l
U7
r)
lI1
F+
E'
(-)
*l
lrI
t,
=U
E:
oN
-l
Frl1
lEl
ECI
Fa
zrd
N
I
N
oH
F
€
Et=
Nts:
8Eigl
lr
F
(,
o
t.DT
_5
!'t
aoq
EFuo
Et,
YZli rd
E- Iq' 'FE=<
UH-H
.)JC)r)r*HF
H H*H
Ys z g g
dIE=I-tr"
-fd'
V74,
gBEEE
=rd--(,t'f 3r'l'u15Z,E
EE9fr
=EEHz>';zAZ' -t
t
rt!
-i
o
,I

16. ra SURVIVEX'
Nicholas Johns
Has successfully completed the following
OPITO Approved Minimum Industry Safety Training
Course lD Number:5301
INCLUDING MODULES
Module 1 lntroduction to the Hazardous Offshore Environment
Module 2 Working Safely including Safety Observation Systems
Module 3 Understanding the Risk Assessment Process
Module 4 Tasks that requlre permit to work
Module 5 Personal Responsibility in rnaintaining Asset lntegrity
Module 6 Using Manual Handling Techniques Every Day
Module 7 Controlling the use of Hazardous Substances Offshore
Module 8 Knowledge and Practices of Working at Height
Module 9 Being Aware of Mechanical Lifting Activities
From 29/09/2A14 To 30/09/201,4
Certificate Expiry Date; 291O9/2OLS
Certificate Number; 98475301300914581
Signed for and on the behalf of Survivex Ltd
George Green
Managing Director
Survivex Limited, Kirkhill Commercial Park, Dyce Avenue, Dyce, Aberdeen, AB21 ole

17. €tsHfvrvEx'
Has been assessed against and met the required learning outcomes of
OPITO Approved Basic Offshore Safety lnduction and
Emergency Training with HUET and EBS
Course lD Number: 5700
From A1/rc/2A14 To a3/LA/2014
Certificate Numbe r 984757000310L4774
Certificate Expiry Date AZILAI}ALS
Signed for and on the behalf of Survivex Ltd
George Green
Managing Director
Survivex Limited, Kirkhill Commercial Park, Dyce Avenue, Dyce, Aberdeen, AB21 ole

18. .r.i:*"
,$.ffi.$
suRvlvEx' &'it
wNicholas Johns
has successfully campleted
OPqO A!{,wd ksic Ofrsl@ S.kt trrtdid and EmryeEy Taining wb HrJEf il.t E*
py66- O'll1Ol2O14 To: O3l1Ol2Ol4
Date of Bi[h: o7tw1985
Certiticate Number: 984757Cf,031O14774
ExDiru Date: O2l1Ol2O18
Course Code 1p 11966.,. 5700
George Green
ww.suryivex.com lel: +t44) 1224 794800 lvlanaging Director

19. tAsH,,nXJ vEx'
Has been assessed against and met the required learning outcomes of
OPITO Approved Compressed Air Emergency Breathing System
(CA-EBS) lnitial Deployment Training
Course lD Number:5902
On 03/10/201"4
Certificate Nu mber 98475902A3LAL43726
Signed for and on the behalf of Survivex Ltd
George Green
Managing Director
Survivex Limited, Kirkhill Commercial Park, Dyce Avenue, Dyce, Aberdeen, AB21 OLQ

20. UNDERWAT=R CENTRE welder rest Certificate
code Testing Standard: Aws D3.6 M-2010 Test Record No: 02846897s1001
Manufacture's Welding Procedure No: 5/001. (Aws D3.6-93) - Not rndependenfly
Visual Assessment to Class B Fillet Weld Standard Assessed
Welder Name: Nicholas Wavne Johns
Date of Birth: 7th Fetrruarv 1985
Employer: Self Employed
Nationality: British
Job Knowledge: Tested
Variables Weld Test Details Range ofApproval
Welding Process:
Plate or Pipe:
Pipe O/D mm:
Material Thickness:
Parent Metal Group:
Joint Type:
Fi11er Metal Type:
Amps / Volts:
Gas / Flux:
Welding Position:
Polarity:
Visibility:
Water Type / Depth:
Welding Technique:
Welding Direction:
MMA (111) Underwater Wet-Welding
Plate
N/A
10.Omm
Carbon Steel BS EN 10025 5275
Lap Fillet in Plate 5.0mm Leg Length
SMP Underwater electrode AWS A 5.1-E6013
Amps: 135 - 145, Yolts:20-22
Rutile
PB I 2F I Hoizontal Vertical
DC Negative
150mm to 300mm
Sea (saltwater): I 2.5m
Drag
Away from Earth Clamp
MMA Underwater Wet-Welding Only
Plate / Pipe at 600mm dia. or Greaier
600mm or Greater
5.0mmto 15.0mm
Group I
2.5mm to 5.0mm Leg Length Fillet
As Specified or Technically Equivalent
Amps: 122 - 159 Volts: 18 - 25
Rutile Only
PB (2F) & PA (1F)
DC - Negative Only
N/A
2.5m to 12.5m
4.Omm
200mm
-
Additional information is available on Welding Procedure Specification No.
s/001. (Aws D3.6)
Type of Test I Results
Visual: I Sarislactory
Radiography: I N'A
MPI/DP: I Un
Macro: I Satisfactory
Fracrure: I lle
Bend: I Nte
Additional Tests:
The Underwater Centre
Fort William
Instructo2frSAfFll
Stuay({Phyte 'Lh-
ofTest:
/c
2014
he, Fort William

21. lllilllililllilllillllllil P21081eo6
rxdA:f E{}NA H. trt}Wg Rg} #AE'
( a E{'g'FE;}{_A?'t - s E-! {.i. :
. rW , c-r-r e L;ari iler ra r..fg,
I-lotder'sname , .'- . .
The holder hm successfully completed a National powerboat
Certficate level 2 come iilard/bostal+ in plmiag/d;splasm**
cmf to the s,,llabus laid dom by the RA at:
/ ,^
ry[**' r Fct-3"5r(6oq f
Rfir
Ticl here if endorscmcnr app
4? *s.- )+
* Delete 6 appro?ndte

22. {rt
o
5
v
z
om
om
!
I'11
o
m
o- o)
a
ooa
I
OEO{ zoo<--r =rA=tg
J*A-
J-tgYl
A+i3 E
E'It L
{=o
voT
e F6s3
t)-t
J
F$oo- o
lrr,'
Eu)
5e"il
N=
S.toE
otrl
a
o
E
U
i
o
z
o.Tt
o
m
qo-tooo
o(oJr
(o==
C6
='=u)
=.-X/+r:q)(c==6
=
j ': a
JU
ao=+x
?.o
=g-"!,nr
3 *H o
5.t1(!
og.= v
't
:J
!llucaiq)
]Qid
o(D^U
ow
^w='F-
9J
O=+
9Zo
=={)
=o 6
c{gr
ooCL
5J
cl
Ito
b(/,

23. VO
vo
voo
r,.l c}
z.@
=rvv=
f/,f!
JO
ON
-oCJ T.r1
H00
z.e
vtn
v(9
{,o.
z. oo
:t-i
OO
-
l,tl
u. o
600
(ro
o_ rr
-J+<>
2
t
{
l*
=
(9
=<t
(i
C],
f
=lO
<
(9:
4.
NI'
Q:r
Z:'
tll Ln a
rI S,
H
l-i>':,O
HlrU:fYi
Lj,.f L:=.1
:..r tr t,
A :&
H:LLt i
F:.:u: 'H ..,
ff. l'*.1 ,
nO'O rE
.t! lll
PT -s
'tA
:<trJ
: l/): o
i : z:2.
ir l;g:1_:
, 1lo.:e
'o-,i--:z
r"l
z
<1
l.
z
kl
F-'
Z
H
z
Z
4+
H
ts
5r'
z
E
F
z
D
:.::+ir
z
o
t-
&
U
&
o
J
o
O
Z
U
t
u
E
ts
i_: I
l::'=t t*
.ia
,.2
lr- =1:3 r
,,d,=
i.a t!
lich lt
'i) q
i.<7
.:(J F
i.@ >
i- v
jaa
9.6
F( o
r.Er r
.'rrl E
r:> >.;t( fr
;9) q
i3E
, x'a
f ca tr
:'< P
':,aP
.q.F

24. Oil & Gas UK
Offshore
Passenger Size
CERTIFICATE
IMASS Group Ltd
Buckland House, 12 William prance Road,
Plymouth lnternational Medical & Technology park
Plymouth, PL6 5WR
Tel: 01752 835900 Fax:01752 788886
email : info@imasssrouo.com
@^
ffi,rt'-'-'a--%€
conducted in accordance with oil and Gas UK Medical Guidelines
Effective from December 2013 the county governor of Rogaland has, in accordance with section 20 in the regulations
regarding health requirements, determined that British and Dutch medical certificates are accepted in line with Norwegian
medical certificates for petroleum activities offshore.
Certificate No:
S3a
nl rC HoLsr* fabt rJ e .
Date of Birth:
o1-oz-tr<
Company Name:
S*t Q e*t Pu,le<)
Occupation:
CaN. M e-:{LC,t
This employee has only been examined for passenger size in accordance with Oil & Gas UK Medical
Guidelines. The result is given at the bottom of this page.
Date of examination , ?fft fi .i.{
Accredited
T?;'#'"'
Accredited Measure/s Licence no.
Company Stamp:
II,1A5S GROUP
Buck[and House
12 Wittiam Prance Road
Plymouth lnternational lr{edicat & Technotogy Parlt
Ptylnouth
Devon PL6 5WR
Tet: 01i52 835900
fax: 01i52 788886
lnfo: imassgroup,com
Passenger Size:
Tick
t/'""
Regular Non-XBR
it ')" LCm
Extra Broad XBR
cm
Super Extra Broad SXBR
cm
oH-TEM-0062-190215-V1-00-C