Seafarer Departure Checklist Form
Complete this checklist to ensure all departure procedures for seafarers are properly followed and documented.
Full Name of Seafarer
*
First Name
Last Name
Vessel Name
*
Departure Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Rank/Position
*
Departure Port
*
Have all personal belongings been collected?
*
Yes
No
Are all official documents (passport, discharge book, etc.) returned?
*
Yes
No
Have safety debriefing and handover procedures been completed?
*
Yes
No
Additional Comments
Signature of Seafarer
*
Submit Checklist
Submit Checklist
Should be Empty: