Certificates compressed 2015

-EHSE 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

Permanentaddress

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 trlf diving activities are RESTRICTED, please give clear advice

No

to the

Date of e

[tltdiver below

Ltl 3* 6^r,a

"T /1_ t

avw3.vd.

Examining doctor (AMED) details

Name

Address

F*urv* HSE Pin No Clt*o6*.3LI 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

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 j6 /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

trtrDIVING

tr

Miritary [l Inshore trtr

Police

Media

trtr

Archeological/Scientific trOffshore 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 completedquestionnaire from the diver's GP, or receive any information from any other doctor?

ves F;l No trtrv". E No

lf UNFIT or RESTRICTED decision given, give medical reasons @ontinue overteaf if necessary)


rr424ASerial number:

EXERCISE TESTING

Risk assessment satisfactory? ves @ *oE

Results

y''t "rCENTRAL 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?


r'1,4240Serial number:

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 (eExercise Test Yes G"Urinalysis Yes

'tgAudiology Yes lf clinically indicated JI ftHb/FBC Yes If clinically indicated d \ ,rResting ECG Yes 5 yearly from age 40 or, if clinically indicated # [Routine Radiology No No


1,1,4240Serial number:

vUKASPERSONNEL

CERTIFICATION

025

Certificateof Proficiency

CSWIP CERT NO 100482

This is to certify that:

Nicholas JohnsDate of birth 7 February 1985

has demonstrated proficiency as an Undenruater lnspector Grade 3.1U inaccordance with the CSWIP requirements published in Document CSWIP-DIV-7-95-Part 1, sth Edition, June 2015 and amendments in force on theexamination date.

Date of issue 17 August 2015

Date of expiry 2 July 2020

Signed \:,u\A,{UV V(For CSWIP)

NEW EMPL.YERS sHouLD orfrh"AolTWI CERTIFICATTON r-rO IOerrrnfv C\

iK TO SEE THE CERTIFICATE HOLDER'SD, AND VERIFY CERTIFICATE VALIDITYAT WWW.CSWIP.COM

PLEASE READ THE NOTES OVERLEAFPhotocopies 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. 025This certificate is the property of TWl Certification Ltd and must be surrendered on request

,,,-iii+'t -

CSWIP

I--^&-__l

t7tI uxns I

lcEflrrFrGFo\ |

025

'..)i1^,.C

TWI Certification LtdGranta Park, Gt AbingtonCambridge, CB21 6AL UK

Tel: +44 (0) 1223 899000UNDERWATER 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.

Heallh and Safety at Work elc Act 1974Diving at Work Regulalions '1997

Surface Supplied

ss/559675/14

Nicholas W Johns

Date of Birth: 0710211985Sird on behaf of the Card lssue Dateroalh and Satety Executive:

2O-Aug-2014

,ltl"vv'^4- =EI-ISE

'€'. /g'

Health and Safety at Work elc Acl 1974Diving al Work Regulations 1997

Surface Supplied (Top Up)

TU/559675/14

Nicholas W Johns

Date o, Birth 07 l02l 1985Sgred m behaf o, the Card lssue DaleHealh and Safetv Fxecdive )o-il6-A1A

(-l"! \-,&\^4 -{Ji.

-EHSE

T' d'

Health and Salety al Work elc Acl 1974Diving al Work Regulalions 1997

SCUBA

sc/559675/14

Nicholas W Johns

Date o, Birth: 07 lOZl1985sigred o behaf of the Card lssue DateHealh ad Safely Executive: 20 Auo_2O14

t-r-v.i-,e{-

tt- -E .g- '.

::II:, -

HSE

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 AidTraining; FIRST AID at WORK + OXycEN ADMTN

Previous First Aid trainingCertificate Number:

Date on which certificate ceases to be valid unless furthertraining is undertaken: 27t08t2018

John T. RaboneManaging Director

InterMedie3 Stoke Damerel Business Cenlre5 Church Sfreef, Sfoke Tet: (01752) SSBOAOPlymouth, Devon, pL3 4DT Fax: (0175i) S6gOgOGreat Britain. Mobite: 0774b 694339

E-mail : ad mi n@i nte rd ive.co. ukWe b s i te : v,rww. i nte rd ive. co. u k

Nicholas Johns

CERTIFICATE OF DIVER MEDIC QUALIFICATIONSRECOGNISED BY IMCA

Interdive'* Services Ltd3 Sfoke Damerel Business Cenfre5 Church Sfreel Stoke Tet: (01752) SSSOBOPlymouth, Devon, PL3 4DT Fax: (01752) 569090Great Britain. Mobile: 07748 694339

E-mail : ad mi [email protected]. ukWe b s ite : vrvrw. i nte rd i ve. co. u k

lNT201-34025

28t08t2015

Nicholas Johnslssued to:

07t02t85Date of Birth:

Date on which certificate ceases to be validunless further training is undertaken:

27t08t2017

John T. Rabone

Seal of issuing body Managing Director

IMGAMembers

ffinrte4edic

Tbis is to certfy tbat

NICHOLAS JOHNS

b as suc c e ssful ly comp le te da training course beld between

17.08 and 28.08 2015

and bas been trained in accordanceruitb tbe syllabus and standards

required by

INTERMEDIC'" SERY'CES

in the folloruing subjects

EMT. REMOTE CARE

Tbis Certificate is ualid for tbree years -fromtbe 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

EmergentrU First Flesptrnse'

This is to certify that

Nicholas W. Johns

has satisfactori ly completed

Emergency First Response

First Aid at Work

Nick Reeves EFR637478lnstructor

The Underwater Centre # 23568Centre

valid for three years from the date of issue

Course completion date: 29 May 2014Expires: 28 May 2017

gt/r-5Mark CaneyDirector, Emergency First Response Ltd.

Certificate number: 1 406UL9795

ln compliance with Health & Safety (FirstAid) Regulations 1981

Emergency First Response Ltd provides training andassessment for first aid at work, in accordance with currentlyaccepted first aid practice.

EMEFIEENEY'first response

Creating fonfidence to Eare"

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\

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 GreenManaging Director

Survivex Limited, Kirkhill Commercial Park, Dyce Avenue, Dyce, Aberdeen, AB21 ole

€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



Survivex Limited, Kirkhill Commercial Park, Dyce Avenue, Dyce, Aberdeen, AB21 ole

.r.i:*",$.ffi.$ suRvlvEx' &'itw

Nicholas Johnshas 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: o7tw1985Certiticate Number: 984757Cf,031O14774

ExDiru Date: O2l1Ol2O18

Course Code 1p 11966.,. 5700George Green

ww.suryivex.com lel: +t44) 1224 794800 lvlanaging Director

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



Survivex Limited, Kirkhill Commercial Park, Dyce Avenue, Dyce, Aberdeen, AB21 OLQ

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 rndependenflyVisual 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 CentreFort WilliamInstructo2frSAfFl\lStuay({Phyte 'Lh-

ofTest:

/c

2014

he, Fort William

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I-lotder'sname , .'- . .

The holder hm successfully completed a National powerboatCertficate level 2 come iilard/bostal+ in plmiag/d;splasm**cmf to the s,,llabus laid dom by the R\A at:

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Oil & Gas UK

OffshorePassenger Size

CERTIFICATE

IMASS Group LtdBuckland House, 12 William prance Road,Plymouth lnternational Medical & Technology parkPlymouth, PL6 5WRTel: 01752 835900 Fax:01752 788886email : [email protected]

@^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 regulationsregarding health requirements, determined that British and Dutch medical certificates are accepted in line with Norwegianmedical 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 MedicalGuidelines. 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

cmSuper Extra Broad SXBR

cm

oH-TEM-0062-190215-V1-00-C

Certificates compressed 2015

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