SEAFARER RESTING HOURS RECORD


Ship’s name:

IMO:

Flag:

Month and year:

Seafarer name:

Position /  Rank:

Watch keeper:
 FORMCHECKBOX FFFFFFFF650000001400060043006800650063006B003100000000000000000000000000000000000000000000000000  YES 
 FORMCHECKBOX FFFFFFFF650000001400060043006800650063006B003200000000000000000000000000000000000000000000000000  NO

Date
(yyyy-mm-dd)
Please mark periods of rest, as applicable, with X, or using a continuous line.
    Rest hours in 24 hrs period
Comments
Not to be completed by the seafarer
0 0
1 0
2 0
3 0
4 0
5 0
6 0
7 0
8 0
9 1
0 1
1 1
2 1
3 1
4 1
5 1
6 1
7 1
8 1
9 2
0 2
1 2
2 2
3 2
Rest hours in any 24hrs period
Rest hours in any 7days period



































































































































































































































































































































































































































































































































































































































































































































































































































































































































Hours
0 0
1 0
2 0
3 0
4 0
5 0
6 0
7 0
8 0
9 1
0 1
1 1
2 1
3 1
4 1
5 1
6 1
7 1
8 1
9 2
0 2
1 2
2 2
3





Name of master / authorized person:

I agree that this record is an accurate reflection of the hours of rest of the seafarer concerned.
Signature:

Signature of seafarer:




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