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GM1 MED.C.030(b) Cabin crew medical report

Available versions for ERULES-1963177438-11218

ED Decision 2019/002/R found in: Aircrew (1178/2011) Part-FCL Part-MED Part-CC Part-ARA Part-ORA Part-DTO (Aug 2023)

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GM1 MED.C.030(b) Cabin crew medical report

ED Decision 2019/002/R

GENERAL

The format of the cabin crew medical report may be as shown in the example below, with the size of each sheet being 1/8 of A4.

<table border="1" cellpadding="0" cellspacing="0" width="604"><tr><td valign="top" width="293">State of issueCABIN CREW MEDICAL REPORT FOR CABIN CREW ATTESTATION (CCA) APPLICANT OR HOLDER</td><td valign="top" width="293"></td><td valign="top" width="19"></td></tr></table>

<table border="1" cellpadding="0" cellspacing="0" width="604"><tr><td valign="top" width="302">I The State where the aero-medical assessment is conducted:III Cabin crew attestation reference number:IV Last and first name:XIV Date of birth (dd/mm/yyyy):VI Nationality:VII Signature of CCA applicant/holder:</td><td valign="top" width="302">II Aero-medical assessment result (fit/unfit): Expiry date of the previous cabin crew medical report (dd/mm/yyyy): Date of aero-medical assessment (dd/mm/yyyy):X Date of issue* (dd/mm/yyyy): X Signature of the AeMC, AME or OHMP:XI Seal or stamp of the AeMC, AME or OHMP:</td></tr><tr><td valign="top" width="302">2</td><td valign="top" width="302">3</td></tr></table>

\* Date of issue is the date the Cabin Crew Medical Report is issued and signed.

GM1 MED.C.030(b) Cabin crew medical report

ED Decision 2019/002/R

GENERAL

The format of the cabin crew medical report may be as shown
in the example below, with the size of each sheet being 1/8 of A4.

<table border="1" cellpadding="0" cellspacing="0" width="604">
<tr>
<td valign="top" width="293">
State of issue
CABIN CREW MEDICAL REPORT 
 FOR CABIN CREW ATTESTATION (CCA) 
 APPLICANT OR HOLDER
</td>
<td valign="top" width="293">
</td>
<td valign="top" width="19">
</td>
</tr>
</table>

<table border="1" cellpadding="0" cellspacing="0" width="604">
<tr>
<td valign="top" width="302">
I             The
 State where the aero-medical assessment is conducted:
III          Cabin crew attestation reference
 number:
IV          Last and first name:
XIV        Date of birth (dd/mm/yyyy):
VI          Nationality:
VII         Signature of CCA applicant/holder:
</td>
<td valign="top" width="302">
II            Aero-medical assessment result (fit/unfit):
              Expiry date of the previous
 cabin crew medical report (dd/mm/yyyy):
              Date of aero-medical assessment
 (dd/mm/yyyy):
X            Date of issue* (dd/mm/yyyy): 
X            Signature of the AeMC, AME or
 OHMP:
XI          Seal or stamp of the AeMC, AME or
 OHMP:
</td>
</tr>
<tr>
<td valign="top" width="302">
2
</td>
<td valign="top" width="302">
3
</td>
</tr>
</table>

\* Date of issue is the date the Cabin Crew
Medical Report is issued and signed.

<table border="1" cellpadding="0" cellspacing="0" width="605">
<tr>
<td valign="top" width="310">
XII         Limitation(s), if applicable:
              Code:
              Description:
              Code:
              Description:
              Code:
              Description:
</td>
<td valign="top" width="295">
IX          Expiry date of this medical report
 (dd/mm/yyyy): 
</td>
</tr>
<tr>
<td width="310">
4
</td>
<td width="295">
5
</td>
</tr>
</table>

##### GM1 MED.C.030(b) Cabin crew medical report

*ED Decision 2019/002/R*

**GENERAL**

The format of the cabin crew medical report may be as shown in the
example below, with the size of each sheet being 1/8 of A4.

<table cellpadding="7" cellspacing="0">
<col/>
<col/>
<col/>
<tr valign="top">
<td>
State
			of issue

 


 


 


 


 


 


 


 


CABIN
			CREW MEDICAL REPORT 
FOR CABIN CREW ATTESTATION
			(CCA) 
APPLICANT OR HOLDER

 


 


 


 


 


 


 


 


 


 


 


 

 

</td>
<td>
 

</td>
<td>
 

</td>
</tr>
</table>

<table cellpadding="7" cellspacing="0">
<col/>
<col/>
<tr valign="top">
<td>
I	The
			State where the aero-medical assessment is conducted:

 


 


III	Cabin
			crew attestation reference number:

 


 


IV	Last
			and first name:

 


 


XIV	Date
			of birth (dd/mm/yyyy):

 


 


VI	Nationality:

 


 

VII	Signature
			of CCA applicant/holder:
</td>
<td>
II	Aero-medical
			assessment result (fit/unfit):

 


 


	Expiry
			date of the previous cabin crew medical report (dd/mm/yyyy):

 


 


	Date
			of aero-medical assessment (dd/mm/yyyy):

 


 


X	Date
			of issue* (dd/mm/yyyy): 


 


 


X	Signature
			of the AeMC, AME or OHMP:

 


 

XI	Seal
			or stamp of the AeMC, AME or OHMP:
</td>
</tr>
<tr valign="top">
<td>
2
</td>
<td>
3
</td>
</tr>
</table>

\* Date of issue is the date the
Cabin Crew Medical Report is issued and signed.

<table cellpadding="7" cellspacing="0">
<col/>
<col/>
<tr valign="top">
<td>
XII	Limitation(s),
				if applicable:

	Code:

	Description:

 


 


 


 


	Code:

	Description:

 


 


 


 


	Code:
	Description:
</td>
<td>
IX	Expiry
				date of this medical report (dd/mm/yyyy): 

</td>
</tr>
<tr>
<td>
4
</td>
<td><a name="_Toc311641384"></a><a name="_Toc311641024"></a><a name="_Toc264294527"></a>
5
</td>
</tr>
</table>

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GM1 MED.C.030(b) Cabin crew medical report

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