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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