Most people attending an ENG1 medical receive their certificate on the day of their appointment. However, some medical conditions require additional assessment before a decision can be made. As MCA Approved Doctors, we are required to apply the same published medical standards fairly and consistently to every seafarer and cannot make exceptions, even where joining a vessel is urgent. We understand that delays or restrictions can be disappointing, and where further tests, treatment or specialist advice are needed, we will do our best to explain the process clearly and support you in obtaining the information needed to reach a final decision. This guide answers some of the most common questions about the ENG1 medical and certification process.

This guide covers some of the questions we are most commonly asked about the ENG1 medical examination. It is not a complete summary of the MCA medical standards, and every assessment is considered individually. If you would like to review the full guidance, the current MCA medical standards are published in MSN 1886.

Does booking an ENG1 guarantee I will receive a certificate?

No.

An ENG1 appointment is an independent medical assessment. While most candidates are issued with a certificate, this cannot be guaranteed.

Your MCA Approved Doctor must decide whether you meet the required medical standards based on your medical history, examination and any additional information available.

I have a medical condition. Can I still get an ENG1?

Many seafarers work safely with long-term medical conditions, and having a diagnosis does not automatically prevent you from obtaining an ENG1.

However, some conditions require additional information, specialist reports, or evidence that they are well controlled before a decision can be made. If you have a significant medical history, we recommend arranging a routine check-up with your usual doctor before your ENG1 and bringing any recent clinic letters, investigation results or specialist reports to your appointment. This can often help avoid unnecessary delays.

The questions below cover some of the conditions we are most commonly asked about. They are intended as general guidance only and are not a complete summary of the MCA medical standards. Every ENG1 assessment is considered individually, and the full guidance is available in MSN 1886.

Which medical conditions commonly need further assessment?

The following conditions commonly require additional review or supporting information. This does not necessarily mean you cannot receive an ENG1. Many seafarers with these conditions are able to work safely at sea, but further assessment or evidence that the condition is well controlled may be needed.

The list below is intended as general guidance and is not exhaustive. Every ENG1 assessment is considered individually in accordance with the MCA medical standards.

High blood pressure

Blood pressure is measured during every ENG1 examination.

If your blood pressure is high, treatment may be needed before a certificate can be issued.

If you have previously been diagnosed with high blood pressure, it is a good idea to have it checked by your usual doctor before your ENG1 appointment.

Diabetes

Many people with diabetes can obtain an ENG1.

Depending on your treatment and blood sugar control, additional information may be required.

Please bring details of your medication and, if available, your most recent diabetes review.

Heart disease

Previous heart attacks, angina, abnormal heart rhythms and other heart conditions often require specialist reports before certification.

If you have recently seen a cardiologist, please bring copies of your clinic letters and any recent investigation results.

Kidney disease or abnormal urine tests

Blood or protein in the urine sometimes requires further investigation before a certificate can be issued.

If you have a history of kidney disease, bringing recent test results or clinic letters can often help avoid delays.

kidney stones

A history of kidney stones does not automatically prevent you from obtaining an ENG1. However, the MCA medical standards recognise that a kidney stone can recur unexpectedly and cause severe pain and other problems, which may make it unsafe to work at sea.

If you have had a kidney stone, recurrent kidney stones, or are currently undergoing investigation or treatment, further assessment is often required before an ENG1 can be issued. In some cases, this may mean delaying certification until there is evidence that the risk of another stone is acceptably low.

If you have a history of kidney stones, please bring any recent urology clinic letters, scan reports (such as ultrasound or CT), and details of any treatment you have received. Having this information available can often help avoid unnecessary delays.

obesity

Being overweight does not automatically prevent you from obtaining an ENG1. However, significant obesity is one of the more common reasons that additional assessment is required before certification can be issued. This is particularly likely if your BMI is above 35 or if your weight is associated with conditions such as high blood pressure, diabetes or sleep apnoea.

Your Approved Doctor must be satisfied that you can safely carry out emergency duties on board. In some cases, this may require further assessment before an ENG1 can be issued.

If your BMI is above 35, we recommend allowing extra time before joining a vessel, as additional investigations or functional assessment may be required.

Vision and hearing problems

Minimum eyesight and hearing standards apply. If you wear glasses or contact lenses, please bring them to your appointment.

If you already know your vision has changed or if you wear glasses/contact lenses, it is worth arranging an eye test before attending your ENG1 to ensure everything is up to date.

Epilepsy, seizures or loss of consciousness

These conditions often require specialist assessment before certification.

Please bring any recent neurology clinic letters or investigation results if available.

Mental health conditions

Having a history of anxiety, depression or another mental health condition does not automatically prevent certification.

Your Approved Doctor will consider how well your condition is controlled, any treatment you are receiving, and whether it could affect your ability to work safely at sea.

Asthma and other lung conditions

Many people with asthma or other long-term lung conditions can obtain an ENG1.

Your Approved Doctor will consider how well your condition is controlled, how often you need medication, whether you have required hospital treatment, and whether your condition could affect your ability to work safely at sea.

If you have recently seen a respiratory specialist or had lung function tests, please bring copies of your clinic letters or test results.

Recent surgery or hospital admission

If you have recently had an operation, been admitted to hospital, or are recovering from a significant illness or injury, you may need additional assessment before an ENG1 can be issued.

This does not necessarily mean you cannot return to work at sea, but your Approved Doctor must be satisfied that you have recovered sufficiently to carry out your duties safely and that the risk of complications at sea is acceptably low.

Please bring your hospital discharge summary, operation notes (if available), and any recent clinic letters relating to your treatment or recovery.

What happens if I can't receive my ENG1 on the day?

Many seafarers receive their ENG1 certificate at the end of their appointment. However, if further information or investigations are needed, it is sometimes necessary to delay certification.

This does not necessarily mean you will be unable to work at sea. In many cases, we simply need additional evidence to show that a medical condition is stable and meets the MCA medical standards.

Depending on your individual circumstances, your Approved Doctor may ask you to:

• provide a recent clinic letter from your GP or specialist

• undergo further investigations, such as blood tests, an ECG, lung function tests or imaging

• attend a specialist review

• allow time for a medical condition to recover or stabilise before reassessment

• wait while we seek advice from the MCA's Chief Medical Adviser (CMA) in the UK if your case requires specialist guidance.

We understand that delays can be frustrating, particularly if you have already accepted a job or travelled to Mallorca for your medical. Wherever possible, we will explain exactly what information is needed and help you obtain it as efficiently as possible.

If we are unable to issue an ENG1 immediately, we will discuss the next steps with you before you leave the clinic.

Understanding ENG1, ENG2, ENG3 and ENG4

There are several different forms and outcomes used during the ENG1 medical examination. These can be confusing, particularly if you have never had an ENG1 before.

ENG1 – Medically fit

An ENG1 certificate confirms that you have been assessed as medically fit for work at sea under the MCA medical standards.

Some ENG1 certificates are issued with restrictions or for a shorter period than the standard two years if ongoing medical review is required.

ENG2 – Medical examination report

An ENG2 is not a medical certificate. It is the official record of your medical examination completed by the Approved Doctor.

If further information is needed, or advice is sought from the MCA's Chief Medical Adviser (CMA), the ENG2 forms part of the assessment process.

Receiving an ENG2 does not mean you have failed your medical.

ENG3 – Temporarily unfit

An ENG3 means that you are temporarily medically unfit for work at sea.

This is often issued while further investigations, treatment or specialist reports are awaited, or while a medical condition recovers or stabilises.

In many cases, an ENG3 is a temporary step before reassessment and does not necessarily mean you will be permanently unable to work at sea.

ENG4 – Permanently unfit

An ENG4 means that, under the current MCA medical standards, you are considered permanently medically unfit for seafaring duties.

This outcome is uncommon and is usually reserved for medical conditions where the risk to you or others at sea cannot be reduced to an acceptable level.

Can I appeal an ENG1 decision?

Yes. If you disagree with an ENG1 decision, you have the right to appeal through the Maritime and Coastguard Agency (MCA).

The appeals process is independent and allows another Approved Doctor, appointed by the MCA, to review your case. Details of how to appeal will be provided if your application is refused.

In some cases, obtaining additional medical evidence or completing further investigations may resolve the issue without the need for a formal appeal. Your Approved Doctor will explain what information is required and discuss the most appropriate next steps with you.

Please remember that MCA Approved Doctors are required to apply the published medical standards consistently and cannot make exceptions outside those standards.