Beruflich Dokumente
Kultur Dokumente
: 04o-00
Initial Issue Date: 07-03-2012
Revision Date: 00
Items
Quantity
Required
Number
At Hand
Inspection
To be accomplished by
STCW Evaluator
To be accomplished by
STCW Inspector
Complied
Not
Not
Complied
Complied
Complied
Evaluators Comments:
______________________________
Evaluators Name & Signature
Date of Evaluation __________________
Description
1
2
3
4
Form
Substitute
Tablets
Liquid
Aspirin
Otic Drops
Selfassessment
Pre inspection
evaluation
To be
accomplished
by TC
To be accomplished
by
STCW Evaluator
Not
Complied
Complied
Garamycin
Solution
Small
canister with
proper
labeling
Suspension
Tablets
Maalox
suspension
Maalox plus
tablets
MECA / Form 2B / Page 2 of 9
Inspection
To be accomplished
by STCW Inspector
Complied
Not
Complied
Description
7
8
9
Amitriptyline tablets, 25 mg
Ampicillin capsules, 250 mg
10
Antihaemorrhoidal suppositories
11
12
13
14
15
16
17
18
19
Form
Substitute
Suppositories
Small
container
with proper
labeling
Tablets
Tablets
Thorazine
Ampicin
250mg
FACTU
Suppository
Suppositories
Selfassessment
Pre inspection
evaluation
To be
accomplished
by TC
To be accomplished
by
STCW Evaluator
Not
Complied
Complied
Tablets
Ampoules
Vial
Ointment
Lotion
Tablets
Cream
Powder
Tablets
Whitefields
Caladryl
Calcium D
Redoxon
Drapolene
Cream
Aralen
Inspection
To be accomplished
by STCW Inspector
Complied
Not
Complied
Description
20
21
22
23
Form
To be
accomplished
by TC
To be accomplished
by
STCW Evaluator
Not
Complied
Complied
Tablets
Ampoules
Tablets
Empty bottle
with proper
labeling
Ampoules
Empty
ampoule with
proper
labeling
25
Tablets
Empty bottle
with proper
labeling
26
27
Tablets
Liquid
Nodiz
29
30
Pre inspection
evaluation
Substitute
24
28
Selfassessment
Toothache
Drops
Ampoule
Tablets
Box
Valium
Valium
Empty
ampoule with
proper
labeling
Inspection
To be accomplished by
STCW Inspector
Complied
Not
Complied
Description
31
32
33
34
35
36
37
38
39
40
Form
Substitute
Capsule
Doxycycline
Hyelate Cap
Tablets
Empty bottle
with proper
labeling
Selfassessment
Pre inspection
evaluation
To be
accomplished
by TC
To be accomplished
by
STCW Evaluator
Not
Complied
Complied
Ampoules
Ampoules
Methergin
Tablets
Erythrocin
Solution
Alcaine
Chloramphe
nicol
Ointment
Terramycin
Optic Drops
Eye Mo
Strip
Inspection
To be accomplished
by STCW Inspector
Complied
Not
Complied
Description
41
42
43
44
45
46
47
48
49
50
51
52
53
Form
Substitute
Tablets
Tablets
Vial
Lasix
Nitrostat
Ointment
Selfassessment
Pre inspection
evaluation
To be
accomplished
by TC
To be accomplished
by
STCW Evaluator
Not
Complied
Complied
Trimycin
Ointment
Bactroban
Solution
Solution
Ampoule
Lotion
Tablets
Tablets
Cream
Off Lotion
Iodine 2%
Xyclocaine
Kwell Lotion
Simeco
Daktarin
Suppository
Inspection
To be accomplished
by STCW Inspector
Complied
Not
Complied
Description
Form
54
55
Oil
Ampoule
56
Ampoule
57
58
59
60
61
62
63
64
Phenobarbital tablets, 30 mg
Phenoxymethyl penicillin potassium
tablets 250 mg
Pilocarpine hydrochloride eye-drops, 2%,
15-ml dropper bottle
Selfassessment
Pre inspection
evaluation
To be
accomplished
by TC
To be accomplished
by
STCW Evaluator
Not
Complied
Complied
Substitute
Empty
ampoule with
proper
labeling
Ointment
Granules
Oresol
Hydrite
Tablets
Cream
Biogesic
Petroleum
Jelly
Tablets
Tablets
Ophthalmic
Solution
Inspection
To be accomplished
by STCW Inspector
Complied
Not
Complied
Description
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
Form
Powder
Tablets
Vial
Pre inspection
evaluation
To be
accomplished
by TC
To be accomplished
by
STCW Evaluator
Not
Complied
Complied
Substitute
Benzyl
Penicillin
Tablets
Tablets
Tablets
Ampoules
Fancidar
Combantrin
Nebulizer
Vial
Tablets
Vial
Pulmocare
Tablets
Selfassessment
Forgram
Bactrim
Powder
Vial
Ampoule
Solution
Inspection
To be accomplished
by STCW Inspector
Complied
Not
Complied
Description
81
82
83
Form
Selfassessment
Pre inspection
evaluation
To be
accomplished
by TC
To be accomplished
by
STCW Evaluator
Not
Complied
Complied
Substitute
Capsules
Ampoules /
Bottle
Evaluators Comments:
______________________________
Evaluators Name & Signature
Date of Evaluation _______________
Inspection
To be accomplished
by STCW Inspector
Complied
Not
Complied