R/V Atlantic Explorer Personal Information Form

RVAE_CM_508

Please Complete & Submit Electronically

Title & Full Name*

Phone (Bus.)*

Gender*

Male
Female
Other

Affiliation (Inst./Employer)*

Email*

Business Address*

City*

State*

Country*

Postal Code*

Position on Cruise*

Student? (please check)

Grad
Undergrad

Nationality

Date of Birth*

Passport Number*

Expiration Date*

IF APPLICABLE: US VISA #

Expiration Date

Not Required

Person to Notify in Case of Emergency*

Relationship*

Their Address*

Their Phone Number*

Cruise Manual

I have read the R/V Atlantic Explorer Cruise Manual.*

Yes
No

If NO, please do so before cruise departure. The cruise manual can be found at here on the BIOS website.

Medical Information

The undersigned acknowledges they have no physical defects or ailments which would prevent the performance of duties at sea for extended periods of time. If medication is required, adequate provision for a supply of prescription drugs must be made prior to boarding the vessel.

Complete and submit Medical History and Information Form CM_509

OTC & Prescription Drugs (Type)

Not Applicable

Food Allergies/Dietary Restrictions

Insurance Coverage

Persons on board vessels operated by the Bermuda Institute of Ocean Sciences (BIOS), Inc. who are not employees or students of the Institution are considered SHIPBOARD GUEST INVESTIGATORS and are expected to make arrangements for all forms of insurance coverage while participating in research cruises. BIOS assumes no responsibility for non-employees; each must agree to hold BIOS harmless of all liability arising from participation in any voyage on a BIOS vessel.

Complete and submit Release and Assumption of Risk Form CM_510

Alcohol Policy

No alcoholic beverages of any type will be permitted on BIOS vessels. All personnel, including scientific staff from other institutions and visitors, are affected by this regulation and must abide by it.

Drug Policy

BIOS is a Zero Tolerance organization. The possession or use of any controlled substance will not be tolerated. Members of the embarked scientific party are subject to drug and alcohol testing under 46 CFR for reasonable cause and in the event of a “Serious Marine Incident” at the discretion of the Master. In accordance with U.S. and Bermuda Customs, Laws and procedures, the Master can routinely search the ship at any time, including staterooms. This search may include personal effects.

Radioactive Materials Policy

No radio isotopes will be permitted aboard ship without express approval from BIOS Radiation Safety Officer.

Hazardous Materials Policy

Scientists must provide ship with Material Safety Data Sheets (MSDS) for ALL Hazardous Materials.

IF NOT DIGITALLY SIGNED – THIS FORM WILL BE VERIFIED AND SIGNED DURING SAFETY BRIEFING

In signing this document, I acknowledge that I understand and will comply with the stated policies of the vessel as per above; all of which are detailed in the R/V Atlantic Explorer Cruise Manual found online.

Signature*