Workboat International DMCCO

REPORTING OF MARITIME LABOUR COMPLAINTS NOT RESOLVED ON BOARD

Note:
1) Seafarers are encouraged to utilize the vessel's Onboard Complaint Procedures in order to resolve complaints at the lowest level possible in accorda
2006. However, in the event a complaint is unable to be resolved on board, the form below is to be completed and sent to the office according to proced
MLC Compliance Manual.

2) The Company will take necessary steps to investigate the matter, ensure that appropriate measures are taken to rectify deficiencies and report it to th
where necessary. It may be noted that all information provided will be strictly treated as confidential.

1 Seafarers Book Number

2 Vessel Name
2a Vessel IMO Number
2b Master Name

3 Seafarers First Name

4 Seafarers Last Name
5 Seafarers Date of Birth (mm/dd/yyyy)

6 Seafarers Contact Details please enter the Seafarers contact details below so that complaint follow up can be done.
6a Seafarers Email Address
6b Please re-enter Seafarers Email Address to confirm

6c Seafarers Alternate Email Address

6d Seafarers Telephone Number

6e Seafarers Address
7 Please indicate the nature of the complaint by selecting one of
the following options

8 Date that onboard complaint was filed (mm/dd/yyyy)

9 Onboard complaint was filed at the following level(s)

(Select all that apply)

10 Brief summary of why the complaint was not resolved

11 Was the complaint taken to the next level?

12 If you selected NO for Box 11, please explain why complaints

should not be taken to the next level

13 If onboard complaint procedures were not used, provide reason

for not using onboard complaint procedure *
 14 Does the complaint relate to one of the following. NOTE:
Please select the area or areas to which the complaint most
closely applies

15 Brief summary of the complaint related to the area(s) selected in

Box 14 *

16 Is this complaint being submitted by the Seafarer? * NOTE: If

you selected NO, please complete the fields 17a-17g

17 Contact Details for Individual other than the Seafarer please enter contact details of person other than seafarer so that Company / Admisitration c
complaint regarding the Seafarer.

17a First Name *

17b Last name
17c Email Address

17d RE-enter email address

17e Telephone Number
17f Address

17g Relationship to the seafarer

18 Give list of supporting documents that are being sent with this
complaint

Seafarer's Signature
Date:
 Template No: WBI T12
Date: 06.08.2013
ternational DMCCO Rev No: 00
Rev Date: NYR

ARITIME LABOUR COMPLAINTS NOT RESOLVED ON BOARD

Onboard Complaint Procedures in order to resolve complaints at the lowest level possible in accordance with MLC
to be resolved on board, the form below is to be completed and sent to the office according to procedure given in the

tigate the matter, ensure that appropriate measures are taken to rectify deficiencies and report it to the administration
on provided will be strictly treated as confidential.

s please enter the Seafarers contact details below so that complaint follow up can be done.

a) Complaint relates to a single seafarer

b) General complaint affecting specific working or living condition

a) Head of Department on the vessel

b) Master
c) WBI
d) MEDS
e) ALAM

a) Yes

b) No
 a) Recrutiment and Placement Services (Manning Agency)

b) Seafarers Employment Agency

c) Payment of Wages
d) Hours of Work or hours of Rest
e) Entitlement of leave
f) Repatriation
g) Accomodation Facilities
h) Food, Water and Catering
i) Medical Care on board and ashore
j) Other

a) Yes
b) No

afarer please enter contact details of person other than seafarer so that Company / Admisitration can follow-up with

Department Head Name & Signature Master's Signature

Date: Date: