Global malaria management and control policy and implementation PO-GL-HSE-007 Date: 29.9.2008 1.

Objective In recognition of the serious health risks faced by employees and subcontractors when operating in areas where malaria is endemic Subsea 7 will implement a sys thematic management and control programme in accordance with the recommendations of the WHO. The objectives of the malaria control plan are to: Increase awareness of staff, visitors, and contractors on the health risks presented by malaria. Prevent staff, visitors, and contractors from contracting malaria through the use of bite prevention and chemical prophylaxis as appropriate. Minimize the health risk by ensuring access to ear ly diagnosis and treatment if prevention efforts are unsuccessful. 2. Scope This global policy is applicable across all Subsea 7 business units that have operations in, or personnel visiting, malaria endemic regions defined by the WHO (appendix A5). 3. Application The malaria management and control plan applies to all Subsea 7 personnel and subcontractors who travel to or reside in infected countries or infected zones within coun tries following specialist medical advice. It is strongly advised that employees, dependents, and visitors fully comply unless otherwise indicated. Employees, dependents, and visitors who are semi-immune are encouraged to comply with the aspects of the plan. Non-immune persons are those that are not native to a particular malaria area. Semi-immune persons are those that have been repeatedly exposed over their lifetime and have acquired some partial immunity to the malaria parasite. Typically, nationals that have not spent any significant time outside of the malaria area. Immunity is normally lost after about 3 months absence from the malaria zone. All non-immune personnel who travel to infected countri es on business are strongly advised to take chemoprophylaxis in consultation with their personal general practitioners, the company medical advisers and a medical practitioner specialised in tropical medicine. All non-immune staff that reside (expatriates) in infected countries are strongly advised to take chemoprophylaxis in consultation with their personal general practitioners and a medical practitioner specialised in tropical medicine. All non-immune personnel (expatriates, commuters and business travellers) travelling to remote locations or to offshore worksites more than 12 h from specialist medical facilities are required to take chemoprophylaxis. Employees unable or unwilling to comply with this requirement will not be allowed to remain in the malaria infected region. Requirements for sub-contractors Sub-contractors doing work on Subsea 7s behalf must,

as a minimum, meet Subsea 7s standards for malaria management. The sub-contractor organisation is respon sible for developing procedures that assure malaria management requirements are communicated to its personnel and for verifying compliance. 4. Policy implementation The policy will be implemented through the execution of project health and safety plans and in association with the HR and travel departments. 5. Roles and responsabilities Responsibilities under the MMCP: 5.1. Departament and project management Actively support the MMCP. Require all personnel to be informed about the MMCP and its requirements. Each offshore project is to ensure that arrangements for the early diagnosis and treatment are available at the worksite, and that there is access to local onshore specialist medical facilities for any suspected cases of malaria. 5.2. HSEQ Ensure that the malaria control plan is included in the HSEQ briefing. Organize and supervise mosquito control measures. Monitor and audit mosquito control measures. Organize distribution of malaria awareness information and literature. Coordinate the display of printed awareness materials. Report the audit results and other relevant data. Provide malaria information pertinent to the specific country. Update recommendations as necessary. Coordinate efforts with HR, health care providers, and other emergency aid providers. Obtain relevant data for reporting malaria cases and other pertinent issues. Coordinate chemoprophylaxis compliance testing. 5.3. Home country health care provider or designed company provider Provide supply of anti malarial drugs. Provide supply of repellent such as DEET. Provide supply of insecticide such as permethrin. Provide awareness material.

5.4. Semi-immune personnel Participate in the HSEQ MMCP awareness programme at hire and annual training programme. Use prevention against mosquito bites: repellents, insecticides, and nettings. Wear long sleeve shirts and trousers during work hours, especially between sunset and sunrise when mosquitoes feed (also recommended offwork). Report any signs and symptoms such as suspectted fever, headache or general malaise immediate ly to the worksite medic, health care provider and HSEQ.

5.5. Non-immune personnel Visit the home country health care provider when planning travel to infected countries. Participate in the HSEQ MMCP awareness programme on mobilisation and prior to initial visit to malaria zone. Use appropriate prevention against mosquito bites: repellents, insecticides, and nettings. Wear long sleeve shirts and trousers during work hours, especially between sunset and sunrise when mosquitoes feed (also recommended offwork). Adhere to programme guidelines regarding aware ness, bite prevention, and the chemoprophylaxis of choice for the specific country. Report any signs and symptoms such as suspectted fever, headache or general malaise immediately to the worksite medic, health care provider and HSEQ. 6. Malaria control plan Malaria is a serious disease transmitted to humans by the bite of an infected female Anopheles mosquito. Malaria can often be prevented by using antimalarial dru gs and by using personal protection measures to prevent mosquito bites. The key components of the programme are based on the WHO ABCD systematic preventative measures of: Awareness, ensuring that all personnel are educated in identifying the risks, the prevention, and the identification of early signs and symptoms. Bite prevention, which is the most effective and im portant means of preventing malaria. Chemical prophylaxis ( the anti-malarial medicateon) is a critical component of the control programme and Diagnosis and treatment. Importance of early diag nosis and programme evaluation. 7. Awareness and personnel prevention The employee educational and orientation programme covers general malaria awareness as well as personal prevention guidelines. AWARENESS Description of malaria Mode of transmission Mode of infection Early recognition of symptoms and signs Role of immunity Bites BITE PREVENTION Self-protection measures and best practices Mosquito control measures CHEMOPROPHYLAXIS Role of chemoprophylaxis Preferred chemoprophylaxis Concerns versus risks of not using chemoprophylaxis DIAGNOSIS Importance of prompt diagnosis Health care providers available for diagnosis Appropriate medical treatment Routine testing and procedures 8. Personal malaria protection measures

The personal malaria protection measures are divided into four categories. 1. Awareness. 2. Personal protection measures: bite prevention & chemoprophylaxis, clothing, bed nets. 3. Mosquito control measures: sprays, repellents, and vector control through elimination of adult mosquitoes, their larvae and breeding grounds. 4. Early diagnosis and treatment. As none of the control measures alone can guarantee complete protection against malaria, it is important to use all available measures to prevent malaria infections. A combination of personal protection and mosquito control measures will help prevent mosquito bites. Chemoprophylaxis helps to prevent the development of malaria following an infectious bite. The goal of personal protection measures is to avoid coming in contact with mosquitoes and mosquito bites. Every individual should be aware of and practice the following protective measures: Mosquito skin repellent - mosquito skin repellent containing DEET should be used. Care must be ta ken to avoid contact with mucous membranes. Insect repellents should not be sprayed on the face or applied to the eyelids or lips. Always wash the hands after applying the repellent. Insect repellents should not be applied to sensitive, sunburned or damaged skin or deep skin folds. Repeated applications may be required every 34 h, especially in hot and humid climates. When the product is appli ed to clothes, the repellent effect lasts longer. Repellents should be used in strict accordance with the manufacturers instructions and the dosage must not be exceeded, especially for young children. The HSEQ department will maintain a supply of approved mosquito repellents and will supply employees when requested. Personnel will be reminded of recommended usage as part of the malaria awareness programme. Bed nets - permethrin treated mosquito nets will be made available for each sleeping area or bed of employees that does not have effective air conditioning. The bed nets will be used where mosqui to proofing is not possible or is ineffective. Protective clothing can be help at times of the day when mosquitoes are active. The thickness of the material is critical, and no skin should be left exposed unless treated with a repellent. Insect repellent applied to clothing is effective for longer than it may be on the skin. Extra protection is provided by treating clothing with permethrin or etofenprox, to prevent mosquitoes from biting through clothing. Label instructions should be followed to avoid damage to certain fabrics. It should not be applied to underwear, hats, waterproof materials, Nomex, or specialty gear. All personnel should wear long sleeved shirts and pants during work hours, long sleeved coveralls for offshore personnel (usage during non-work hours is strongly encouraged). Other requirements may apply as a result of other safety factors in the work environment. 9. Chemoprophylaxis The objective of chemoprophylaxis is to prevent the development of malaria following an infectious bite by a mosquito.

There are several chemoprophylactics available and recommendation of which to use is dependent on the region being visited. Chemoprophylactics include chloroquine and proguanil, atovaquone/proguanil, doxycycline, mefloquine, and primaquine (in some cases, but not in the UK). However, some clients have approved the use of speci fic medication such as mefloquine, atovaquone/proguanil and doxycycline and will reject non-approved medications. Consult Subsea 7 and your health care provider for advice regarding the required medicine for the location. All persons travelling to infected countries should start taking approved malaria prophylaxis as prescribed prior to departure. All personnel arriving in an infected country should inform the local HSEQ department of the type of prophylaxis they are taking. Any person arriving in an infected country who is not taking an approved prophylaxis, or whose sup ply runs out should contact the local HSEQ department immediately. All non-immune permanent residents (expatriates) are strongly advised to take an approved chemoprophylaxis except when visiting or located in a re mote location without access to specialist medical facilities within 12 h (worksite medical facilities are not specialist). 10. Mosquito control measures The intent of mosquito control measures is to reduce the factors that promote the presence and propagation of mosquitoes in areas near Subsea 7 facilities. The local HSEQ representative will supervise and assist local staff to organize and implement the following control measures: At work location and accommodation elimina te standing water where possible, repair windows and door screens, seal any access holes, make sure that air conditioning equipment is working pro perly and used. Note that this list is an example and not to be considered all inclusive. Mosquito coils are the best known example of insecticide vaporizer, usually with a synthetic pyreth roid as the active ingredient. One coil serves a nor mal bedroom through the night, unless the room is particularly draughty. A more sophisticated version, which requires electricity, is an insecticide mat that is placed on an electrically heated grid, causing the insecticide to vaporise. Aerosol sprays intended to kill flying insects are effective for quick knockdown and killing. Indoor sleeping areas should be sprayed before bedtime. Treating a room with an insecticide spray will help to free it from insects, but the effect may be shortli ved. Spraying combined with the use of a coil, a vaporiser or a mosquito net is recommended. Additional control measures: air-conditioning is a highly effective means of keeping mosquitoes and other insects out of a room. In air-conditioned hotels, other precautions are not necessary indoors. 11. Diagnosis and treatment Early diagnosis and treatment of a malaria infected person is critical in preventing severe or lethal health effects.

Symptoms may include fever and flu-like illness, including chills, headache, muscle aches, and fatigue. Malaria may cause anemia and jaundice. Plasmodium falcipa rum infections, (found predominantly in west africa) if not immediately treated, may cause kidney failure, coma, and death. Malaria symptoms will occur at least 7 to 9 days after being bitten by an infected mosquito. Fever in the first week of travel in a malaria-risk area is unlikely to be malaria; however, any fever should be promptly evaluated. Malaria is always a serious disease and may be a deadly illness. If a staff member becomes ill with a fever or flu-like illness either while travelling in a malaria-risk area or after their return home (for up to 1 year), they should seek immediate medical attention. Rapid test kits for the early detection of malaria will be made available for all remote sites and offshore locationns where access to a specialist medical facility is not available within 12h of the onset of first symptoms. The test kit is not an alternative to the standard diagnostic blood test and caution is advised in determining a case of malaria when the patient has convincing symptomms. It is useful where the symptoms are not typical of malaria and additional confirmatory evidence is required. In other words, if the symptoms are classic, use the stand-by emergency treatment followed by a confirmatory test from a competent doctor. If the rapid test kit proves negative then a telephone /radio consultation with a medical specialist is required. All positive tests should be immediately confirmed by a medical doctor so appropriate treatment can be provided. In the event of a confirmed malaria case: 1. Continue chemoprophylaxis as outlined by drug manufacturer and health care provider. 2. Immediately inform the HSEQ department. 3. Immediately inform the companys medical officer. 11.1. Emergency treatment If a diagnosis cannot be obtained within 12h of the onset of symptoms then standby emergency treatment (SBET) will be indicated. Worksites or personnel provided with stand-by emergency treatment should be given clear and precise written instructions on the recognition of symptoms, when and how to take the treatment, the treatment regimen, possible side-effects, and the possibility of drug failure. st They should be made aware that self-treatment is a 1 aid measure, and that they should seek medical advice as soon as possible. In general, personnel carrying stand-by emergency treat ment should observe the following guidelines: Consult a physician immediately if fever occurs 1 week or more after entering an area with malaria risk. If it is impossible to consult a physician and/or establish a diagnosis within 24 h of the onset of fever, start the stand-by emergency treatment and seek medical care as soon as possible for complete evaluation and to exclude other serious causes of fever. Complete the stand-by treatment course and rest sume antimalarial prophylaxis 1 week after the 1 treatment dose. Mefloquine prophylaxis, however, should be resumed 1 week after the last treatment dose of quinine.

 Vomiting of antimalarial drugs is less likely if fever st nd is 1 lowered with antipyretics. A 2 full dose should be taken if vomiting occurs within 30min. of taking the drug. If vomiting occurs 3060 min. after a dose, an additional half-dose should be taken. Vomiting with diarrhoea may lead to treatment failure because of poor drug absorption. Do not treat suspected malaria with the same drugs used for prophylaxis, because of the increased risk of toxicity and resistance. Depending on the area visited and the chemoprophylaxis regimen taken, one of the following stand-by treatment regimens can be recommended: chloroquine, (P. vivax areas only), mefloquine, quinine, or quinine fol lowed by doxycycline. Offshore SBET If SBET is administered offshore the patient must be transferred to a specialist medical facility at the earliest opportunity to confirm the diagnosis. 12. Additional training for worksite medic Where operations are planned in remote regions where malaria is endemic and access to specialist medical laboratory facilities cannot be achieved within 12 hours, the worksite medics or a person nominated by the project shall be provided with additional training on the diagnosis and emergency treatment of malaria. 13. Chemoprophylaxis compliance testing Where the use of chemoprophylaxis is mandatory, the company reserves the right to conduct random, unannounced urinalysis for the presence of chemo-prophylactics in nonimmune personnel. All personnel assigned to a malarial zone must acknowledge compliance with the programme by signing an employee statement of understanding and compliance (appendix A2) and on leaving an area the employee signs an employee departure acknowledgement (appendix A 3). Each employee should be issued with an employee information card (appendix A4) which provides information for a doctor advising possible exposure to malaria. The regional HSE department will administer this process. 14. Reporting The regional HSEQ department will be responsible for maintaining a database of reportable cases of malaria. The definition of reportable cases of malaria is defined by the company as follows: All confirmed malaria cases in non-immune personnel; Confirmed cases in semi-immune personnel with any one of the following criteria: hospitalisation for treatment; 5% parasitaemia; patient meeting criteria for severe malaria under WHO standards 15. Project interface The following table sets out the project responsibilities for programme implementation. Appedix A1: malaria information note. A1.1. General considerations.

Malaria is a common and life-threatening disease in many tropical and subtropical areas. It is currently endemic in over 100 countries. Each year many international travellers fall ill with malaria while visiting countries where the disease is endemic, and well over 10.000 fall ill after returning home. Fever occurring in a traveller within 3 months of leaving a malaria-endemic area is a medical e mergency and should be investigated urgently. A1.2. Cause Human malaria is caused by four different species of the protozoan parasite plasmodium: Plasmodium falciparum, P. vivax, P. ovale and P. malariae. A1.3. Transmission The malaria parasite is transmitted by various species of Anopheles mosquitoes, which bite mainly between sunset and sunrise. A1.4. Nature of desease Malaria is an acute febrile illness with an incubation period of 7 days or longer. Thus, a febrile illness developping less than one week after the first possible exposure is not malaria. The most severe form is caused by P. falciparum, in which variable clinical features include fever, chills, headache, muscular aching and weakness, vomiting, cough, di arrhoea and abdominal pain; other symptoms related to organ failure may supervene, such as: acute renal failure, generalized convulsions, circulatory collapse, followed by coma and death. It is estimated that about 1% of patients with P. falciparum infection die of the disease. The initial symptoms, which may be mild, may not be easy to recognise as being due to malaria. It is important that the possibility of falciparum malaria is considered in all cases of unexplained fever starting at any time between the seventh day of first possible exposure to malaria and three months (or, rarely, later) after the last possi ble exposure, and any individual who experiences a fever in this interval should immediately seek diagnosis and effective treatment. Early diagnosis and appropriate treatment can be life-saving. Falciparum malaria may be fatal if treatment is delayed beyond 24h. A blood sample should be examined st for malaria parasites. If no parasites are found in the 1 blood film but symptoms persist, a series of blood samples should be taken and examined at 612h intervals. Pregnant women, young children and elderly travellers are particularly at risk. Malaria in pregnant travellers increases the risk of maternal death, miscarriage, stillbirth and neonatal death. The forms of malaria caused by other Plasmodium species are less severe and rarely lifethreatening. 1.1 Taken from WHO, international travel and health, 23 april 2004. Prevention and treatment of falciparum malaria are becoming more difficult because P. falciparum is increasingly resistant to various antimalarial drugs. Of the other malaria species, drug resistance has to date been reported for P. vivax, mainly from Indonesia (Irian Jaya) and Papua New Guinea, with more sporadic cases reported from Guyana. P. vivax with declining sensitivety has been reported for Brazil, Colombia, Guatemala, India, Myanmar, the Republic of Korea, and Thailand. P. malariae resistant to chloroquine has been reported from Indonesia.

A1.5. Geographical distribution Malaria is found in most tropical and some sub-tropical regions of the world and the risk for travellers of contracting malaria is highly variable from country to country and even between areas in a country. In many endemic countries of latin america and the caribbean, asia and the mediterranean region, the main urban areasbut not necessarily the outskirts of towns are free of malaria transmission. However, malaria can occur in main urban areas in Africa and India. There is usually less risk of the disease at altitudes above 1500 m, but in favourable climatic conditions it can occur at altitudes up to almost 3000m. The risk of infection may also vary according to the season, being highest at the end of the rainy season. There is no risk of malaria in many tourist destinations in south-east asia, latin america and the caribbean. A1.6. Risk for travellers During the transmission season in malaria-endemic areas, all non-immune travelers exposed to mosquito bites, especially between dusk and dawn, are at risk of ma laria. This includes previously semi-immune travellers who have lost their immunity during stays of 2 years or more in non-endemic areas. Most cases of malaria in travellers occur because of poor compliance with prophy lactic drug regimens or use of inappropriate prophylaxis. Travellers to countries where the degree of malaria trans mission varies in different areas should seek for advice on the risk of malaria in the specific zones that they will be visiting. If specific information is not available before travelling, it is recommended to assume that there is a uniformly high malaria risk throughout the country. This applies particularly to individuals backpacking to remote places and visiting areas where diagnostic facilities and medical care are not readily available. Travellers staying overnight in rural areas may be at highest risk. A1.7. Precations Travellers and their advisers should note the 4 principles of malaria protection: Be aware of the risk, the incubation period, and the main symptoms. Avoid being bitten by mosquitoes, especially between dusk and dawn. Take antimalarial drugs (chemoprophylaxis) to suppress infection when appropriate. Immediately seek diagnosis and treatment if a fever develops one week or more after entering an area where there is a malaria risk, and up to 3 months after departure A1.8. Chemoprophylaxis The correct dosage of the most appropriate antimalarial drug(s) (if any) for the destination(s) should be prescribed. Travellers and their doctors should be aware that no anti-malarial prophylactic regimen gives complete pro tection. The following should also be taken into account: Dosing schedules for children should be based on body weight. Antimalarials that have to be taken daily should be started the day before arrival in the risk area. Weekly chloroquine should be started 1 week before arrival. Weekly mefloquine should be started at least 1

week, but preferably 23 weeks before departure, to provide optimal protective blood levels and to allow any sideeffects to be detected before travel so that possible alternatives can be considered. Antimalarial drugs must be taken with food and swallowed with plenty of water. All prophylactic drugs should be taken with unfairling regularity for the duration of the stay in the ma laria risk area, and should be continued for 4 weeks after the last possible exposure to infection, since parasites may still emerge from the liver during this period. The single exception is atovaquone/proguanil, which can be stopped 1 week after return. Depending on the predominant type of malaria at the destination, travellers should be advised about possible late onset of P. vivax. Depending on the area visite the recommended prophylaxis may be chloroquine, chloroquine plus proguanil, mefloquine or doxycycline. In areas where mefloquine is the prophylactic drug of choice, doxycycline or atovaquone/proguanil can be used as an alternative that can be started the day before travel; chloroquine plus proguanil would offer less protection. Chloroquine on its own can be recommended only for areas where malaria is due exclusively to P. vivax or chloroquine-sensitive P. falciparum. Atovaquone/proguanil offers an alternative prophylaxis for travellers on short trips to areas where there is chloroquine resistance, who cannot take mefloquine or doxycycline. It is registered in 11 european countries for chemo-prophylactic use, with a restriction on body weight (> 40 kg) and duration of use (no more than 28 days). In the USA these restrictions do not apply. All antimalarial drugs have specific contraindications and possible side-effects. Adverse reactions attributed to ma laria chemoprophylaxis are common, but most are minor and do not affect the activities of the traveller. Serious adverse eventsdefined as constituting an apparent threat to life, requiring or prolonging hospitalization, or resulting in severe disabilityare rare. With mefloquine the incidence range of serious adverse events has been estimated at 1 per 6000 to 1 per 10 600 travellers, compared with 1 per 13 600 with chloroquine. The risk of drug-associated adverse events should be weighed against the risk of malaria, especially falciparum malaria, and local drug-resistance patterns. Each of the antimalarial drugs is contraindicated in certain groups and individuals, and the contraindica tions should be carefully considered to reduce the risk of serious adverse reactions. People with chronic illnesses should seek individual medical advice. Any traveller who develops serious side-effects to an antimalarial should stop taking the drug and seek immediate medical attention. This applies particularly to neurological or psychological disturbances after mefloquine treatment. Mild nausea, occasional vomiting or loose stools should not prompt discontinuation of prophylaxis, but medical advice should be sought if symptoms persist. Because of the risk of adverse side-effects, chemoprophylaxis should not be prescribed in the absence of malaria risk. It is important to note that malaria is not present in all tropical countries. A1.9. Long-term use of chemoprophylaxis The risk of serious side-effects associated with long-

term prophylactic use of chloroquine and proguanil is low. However, anyone who has taken 300mg of chloroquine weekly for over 5 years and requires further prophylaxis should be screened twice-yearly for early retinal changes. If daily doses of 100mg chloroquine have been taken, screening should start after three years. An alternative drug should be prescribed if changes are seen. Data indicate no increased risk of serious side-effects with long-term use of mefloquine if the drug is tolerated in the short-term. Experience with doxycycline for longterm chemoprophylaxis (i.e. more than 46 months) is limited, but available data are reassuring. Mefloquine and doxycycline should be reserved for those at greatest risk of chloroquineresistant infections. Atovaquone/proguanil cannot yet be recommended for long-term chemoprophylactic use because of the lack of data. The following table has been produced from WHO data. Note 1. the choice of drug to be used for stand-by treatment depends on the prophylaxis taken and on the presence of drug-resistant malaria in the countries to be visi ted. The drug selected for stand-by treatment should be one to which no resistance has been reported in the countries concerned. Note 2. as yet no stand-by treatment can be recommended for travellers taking atovaquone/proguanil prophylaxis because of the lack of data and the possibility of drug interactions. a) There is limited experience at present of drug interactions with other antimalarial durgs. These drugs cannot therefore be recommended for SBET if the patient is already taking an antimalarial as pro phylaxis. b) In these situations, mefloquine prophylaxis should only be resumed 7 days after the last self-treatment dose of quinine. Appendix A2: employee statement of understanding and compliance I understand that Subsea 7 (the company) is committed to a safe, healthy, and productive workplace for all employees. We take very seriously the threat of illness or death presented by malaria. The company has implemented a malaria control program with the stated goal of no cases of malaria among its non-immune populations. I also understand that this program applies to me because I am considered "non-immune with respect to malaria at the site(s)/in the location(s) where I am going. I have been provided with information about the malaria con trol program as it applies where I am going and if I have any questions about this program I understand that I should seek guidance from a qualified medical professional. I further understand and agree that: 1. It is a condition of my assignment in/travel to a ma larious location that I take an approved malaria chemoprophylaxis (medication designed to help prevent me from contracting malaria if bitten by a mosquito carrying the parasite that causes the disease). The company has advised me that the malaria chemoprophylaxis currently acceptable include malarone, doxycycline, mefloquine (lariam), or other medication at least as effective as one of these three, taken according to a prescribed treatment regiment. I have been advised to consult a travel medicine professional with questions I may have about the side effects that may be inherent in taking malaria chemoprophylaxis.

2. I am subject to unannounced, random and periodic testing to determine my compliance with the re quirement that I take approved malaria chemoprophylaxis as described above and that I am required, as a part of this testing, to provide, when/whe re instructed, a urine sample for laboratory verification of my use of an approved malaria chemoprophylaxis according to the prescribed treatment regimen. 3. If I refuse to submit to a test or if a medical review of the laboratory analysis of my urine specimen do es not indicate that I am taking an approved malaria chemoprophylaxis, I may be declared unfit for work in a malarious location and may be removed from my assignment and/or terminated by the company. Print name: __________________________________ Signature: ___________________________________ Date: ________________________________________ Type of chemoprophylaxis used: ________________ Appendix A3: employee departure acknowledgemen t 1. I have read the project health and security guidance booklet and understand the general rules therein. 2. I understand that I need to keep about my person for at least 12 months following my return home the dear doctor card I have been provided with. I will pass this card on to a doctor as required. 3. I have been advised & understand that as soon as suffer from the signs and symptoms of malaria, such as fever, headache, chills, vomiting, diarrhe a, or symptoms similar to influenza, I need to seek medical advice as soon as possible by going to my GP or to the emergency department of the nea rest hospital. I will mention to the doctor that I have been in a P.falciparum infected country. 4. I am committed to finishing my treatment of antimalarial medication after my return from the exposed area in accordance with the directions for use. 5. I have checked that I have enough medication to fi nish my treatment once at home. If not I will liaise with the medic before I leave the worksite. 6. I understand alcohol limitations after leaving the vessel and that I may be refused access to board the plane in case my behaviour is impaired by alcohol for safety reasons. Print name: Signature: Date: Appendix A4: employee information card health, safety & environment department special information card Name: Known allergies: Dear doctor, the bearer of this card works or has been working in west africa within the last 12 months. Falciparium malaria is endemic and chloroquine malaria is endemic and chloroquine resistance is frequent. Thank you Appendix A5: WHO: countries and territories with malarious a-reas

The following list shows all countries where malaria occurs. In some of these countries, malaria is present only in certain areas or up to a particular altitude. In many countries, malaria has a seasonal pattern. (* = P. vivax risk only). Check with tropical medical adviser for the latest malarious and malaria free zones within these countries.