Příloha č. 3
Vzor formuláře evidence pracovní doby členů posádky lodě
EVIDENCE PRACOVNÍ DOBY ČLENA POSÁDKY LODĚ
RECORD OF HOURS OF WORK OF SEAFARER
Jméno lodě/Name of ship: ................ Vlajka lodě/Ship's flag: ...............
IMO No.: ............ Jméno člena posádky lodě/Seafarer's full name: .............
Pozice na lodi/Position: ........ Člen strážní služby/Watchmember: ano/ne / yes/no
+------------+-----------------------------------------------------------------------------------------------------------------------+----------+------------+-----------+---------------------------+
| | | | | | Nevyplňuje námořník/Not |
| | Hodina/Hour | | | | to be completed by the |
| | | | | | seafarer |
| | | Celkem | Celkem | Poznámka/ | |
| Datum/Date +----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+ práce/ | odpočinek/ | Note +-------------+-------------+
| | | | | | | | | | | | | | | | | | | | | | | | | | Work | Rest hours | | Práce za | Práce za |
| | 00 | 01 | 02 | 03 | 04 | 05 | 06 | 07 | 08 | 09 | 10 | 11 | 12 | 13 | 14 | 15 | 16 | 17 | 18 | 19 | 20 | 21 | 22 | 23 | hours | in total | | 24 hodin/ | 7 dní/ |
| | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | in total | | | Hours of | Hours of |
| | 01 | 02 | 03 | 04 | 05 | 06 | 07 | 08 | 09 | 10 | 11 | 12 | 13 | 14 | 15 | 16 | 17 | 18 | 19 | 20 | 21 | 22 | 23 | 24 | | | | work within | work within |
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | 24 hours | 7 days |
+-----+------+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----------+------------+-----------+-------------+-------------+
| 1. | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
+-----+------+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----------+------------+-----------+-------------+-------------+
| 2. | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
+-----+------+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----------+------------+-----------+-------------+-------------+
| 3. | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
+-----+------+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----------+------------+-----------+-------------+-------------+
| 4. | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
+-----+------+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----------+------------+-----------+-------------+-------------+
| 5. | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
+-----+------+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----------+------------+-----------+-------------+-------------+
| 6. | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
+-----+------+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----------+------------+-----------+-------------+-------------+
| 7. | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
+-----+------+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----------+------------+-----------+-------------+-------------+
| Potvrzení člena posádky/Seafarers confirmation | Podpis/Signature: |
+-----+------+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----------+------------+-----------+-------------+-------------+
| 8. | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
+-----+------+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----------+------------+-----------+-------------+-------------+
| 9. | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
+-----+------+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----------+------------+-----------+-------------+-------------+
| 10. | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
+-----+------+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----------+------------+-----------+-------------+-------------+
| 11. | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
+-----+------+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----------+------------+-----------+-------------+-------------+
| 12. | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
+-----+------+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----------+------------+-----------+-------------+-------------+
| 13. | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
+-----+------+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----------+------------+-----------+-------------+-------------+
| 14. | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
+-----+------+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----------+------------+-----------+-------------+-------------+
| Potvrzení člena posádky/Seafarers confirmation | Podpis/Signature: |
+-----+------+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----------+------------+-----------+-------------+-------------+
| 15. | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
+-----+------+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----------+------------+-----------+-------------+-------------+
| 16. | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
+-----+------+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----------+------------+-----------+-------------+-------------+
| 17. | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
+-----+------+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----------+------------+-----------+-------------+-------------+
| 18. | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
+-----+------+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----------+------------+-----------+-------------+-------------+
| 19. | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
+-----+------+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----------+------------+-----------+-------------+-------------+
| 20. | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
+-----+------+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----------+------------+-----------+-------------+-------------+
| 21. | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
+-----+------+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----------+------------+-----------+-------------+-------------+
| Potvrzení člena posádky/Seafarers confirmation | Podpis/Signature: |
+-----+------+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----------+------------+-----------+-------------+-------------+
| 22. | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
+-----+------+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----------+------------+-----------+-------------+-------------+
| 23. | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
+-----+------+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----------+------------+-----------+-------------+-------------+
| 24. | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
+-----+------+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----------+------------+-----------+-------------+-------------+
| 25. | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
+-----+------+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----------+------------+-----------+-------------+-------------+
| 26. | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
+-----+------+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----------+------------+-----------+-------------+-------------+
| 27. | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
+-----+------+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----------+------------+-----------+-------------+-------------+
| 28. | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
+-----+------+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----------+------------+-----------+-------------+-------------+
| Potvrzení člena posádky/Seafarers confirmation | Podpis/Signature: |
+-----+------+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----------+------------+-----------+-------------+-------------+
| 29. | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
+-----+------+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----------+------------+-----------+-------------+-------------+
| 30. | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
+-----+------+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----------+------------+-----------+-------------+-------------+
| 31. | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
+-----+------+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----+----------+------------+-----------+-------------+-------------+
Označte dobu práce "W", dobu odpočinku "R", dobu práce přesčas "O", dobu pracovní pohotovosti "S", odpracovaná doba v době pracovní pohotovosti "SW"/Please mark period of work "W", period of rest "R", period of overtime "O", period of standby "S" and period of work during standby "SW"
Jméno a podpis velitele lodě nebo pověřeného důstojníka/Name of Master of Officer authorized by Master
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