NAME OF VESSEL: PREVIOUS NAMES: CURRENT PORT OF REGISTRY: CURRENT OWNER: OPERATOR/ MANAGER: TYPE OF VESSEL: YEAR & PLACE OF CONSTRUCTION: ITC 69/REGULATORY GRT: ITC 69/REGULATORY NRT: DEADWEIGHT TONNAGE: CLASSED BY: DATE AND PLACE OF SURVEY: SURVEYED BY: BRIEF DESCRIPTION OF VESSEL AND ITS CONDITION: A. CONDITION OF HULL, STRUCTURES AND FITTINGS PAGE: 1
A. CONDITION OF HULL, STRUCTURES AND FITTINGS 1. EXTERNAL SHELL PLATING 2. INTERNAL SHELL PLATING 3. FRAMES, BEAMS, BULKHEADS, ETC. 4. WEATHERDECKS, FORECASTLE, POOP, CATWALKS, ETC. 5. WATERTIGHT OPENINGS, PORTS, SKYLIGHTS, SCUTTLES 6. HANDRAILS, BULWARKS, ACCOMMODATIONS, DECK LADDERS, & PILOT LADDERS 7. VENTILATORS, MUSHROOM HEADS, FIRE FLAPS, AIR, VENT AND FILLING PIPES 8. MOORING ARRANGEMENTS 1. ANCHORS, CABLES 2. WINDLASS, DRUMS 3. BITS, FAIRLEADS, HAWSERS 9. BUNKERING CONNECTIONS & BUNKER TANK VENT SAVEALLS REMARKS: PAGE: 2
B. CARGO WORTHINESS ITEMS -- TANKERS & LPG/LNG CARRIERS 1. CARGO TANKS (INCL.UDING COFFERDAMS, DEEP TANKS/DRY CARGO HOLDS) 2. CARGO TANK COATING (IF ACCESSIBLE) 3. ON DECK PIPE SYSTEMS & VALVES 4. CARGO SPACE PUMPROOM, PUMPING MACHINERY & BILGES 5. TANK ACCESS TRUNKS/HATCHES & DOOR ULLAGE OPENINGS OR BUTTERWORTH OPENINGS 6. INERT GAS SYSTEM - DECK WATER SEALS & DECK NON-RETURN VALVES 1. TYPE: 2. MAKERS LAST TEST: / / 7. CARGO TANK GAUGES 8. DECK OILY WATER SEPERATION SYSTEM 1. CRUDE OIL WASHING SYSTEM 9. LOADICATOR/STRESS FINDER FITTED? B. CARGO WORTHINESS ITEMS -- DRY CARGO & BULK CARRIERS 1. NUMBER OF HATCHES 2. TYPE OF HATCH COVERS 1. MAIN DECK: 2. TWEEN DECK: 3. HATCHES 1. COVERS & SEALS 2. COMING, COMPRESSION BARS & CLEATS 4. NUMBER OF HOLDS 1. HOLDS/TWEENDECKS & SPAR CEILINGS 2. TANKTOPS & CEILINGS 3. TWEENDECK HATCH COVERS 4. AIR & SOUNDING PIPE PROTECTION 5. DECK MACHINERY - WINCHES, BOOM, DERRICKS ASSOCIATED RUNNING AND PAGE: 3
B. CARGO WORTHINESS ITEMS -- DRY CARGO & BULK CARRIERS DERRICKS, ASSOCIATED RUNNING AND SAFETY GEAR 6. LADDERS & STANCHIONS 7. HOSE TEST OF HATCH COVERS 8. BILGE SUCTIONS, BOXES & SPINDLES 9. PRESSURE TEST OF DB S 10. INTERNAL INSPECTION OF TOP-SIDE TANKS 11. TANK MANHOLE COVERS 12. HOLD LIGHTING 13. TONNAGE OPENINGS 14. DEEP TANKS 15. PLATFORMS & GUARDRAILS 16. MASTHOUSE & DOORS REMARKS: PAGE: 4
C. MAIN & AUXILIARY MACHINERY (GENERAL CONDITION & CLEANLINESS OF MACHINERY SPACES & BILGES. NOTE ANY SIGNIFICANT DEFICIENCY IN CLEANLINESS, PROTECTION, LIGHTING OR ACCESS) 1. MAIN ENGINES 1. MAKER: 2. TYPE: 3. OUTPUT: 3. MAIN BOILERS 1. MAKER: 2. TYPE: 3. AUX. BOILERS 1. MAKER: 2. TYPE: 4. MAIN MACHINERY LAGGING 5. STEERING GEAR 1. MAKER: 2. TYPE: 3. EMERGENCY STEERING ARRANGEMENTS, CONTROL POSITIONS & COMMUNICATIONS 6. GENERATORS 1. NUMBER: 2. PRIME MOVER: 3. ALTERNATOR: 4. OUTPUT: 5. VOLTAGE 7. SWITCHBOARDS 8. EMERGENCY GENERATOR 11. SEA INLET & DISCHARGE VALVES (IF IN DRY DOCK) 12. SHAFT TUNNEL PASSAGES WEATHERTIGHT AND WATERTIGHT DOORS LINE SHAFTING PAGE: 5
C. MAIN & AUXILIARY MACHINERY (GENERAL CONDITION & CLEANLINESS OF MACHINERY SPACES & BILGES. NOTE ANY SIGNIFICANT DEFICIENCY IN CLEANLINESS, PROTECTION, LIGHTING OR ACCESS) AND WATERTIGHT DOORS, LINE SHAFTING & STERN GLAND 13. CONDITION OF PROPELLOR & RUDDER 14. SPARE GEAR: QUANTITY, STOWAGE & CONDITION 15. CO2/HALON/STEAM SMOTHERING 16. EMERGENCY FIRE PUMP - TESTED? YES 17. BILGE & BALLAST SYSTEMS 18. SANITATION DEVICE (USCG/MARPOL) 19. REMOTE DEVICES 1. STOP - MAIN ENGINE AND FANS 2. CLOSING - BULKHEADS & SKYLIGHTS 20. REFRIGERATION PLANT REMARKS: 1. DUCTING 2. LAGGING/INSULATION 3. BATTERIES 4. REMOTE THERMOMETERS 5. COMPRESSORS 6. DOMESTIC PLANT ONLY D. BRIDGE, NAVIGATION & COMMUNICATION EQUIPMENT 1. GYRO COMPASS & REPEATERS 2. AUTO PILOT PAGE: 6
D. BRIDGE, NAVIGATION & COMMUNICATION EQUIPMENT 3. COURSE RECORDER 4. STANDARD MAGNETIC COMPASS 1. DATE/PLACE OF LAST ADJUSTMENT 10/ 07 / 97,, 2. DEVIATION CARD 3. COMPASS ERROR BOOK 5. RADAR 1. #1 (RM/TM) FURUNO- F 1351 2. #1 (RM/TM) _FURUNO F 1351 6. RDF 3. ARPA 4. RADAR LOG 5. RADAR MAINTENANCE RECORD 1. DATE OF LAST CALIBRATION / / 2. DF LOG 7. GPS/LORAN C/DECCA/OMEGA : 8. ECHO SOUNDER 1. TYPE: 9. LOG/SPEED INDICATOR 1. TYPE: 10. SEXTANTS 11. CHRONOMETERS 1. RATE BOOK IN USE REMARKS: E. SHIP S COMPANY AND ACCOMMODATION 1. OFFICERS (CHECK MINIMUM SAFE MANNING CERTIFICATE) PAGE: 7
E. SHIP S COMPANY AND ACCOMMODATION 1. NUMBER 2. NATIONALITY 3. APPROPRIATE CERTIFICATES 2. CREW 1. NUMBER 2. NATIONALITY 3. APPROPRIATE DOCUMENTS 3. ACCOMMODATION SPACES 4. GALLEY & STOREROOMS 5. SICK BAY 1. FITTED TO ACCOMMODATE PERSONS 2. DRUGS & MEDICAL STORES 6. SHIP S ORDERS, FIRE/MUSTER DRILLS, EMERGENCY PROCEDURES 1. LANGUAGE 2. DATE LAST EXERCISED / / REMARKS: 3. RANDOMLY CHECK OFFICERS & CREW TO DETERMINE IF THEY ARE FULLY ACQUAINTED WITH THEIR EMERGENCY DUTIES AT FIRE AND BOAT DRILLS F. SAFETY AND FIREFIGHTING EQUIPMENT 1. LIFE BOATS NO. TYPE CAPACITY PAGE: 8
F. SAFETY AND FIREFIGHTING EQUIPMENT 1. PORT 2. STBD 3. EPIRB, TRANSCEIVER, SARTS NUMBER & TYPE 2. LIFERAFTS 3. LIFEBOUYS WITH LIGHTS/SMOKEFLOATS 4. LIFEJACKETS 5. FIRE LINES - PIPING & HYDRANTS 6. INTERNATIONAL SHORE CONNECTION 7. FIRE HOSE, NOZZELS, ETC. 8. SCBA - NUMBER 9. FIREMEN S OUTFITS 1. NUMBER 2. LOCATION 10. MEDICAL AIR COMPRESSOR 11. PORTABLE FIRE EQUIPMENT 1. TYPES LOCATION: 3. DATE OF LAST TEST/ INSPECTION / / 12. FIREFIGHTING FACILITIES FITTED (WATER/STEAM/FOAM/CO2,/HALON ETC.) 1. CARGO HOLDS/TANKS 2. DECKS 3. ENGINE ROOM 4. ACCOMMODATIONS ADDITIONAL FOR TANKERS 13. DECK FOAM LINES 14. GAS/OXYGEN DETECTION METERS 15. IGS SYSTEMS PAGE: 9
REMARKS: PAGE: 10
G. SHIP S DOCUMENTS ITEM CONDITION DATE ISSUED EXPIRY DATE RECOMMENDATIONS REMARKS SHIP S CERTIFICATES 1. REGISTRATION 2. RADIO LICENSE 3. MINIMUM SAFE MANNING 4. LOG BOOK 5. OIL RECORD BOOK 6. NIGHT ORDER BOOK 7. SOUNDINGS BOOK CLASS & STATUTORY CERTS 8. HULL 9. MACHINERY 10. LOAD LINE 11. SAFETY CONSTRUCTION 12. SAFETY EQUIPMENT 13. SAFETY RADIO 14. IOPP 15. INSURANCE (CLC IF APPLICABLE) 16. CARGO GEAR 1. ANNUAL 2. QUADRENNIAL 17. FIREFIGHTING APPL. 18. LIFERAFT SERVICING 19. CERTIFICATE OF FITNESS FOR CARRYING LIQUIFIED GAS OR BULK CHEMICALS 20. REFRIGERATION 21. LAST DRYDOCKING 22. LAST SPECIAL SURVEY PAGE: 11
REMARKS: (INCLUDE ANY RECOMMENDATIONS OR MEMOS ON CLASS OR STATUTORY CERTIFICATES OR EXEMPTION CERTIFICATES) PAGE: 12