You are on page 1of 86

Vessel

Nationality of ship
IMO No.
Gross Tonnage
Call Sign
Master
Voyage No
Year
Month
Port of arrival
Date of arrival
Port arrived from
Period of stay
Port of Departre
Ne!t Destination
Date of Departre
Inventory of Forms
M 01 Safety Equipment Q 01 Safety Equipment C 01 Arrival Check
M 02 Maint Report Deck Q 02 Lashin Equipment C 02 Departure Check
M 0! "reasin # $u%% Q 0! Security Equipment C 03 Familiarisation
M 0& 'aint Inventory Q 0& (ank Summary C 04 Master Change
M 0) (rainin '%an C 05 Welding Work
M 0* + M 12 Rest (ime F 01 ,re- List C 0 !ut"oard # Alo$t Work
Form M 1! .atch '%an F 02 'assener List C 0% &nclosed 'paces
M 1& Sta/i%ity Report F 0! Ship Stores C 0( Change over '!
M 1) Month%y Statement F 0& ,re- E0ects C 0) Change over C!
M 1* (ainin Report F 0) "enera% Dec%aration
F 01 2accination List ,re- Fam 0&,re- Fam 0)
M 03 M 01 F 04 Dec%aration of $ea%th ,re- Fam 02,re- Fam 0!
M 04 M 10 F 10 Sche5u%e to the Do$ ,re- Fam 0&,re- Fam 0)
M 11 M 12 I 01 Dec%aration of SecurityI 01 IS'S Fami%iari6ation
MONT"#Y
$%# $O&MS
C"'C(#ISTS )*%&T'&#Y
C''M
F!*M 00
+nventor, Deliver, -ist
Deck
*evision. 01/01/200( Approved ", D0 0age 2 o$ (
Master 0 Month: 0
Vessel 0 Year: 0
$orm Title &ev &esp. To do Print ot Sign
+nventor, and Deliver, -ist 0 Master 1 1
+ee,ly W 01 'a$et, &2uipment 0 '! 3eekl,
Monthly M 01 'a$et, &2uipment 0 '! monthl,
M 02 Maint *eport Deck 0 C! monthl,
M 03 4reasing # 5ull 0 C! monthl,
M 04 0aint +nventor, 0 C! monthl,
M 05 6raining 0lan 0 '! monthl,
M 0 7 M 12 *est 8 !ver 6ime 0 C! monthl, 1 1
M 13 Watch 0lan 0 C! monthl, 1 1
M 14 'ta"ilit, *eport 0 'ta$$ monthl, 1 1
M 15 Monthl, 'tatement 0 'ta$$ monthl, 1 1
M 1 6raining *eport 0 C! monthl, 1 1
)arterly 9 01 'a$et, &2uipment 0 Master 2uarterl,
9 02 -ashing &2uipment 0 '! 2uarterl,
9 03 'ecurit, &2uipment 0 Master 2uarterl,
9 04 6ank 'ummar, 0 Master 2uarterl,
$%# F 01 Cre3 -ist 0 Master i$ changed 1 1
F 02 0assenger -ist 0 Master i$ applica"le 1 1
F 03 'hip 'tores 0 Master
F 04 Cre3 &$$ects 0 Master
F 0% 4eneral Declaration 0 Master
F 0( :accination -ist 0 Master
F 0) Declaration o$ 5ealth 0 Master
F 10 'chedule to the Do5 0 Master
On
Demand ! 01 Certi$icates 0 Master
! 02 Master *evie3 0 Master 5anding !ver 1 1
! 03 'M' *eport 0 Master i$ applica"le 1 1
! 05 *e2uisition -ist 0 Master i$ applica"le 1 1
! 0 Container Damages 0 C!
! 0% 'teved Dam *ep 0 C!
! 0( 'ummar, Damages 0 C!
! 0) :o,age 0lan 0 Master
! 10 6ank *eport 0 C! 6k open 1 1
! 11 0ort 'ta, &m -ist 0 C!
! 12 ;otice o$ *eadiness 0 Master
Che-,lst C 01 Arrival Check 0 W!
C 02 Departure Check 0 W!
C 03 Familiarisation 0 Master all 1 1
C 04 5anding !ver Master 0 Master all 1 1
C 05 Welding Work 0 C!#C&
C 0 !ut"oard # Alo$t Work 0 C!#C&
C 0% &nclosed 'paces 0 C!#C&
C 0( 5anding !ver C! 0 C! all 1 1
C 0) 5anding !ver '! 0 '! all 1 1
ISPS + 01 Declaration o$ 'ecurit, 0 ''! all 1 1
+ 01 +'0' Familiari<ation 0 ''! all 1 1
+ 03 -ast 10 0orts o$ call 0 ''!
=ack
C''M
F!*M 00
+nventor, Deliver, -ist
Deck
*evision. 01/01/200( Approved ", D0 0age 3 o$ (
&emar,.
4enerall, the 3hole >-' $ile 3ill "e sent to the o$$ice/ Additionall, all $orms marked 3ith ?print out? and#or
signed? have to "e sent accordingl,/
+t is supposed to have $rom all $orms onl, one and the latest version $or documentation on "oard/ ;o other
'M' $orms@ especiall, $rom other companies@ are allo3ed/
An, change#improvement has to "e announced to the o$$ice in advance@ "e$ore it is doneA
Master C! Date
5ere3ith 3e con$irm to have sent the crossed $orms to the o$$ice 3ith the re2uested content and 3e sign $or the correct $illing/
Further a cop, $or this month is $iled on "oard in electronic $ormat/
C''M
F!*M W 01
Maintenance 'a$et, &2uipment
3eekl, check
*evision. 01/01/200( Approved ", D0 0age 4 o$ (
MV: 0 Year: 0
Master: 0 Month: 0
last Maint
1 2 3 4 5 % ( ) 10 11 12 13 14 15 1 1% 1( 1) 20 21 22 23 24 25 2 2% 2( 2) 30 31 32 33 34 35 3 3% 3( 3) 40 41 42 43 44 45 4 4% 4( 4) 50 51 52 53 54 55 5
Navigations #ights / Signalling #amps
01/02/0( 1
01/02/0( 1
6est on main and emergenc, source o$ po3er 01/02/0( 1
01/02/0( 1
01/02/0( 1
Indi-ators
'peed and Distance indicators in 3orking condition
01/02/0( 1
*udder angle indicator correctl, operational 01/02/0( 1
0ropeller rate o$ revolution indicators operational
01/02/0( 1
:aria"le pitch propeller indicator operational 01/02/0( 1
;A:6&> receiver run sel$7test program 01/02/0( 1
+;MA*'A6 &4C $acilit, run sel$7test program 01/02/0( 1
'hip earth station $acilit, run sel$7test program 01/02/0( 1
01/02/0( 1
Check :5F D'C 3atch receiver operation BC5 %0C
01/02/0( 1
Check MF D'C operation BFre2uenc, 21(%/5 D5<C
01/02/0( 1
Check MF 6E* operation BFre2uenc, 21(%/5 D5<C
01/02/0( 1
01/02/0( 1
01/02/0( 1
Check Distress 3atch receiver 7 0reset on 21(2 D5<
01/02/0( 1
01/02/0( 1
01/02/0( 1
+nstruction card $or Distress procedures displa,ed
01/02/0( 1
-ast maintenance 01/02/0( 1
Porta0le T1o21ay V"$ &adio Telephone
63o73a, :5F radios and valid "atteries
01/02/0( 1
Check charger activit, 8 $unction
01/02/0( 1
Check spare num"er o$ spare "atteries
01/02/0( 1
Compasses
Magnetic Compasses li2uid level satis$actor,
01/02/0( 1
01/02/0( 1
01/02/0( 1
01/02/0( 1
!$$7Course alarm # indicators are $unctioning correct
01/02/0( 1
;avigation -ights@ Anchor and ;ot7under command
lights 3orking
Distri"ution panel and relevant alarms in 3orking
condition
Check 'ignalling -amps correctl, operate@ charged
and spares are availa"le
Check the porta"le =atter, to "e $ull, charged@
covers and carr,ing strap/
&adio 3 Telephony '4ipment / GMDSS2
Installation
Check :5F 6E* $or satis$actor, operation BChannels
@ 13@ 1C
Check MF#5F D'C operation B420%/573127(414/57
125%%71(04/5 D5<C
Check MF#5F 6E* B21%4/5741%%/572(7(3%/57
1252071)5 D5<C
Check Distress 3atch receiver 7 mute # demute
$unction@ loud speakers
Call sign@ 'tation identi$, and other re2uired codes
clearl, marked
'peaking tu"e "et3een standard compass and
steering position
Magnetic Compass ta"le # curve deviation records
maintained
4,rocompass and repeaters in good operational
condition
=ack
C''M
F!*M W 01
Maintenance 'a$et, &2uipment
3eekl, check
*evision. 01/01/200( Approved ", D0 0age 5 o$ (
last Maint
1 2 3 4 5 % ( ) 10 11 12 13 14 15 1 1% 1( 1) 20 21 22 23 24 25 2 2% 2( 2) 30 31 32 33 34 35 3 3% 3( 3) 40 41 42 43 44 45 4 4% 4( 4) 50 51 52 53 54 55 5
Navigations #ights / Signalling #amps
01/02/0( 1
;avigation -ights@ Anchor and ;ot7under command
lights 3orking
=ack
$ire dete-ting system 5loop21ise6
'ample check o$ sensors B10 F each 3eekC
01/02/0( 1
Check i$ alarm is heard on "ridge or indicated
01/02/0( 1
General %larm System
01/02/0( 1
Activation o$ 4eneral Alarm ", $ire detection panel
01/02/0( 1
'mergen-y es-ape
01/02/0( 1
$ire fighting
01/02/0( 1
Close # open check o$ $ire line isolating valves
01/02/0( 1
01/02/0( 1
01/02/0( 1
#ife 0oats7 res-e 0oats7 life rafts 1
01/02/0( 1
01/02/0( 1
01/02/0( 1
6est o$ general alarm@7Check that all "ells@ horns@
3histles are heard 3ell
Check $or eas, opening o$ doores@ 3indo3s/ Check
$or clear passage through escape doors/ Check
escape ropes and lights in escape trunks
Check $ire pumps and suppl, 3ater 3ith su$$icient
pressure on the highest deck 3ith at least t3o Gets/
!perate pumps ", remote start/
Check eas, operation o$ dampers and open#close
position is properl, marked/
Check o$ $uel and oil tanks gauge glases $or correct
position o$ cocks/
:isual inspection/ Check $or damages and correct
operation@ retro7re$lective tapes ///
!perate engines $or at least 5 minutes@ test gear
ahead#astern check oil and $uel levels/
Check # +nspect # Hpdate li$e "oat # rescue "oat
e2uipment
C''M
F!*M M 01
Maintenance 'a$et, &2uipment
monthl, check
*evision. 01/01/200( Approved ", D0 0age o$ (
MV: 0 Year: 0
Master: 0 Month: 0
Month 200( Month 200)
last Maint
1 2 3 4 5 % ( ) 10 11 12 1 2 3 4 5 % ( 10 11 12
0lans and +nstructions 01/02/0( 1
*ecords 01/02/0( 1
;avigational e2uipment 01/02/0( 1
'teering gear 01/02/0( 1
;avigation lights 01/02/0( 1
6ests 01/02/0( 1
Magnetic deviation ta"le 2 ,ears 1
$ire fighting and response e4ipment
Check o$ $ire stations 01/02/0( 1
Check o$ $ire "o1es 01/02/0( 1
Check o$ $ire e1tinguishers 01/02/0( 1
Check o$ $i1ed $ire $ighting e2/ 01/02/0( 1
Commni-ation e4ipment
Working condition 01/02/0( 1
Antenna s,stem 01/02/0( 1
&0+*= 01/02/0( 1
'A* 01/02/0( 1
4MD'' 01/02/0( 1
Safety '4ipment
Check o$ sa$et, e2uipment 01/02/0( 1
-i$e "oat 01/02/0( 1
-i$era$ts 01/02/0( 1
-i$e"uo,s 01/02/0( 1
-i$eGackets 01/02/0( 1
'urvival suites 01/02/0( 1
6hermal protective aids 01/02/0( 1
!ther -i$e 'aving Appliances 01/02/0( 1
Medi-al '4ipment
Medical locker 01/02/0( 1
Completeness 8 e1pir, dates 01/02/0( 1
Polltion response e4ipment
Completeness 8 condition 01/02/0( 1 1
*emarks.
=ack
C''M
F!*M M 02
Maintenance report
Deck
*evision. 01/01/200( Approved ", D0 0age % o$ (
0 0
0 0
Date
%#3#200 painting a$t "ollards distri"ution o$ lashing e2uipment
cleaning inside superstructure
%#4#200 distri"ution o$ lashing e2uipment cleaning inside superstructure
%#5#200 distri"ution o$ lashing e2uipment cleaning inside superstructure
%##200 2uick acting cleat check#adGustment distri"ution o$ lashing e2uipment
cleaning inside superstructure
%#%#200 'ecuring $irst aid kits securing opening the $ridge in o$$icer messroom
cleaning inside superstructure
%#(#200 4reasing vent mashrooms $i1ing "ridge port side chair
cleaning inside superstructure
%#)#200 2uick acting cleat check#adGustment drain plugs dismountled#greased#placed "ack
installation o$ international shore connection greasing "utter$l, nuts
Fitting ratguards 3ith ropes cleaning inside superstructure
%#10#200 2uick acting cleat check#adGustment drain plugs dismountled#greased#placed "ack
making stencils on gar"age station $a"ricating hinges on li$eGacket "o1
Cleaning air7condition room
=ack
C''M
F!*M M 03
4reasing
*evision. 01/01/200( Approved ", D0 0age ( o$ (
MV: 0 Year: 0
Master: 0 Month: 0
200( 200) 2010 2011
A*&A Maintenance 1 2 3 4 5 % ( ) 10 11 12 1 2 3 4 5 % ( ) 10 11 12 1 2 3 4 5 % ( ) 10 11 12 1 2 3 4 5 % ( ) 10 11 12
+in-hes monthl,
Fore 01/02/0(
A$t 01/02/0(
Mis-ellaneos monthl,
Fire hose couplings 01/02/0(
Fire h,drants 8 no<<les 01/02/0(
Firemains drain valves 01/02/0(
Anchor 2uick7realising device 01/02/0(
Anchor covers@ "oltsEnuts 01/02/0(
$ire2$laps monthl,
0oopdeck 01/02/0(
A7Deck 01/02/0(
=7Deck 01/02/0(
C7Deck 01/02/0(
D7Deck 01/02/0(
&7Deck 01/02/0(
F7Deck 01/02/0(
Funnel 01/02/0(
&* ventilation $ire dampers 01/02/0(
#ashing Material monthl,
4reasing 01/02/0(
"ll inspe-tion 2uarterl,
'hip side shell plates 01/02/0(
Condition o$ cargo holds 01/02/0(
Watertight doors 01/02/0(
Manhole covers 01/02/0(
=ulkheads@ $rames 01/02/0(
6ank top@ "rackets 01/02/0(
Cat3alks@ handrails@ "ul3arks 01/02/0(
Crane No. 8 2uarterl,
;ipples 01/02/0(
Wires 01/02/0(
Crane No. 9 2uarterl,
;ipples 01/02/0(
Wires 01/02/0(
Prov. Crane No. 8 2uarterl,
=ack
C''M
F!*M M 03
4reasing
*evision. 01/01/200( Approved ", D0 0age ) o$ (
200( 200) 2010 2011
A*&A Maintenance 1 2 3 4 5 % ( ) 10 11 12 1 2 3 4 5 % ( ) 10 11 12 1 2 3 4 5 % ( ) 10 11 12 1 2 3 4 5 % ( ) 10 11 12
=ack
;ipples 01/02/0(
Wires 01/02/0(
Prov. Crane No. 9 2uarterl,
;ipples 01/02/0(
Wires 01/02/0(
%--omodation #adders 2uarterl,
;ipples 01/02/0(
Wire 01/02/0(
#ife0oat2Davit 2uarterl,
;ipples 01/02/0(
Wire 01/02/0(
&es-e0oat2Crane 2uarterl,
;ipples 01/02/0(
Wire 01/02/0(
Mis-ellaneos 2uarterl,
Manhole7&ntries 01/02/0(
:entilator75eads 01/02/0(
:ent7Flaps F3d/ 01/02/0(
:ent7Flaps A$t 01/02/0(
:alves 01/02/0(
C''M
F!*M M 04
0aint +nventor,
*evision. 01/01/200( Approved ", D0 0age 10 o$ (
MV: 0 Year: 0
Master: 0 Month: 0
Paint Type S-hade No De-, 'ngine Order
'igma 11)) topacr,l $inish "lue 140 20 120
'igma %000 sigma enamel 3hite 140 20 120
'igma undercoat 3hite 0 0
'igma 41)) topacr,l $inish green 10 40 120
'igma 21(2 topacr,l $inish "ro3n 100 (0 20
'igma 31%) topacr,l $inish "u$$ 110 30 (0
'igma 51%% topacr,l $inish gre, 140 0 (0
'igma sigmaplane 6A red"ro3n 0
'igma sigma $luorescent orange 40 40
'igma 1(( sigmarine =6D red 40 40
'igma multiprimer red"ro3n 0 0
'igma multiprimer gre, 0 0
'igma chlor primer gre, (0 40 40
'igma multimastic red"ro3n 1%) 0 0
'igma multimastic gre, 51%% 0 40 20
'igma thinner 20705 (0 (0
'igma thinner 2170 140 20 120
'igma thinner )17)2 120 120
'igma 11(( topacr,l $inish "lue 0
'igma %000 sigmaguard C'F %5 0
'igma 313( sigmarine =6D ,ello3 20 20
'igma %21 alluminium 5* 500 35 35
'igma %20 alluminium 5* 45 45
'igma (000 topacr,l $inish "lack (0 20 0
'igma 41%1 sigmarine =6D green (0 20 0
'igma %5( silicate MC pigment 0 140I
'igma %41% universal primer (0 (0
'igma %23( ,ello3 45 45
'igma %240 enamel 3hite 120 120
'igma %4) miocoat gra, 0 0I
'igma %4 sigma coating (0 (0
5ardener 20 20
'igma 1154 Anti7$ouling red"ro3n 100 100
0
0
0
0
0
0
0
0
0
0
0
*emarks
:alan-e &O:
#tr
=ack
D*+-- A;D 6*A+;+;4 0-A;
Form M 05
according to '!-A'@ MA*0!-@ +'M@ +'0'
*evision. 01/01/200( Approved ", D0 0age 11 o$ (
MV: 0 Year: 0
Master: 0 Month: 0
;anary $e0rary Mar-h %pril May ;ne ;ly %gst Septem0er O-to0er Novem0er De-em0er
! ! ! ! ! ! ! ! ! ! ! !
%0andon Ship ! ! ! ! ! ! ! ! ! ! ! !
BdoneC J
Man over :oard7 S%& ! ! ! !
BdoneC J
Oil Spill ! ! ! !
BdoneC J
'mergen-y Steering ! ! ! !
BdoneC J
'':D 2 training ! !
BdoneC J
Collision !
BdoneC J
Gronding / $looding !
BdoneC J
Main 'ngine $ailre !
BdoneC J
! ! ! !
BdoneC J
Commni-ation 2 offi-e !
BdoneC J
&emar,s. 7 +$ not possi"le to hold the schedule@ make note in the log "ook/ 6he special training should "e made in the ne1t month additionall,/
7 'everal training tasks can "e added in one training session o$ course Be/g/ collision@ $ire and emergenc, steering drillC
I 7 +'0' drills have to "e carried out at least per 2uarter and in acc/ to +'0' Code part =@ chapter 13/ Bdrill topics acc/ (/)C
$ire Drill 5in-lding $irst %id6
BdoneC $ill in date J
ISPS <
=ack
C''M
Form M 0
*est 6ime
*evision. 01/01/200( Approved ", D0 0age 12 o$ (
MV: 0 Rank: 2nd officer Month: 0
Name: Year: 0
0lease mark periods o$ 3ork 3ith ?1?
5ours 007 017 027 037 047 057 07 0%7 0(7 0)7 107 117 127 137 147 157 17 1%7 1(7 1)7 207 217 227 237 5ours o$ rest 5ours o$ rest !vertime
Date 1 2 3 4 5 % ( ) 10 11 12 13 14 15 1 1% 1( 1) 20 21 22 23 24 in 247hrs in % da,s
1 1 1 1 1 1 1 1 1 1 1 14 2
2 1 1 1 1 1 1 1 1 1 15 1
3 1 1 1 1 1 1 1 1 1 15 1
4 s 1 1 1 1 1 1 1 1 1 15 )
5 1 1 1 1 1 1 1 1 1 15 1
1 1 1 1 1 1 1 1 1 15 1
% s 1 1 1 1 1 1 1 1 1 15 104 )
( 1 1 1 1 1 1 1 1 1 15 1
) 1 1 1 1 1 1 1(
10 1 1 1 1 1 1 1 1 1
11 1 1 1 1 1 1 1 1 1 1 1 1 1 11 5
12 1 1 1 1 1 1 1 1 1
13 s 1 1 1 1 1 1 1 1 1 1 14 10
14 1 1 1 1 1 1 1 1 1 10
15 1 1 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1 1 1
1% 1 1 1 1 1 1 1 1 1
1( 1 1 1 1 1 1 1 1 1
1) 1 1 1 1 1 1 1 1 1
20 1 1 1 1 1 1 1 1 1
21 1 1 1 1 1 1 1 1 1 112
22 1 1 1 1 1 1 1 1 1
23 1 1 1 1 1 1 1 1 1
24 1 1 1 1 1 1 1 1 1
25 1 1 1 1 1 1 1 1 1
2 1 1 1 1 1 1 1 1 1
2% 1 1 1 1 1 1 1 1 1
2( 1 1 1 1 1 1 1 1 1 112
2) 1 1 1 1 1 1 1 1 1
30 1 1 1 1 1 1 1 1 1
31 24
Con$irmation ", cre3mem"er. *est 6ime total. 4)0 !6 tota-. 40
'
a
t
u
r
d
a
,
'
u
n
d
a
,
=ack
C''M
Form M 0%
*est 6ime
*evision. 01/01/200( Approved ", D0 0age 13 o$ (
MV: 0 Rank: 2nd officer Month: 0
Name: Year: 0
0lease mark periods o$ 3ork 3ith ?1?
5ours 007 017 027 037 047 057 07 0%7 0(7 0)7 107 117 127 137 147 157 17 1%7 1(7 1)7 207 217 227 237 5ours o$ rest 5ours o$ rest !vertime
Date 1 2 3 4 5 % ( ) 10 11 12 13 14 15 1 1% 1( 1) 20 21 22 23 24 in 247hrs in % da,s
1 1 1 1 1 1 1 1 1 1 1 14 2
2 1 1 1 1 1 1 1 1 1 15 1
3 1 1 1 1 1 1 1 1 1 15 1
4 s 1 1 1 1 1 1 1 1 1 15 )
5 1 1 1 1 1 1 1 1 1 15 1
1 1 1 1 1 1 1 1 1 15 1
% s 1 1 1 1 1 1 1 1 1 15 104 )
( 1 1 1 1 1 1 1 1 1 15 1
) 1 1 1 1 1 1 1(
10 1 1 1 1 1 1 1 1 1
11 1 1 1 1 1 1 1 1 1 1 1 1 1 11 5
12 1 1 1 1 1 1 1 1 1
13 s 1 1 1 1 1 1 1 1 1 1 14 10
14 1 1 1 1 1 1 1 1 1 10
15 1 1 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1 1 1
1% 1 1 1 1 1 1 1 1 1
1( 1 1 1 1 1 1 1 1 1
1) 1 1 1 1 1 1 1 1 1
20 1 1 1 1 1 1 1 1 1
21 1 1 1 1 1 1 1 1 1 112
22 1 1 1 1 1 1 1 1 1
23 1 1 1 1 1 1 1 1 1
24 1 1 1 1 1 1 1 1 1
25 1 1 1 1 1 1 1 1 1
2 1 1 1 1 1 1 1 1 1
2% 1 1 1 1 1 1 1 1 1
2( 1 1 1 1 1 1 1 1 1 112
2) 1 1 1 1 1 1 1 1 1
30 1 1 1 1 1 1 1 1 1
31 24
Con$irmation ", cre3mem"er. *est 6ime total. 4)0 !6 tota-. 40
'
a
t
u
r
d
a
,
'
u
n
d
a
,
=ack
C''M
Form M 0(
*est 6ime
*evision. 01/01/200( Approved ", D0 0age 14 o$ (
MV: 0 Rank: 2nd officer Month: 0
Name: Year: 0
0lease mark periods o$ 3ork 3ith ?1?
5ours 007 017 027 037 047 057 07 0%7 0(7 0)7 107 117 127 137 147 157 17 1%7 1(7 1)7 207 217 227 237 5ours o$ rest 5ours o$ rest !vertime
Date 1 2 3 4 5 % ( ) 10 11 12 13 14 15 1 1% 1( 1) 20 21 22 23 24 in 247hrs in % da,s
1 1 1 1 1 1 1 1 1 1 1 14 2
2 1 1 1 1 1 1 1 1 1 15 1
3 1 1 1 1 1 1 1 1 1 15 1
4 s 1 1 1 1 1 1 1 1 1 15 )
5 1 1 1 1 1 1 1 1 1 15 1
1 1 1 1 1 1 1 1 1 15 1
% s 1 1 1 1 1 1 1 1 1 15 104 )
( 1 1 1 1 1 1 1 1 1 15 1
) 1 1 1 1 1 1 1(
10 1 1 1 1 1 1 1 1 1
11 1 1 1 1 1 1 1 1 1 1 1 1 1 11 5
12 1 1 1 1 1 1 1 1 1
13 s 1 1 1 1 1 1 1 1 1 1 14 10
14 1 1 1 1 1 1 1 1 1 10
15 1 1 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1 1 1
1% 1 1 1 1 1 1 1 1 1
1( 1 1 1 1 1 1 1 1 1
1) 1 1 1 1 1 1 1 1 1
20 1 1 1 1 1 1 1 1 1
21 1 1 1 1 1 1 1 1 1 112
22 1 1 1 1 1 1 1 1 1
23 1 1 1 1 1 1 1 1 1
24 1 1 1 1 1 1 1 1 1
25 1 1 1 1 1 1 1 1 1
2 1 1 1 1 1 1 1 1 1
2% 1 1 1 1 1 1 1 1 1
2( 1 1 1 1 1 1 1 1 1 112
2) 1 1 1 1 1 1 1 1 1
30 1 1 1 1 1 1 1 1 1
31 24
Con$irmation ", cre3mem"er. *est 6ime total. 4)0 !6 tota-. 40
'
a
t
u
r
d
a
,
'
u
n
d
a
,
=ack
C''M
Form M 0)
*est 6ime
*evision. 01/01/200( Approved ", D0 0age 15 o$ (
MV: 0 Rank: 2nd officer Month: 0
Name: Year: 0
0lease mark periods o$ 3ork 3ith ?1?
5ours 007 017 027 037 047 057 07 0%7 0(7 0)7 107 117 127 137 147 157 17 1%7 1(7 1)7 207 217 227 237 5ours o$ rest 5ours o$ rest !vertime
Date 1 2 3 4 5 % ( ) 10 11 12 13 14 15 1 1% 1( 1) 20 21 22 23 24 in 247hrs in % da,s
1 1 1 1 1 1 1 1 1 1 1 14 2
2 1 1 1 1 1 1 1 1 1 15 1
3 1 1 1 1 1 1 1 1 1 15 1
4 s 1 1 1 1 1 1 1 1 1 15 )
5 1 1 1 1 1 1 1 1 1 15 1
1 1 1 1 1 1 1 1 1 15 1
% s 1 1 1 1 1 1 1 1 1 15 104 )
( 1 1 1 1 1 1 1 1 1 15 1
) 1 1 1 1 1 1 1(
10 1 1 1 1 1 1 1 1 1
11 1 1 1 1 1 1 1 1 1 1 1 1 1 11 5
12 1 1 1 1 1 1 1 1 1
13 s 1 1 1 1 1 1 1 1 1 1 14 10
14 1 1 1 1 1 1 1 1 1 10
15 1 1 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1 1 1
1% 1 1 1 1 1 1 1 1 1
1( 1 1 1 1 1 1 1 1 1
1) 1 1 1 1 1 1 1 1 1
20 1 1 1 1 1 1 1 1 1
21 1 1 1 1 1 1 1 1 1 112
22 1 1 1 1 1 1 1 1 1
23 1 1 1 1 1 1 1 1 1
24 1 1 1 1 1 1 1 1 1
25 1 1 1 1 1 1 1 1 1
2 1 1 1 1 1 1 1 1 1
2% 1 1 1 1 1 1 1 1 1
2( 1 1 1 1 1 1 1 1 1 112
2) 1 1 1 1 1 1 1 1 1
30 1 1 1 1 1 1 1 1 1
31 24
Con$irmation ", cre3mem"er. *est 6ime total. 4)0 !6 tota-. 40
'
a
t
u
r
d
a
,
'
u
n
d
a
,
=ack
C''M
Form M 10
*est 6ime
*evision. 01/01/200( Approved ", D0 0age 1 o$ (
MV: 0 Rank: 2nd officer Month: 0
Name: Year: 0
0lease mark periods o$ 3ork 3ith ?1?
5ours 007 017 027 037 047 057 07 0%7 0(7 0)7 107 117 127 137 147 157 17 1%7 1(7 1)7 207 217 227 237 5ours o$ rest 5ours o$ rest !vertime
Date 1 2 3 4 5 % ( ) 10 11 12 13 14 15 1 1% 1( 1) 20 21 22 23 24 in 247hrs in % da,s
1 1 1 1 1 1 1 1 1 1 1 14 2
2 1 1 1 1 1 1 1 1 1 15 1
3 1 1 1 1 1 1 1 1 1 15 1
4 s 1 1 1 1 1 1 1 1 1 15 )
5 1 1 1 1 1 1 1 1 1 15 1
1 1 1 1 1 1 1 1 1 15 1
% s 1 1 1 1 1 1 1 1 1 15 104 )
( 1 1 1 1 1 1 1 1 1 15 1
) 1 1 1 1 1 1 1(
10 1 1 1 1 1 1 1 1 1
11 1 1 1 1 1 1 1 1 1 1 1 1 1 11 5
12 1 1 1 1 1 1 1 1 1
13 s 1 1 1 1 1 1 1 1 1 1 14 10
14 1 1 1 1 1 1 1 1 1 10
15 1 1 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1 1 1
1% 1 1 1 1 1 1 1 1 1
1( 1 1 1 1 1 1 1 1 1
1) 1 1 1 1 1 1 1 1 1
20 1 1 1 1 1 1 1 1 1
21 1 1 1 1 1 1 1 1 1 112
22 1 1 1 1 1 1 1 1 1
23 1 1 1 1 1 1 1 1 1
24 1 1 1 1 1 1 1 1 1
25 1 1 1 1 1 1 1 1 1
2 1 1 1 1 1 1 1 1 1
2% 1 1 1 1 1 1 1 1 1
2( 1 1 1 1 1 1 1 1 1 112
2) 1 1 1 1 1 1 1 1 1
30 1 1 1 1 1 1 1 1 1
31 24
Con$irmation ", cre3mem"er. *est 6ime total. 4)0 !6 tota-. 40
'
a
t
u
r
d
a
,
'
u
n
d
a
,
=ack
C''M
Form M 11
*est 6ime
*evision. 01/01/200( Approved ", D0 0age 1% o$ (
MV: 0 Rank: 2nd officer Month: 0
Name: Year: 0
0lease mark periods o$ 3ork 3ith ?1?
5ours 007 017 027 037 047 057 07 0%7 0(7 0)7 107 117 127 137 147 157 17 1%7 1(7 1)7 207 217 227 237 5ours o$ rest 5ours o$ rest !vertime
Date 1 2 3 4 5 % ( ) 10 11 12 13 14 15 1 1% 1( 1) 20 21 22 23 24 in 247hrs in % da,s
1 1 1 1 1 1 1 1 1 1 1 14 2
2 1 1 1 1 1 1 1 1 1 15 1
3 1 1 1 1 1 1 1 1 1 15 1
4 s 1 1 1 1 1 1 1 1 1 15 )
5 1 1 1 1 1 1 1 1 1 15 1
1 1 1 1 1 1 1 1 1 15 1
% s 1 1 1 1 1 1 1 1 1 15 104 )
( 1 1 1 1 1 1 1 1 1 15 1
) 1 1 1 1 1 1 1(
10 1 1 1 1 1 1 1 1 1
11 1 1 1 1 1 1 1 1 1 1 1 1 1 11 5
12 1 1 1 1 1 1 1 1 1
13 s 1 1 1 1 1 1 1 1 1 1 14 10
14 1 1 1 1 1 1 1 1 1 10
15 1 1 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1 1 1
1% 1 1 1 1 1 1 1 1 1
1( 1 1 1 1 1 1 1 1 1
1) 1 1 1 1 1 1 1 1 1
20 1 1 1 1 1 1 1 1 1
21 1 1 1 1 1 1 1 1 1 112
22 1 1 1 1 1 1 1 1 1
23 1 1 1 1 1 1 1 1 1
24 1 1 1 1 1 1 1 1 1
25 1 1 1 1 1 1 1 1 1
2 1 1 1 1 1 1 1 1 1
2% 1 1 1 1 1 1 1 1 1
2( 1 1 1 1 1 1 1 1 1 112
2) 1 1 1 1 1 1 1 1 1
30 1 1 1 1 1 1 1 1 1
31 24
Con$irmation ", cre3mem"er. *est 6ime total. 4)0 !6 tota-. 40
'
a
t
u
r
d
a
,
'
u
n
d
a
,
=ack
C''M
Form M 12
*est 6ime
*evision. 01/01/200( Approved ", D0 0age 1( o$ (
MV: 0 Rank: 2nd officer Month: 0
Name: Year: 0
0lease mark periods o$ 3ork 3ith ?1?
5ours 007 017 027 037 047 057 07 0%7 0(7 0)7 107 117 127 137 147 157 17 1%7 1(7 1)7 207 217 227 237 5ours o$ rest 5ours o$ rest !vertime
Date 1 2 3 4 5 % ( ) 10 11 12 13 14 15 1 1% 1( 1) 20 21 22 23 24 in 247hrs in % da,s
1 1 1 1 1 1 1 1 1 1 1 14 2
2 1 1 1 1 1 1 1 1 1 15 1
3 1 1 1 1 1 1 1 1 1 15 1
4 s 1 1 1 1 1 1 1 1 1 15 )
5 1 1 1 1 1 1 1 1 1 15 1
1 1 1 1 1 1 1 1 1 15 1
% s 1 1 1 1 1 1 1 1 1 15 104 )
( 1 1 1 1 1 1 1 1 1 15 1
) 1 1 1 1 1 1 1(
10 1 1 1 1 1 1 1 1 1
11 1 1 1 1 1 1 1 1 1 1 1 1 1 11 5
12 1 1 1 1 1 1 1 1 1
13 s 1 1 1 1 1 1 1 1 1 1 14 10
14 1 1 1 1 1 1 1 1 1 10
15 1 1 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1 1 1
1% 1 1 1 1 1 1 1 1 1
1( 1 1 1 1 1 1 1 1 1
1) 1 1 1 1 1 1 1 1 1
20 1 1 1 1 1 1 1 1 1
21 1 1 1 1 1 1 1 1 1 112
22 1 1 1 1 1 1 1 1 1
23 1 1 1 1 1 1 1 1 1
24 1 1 1 1 1 1 1 1 1
25 1 1 1 1 1 1 1 1 1
2 1 1 1 1 1 1 1 1 1
2% 1 1 1 1 1 1 1 1 1
2( 1 1 1 1 1 1 1 1 1 112
2) 1 1 1 1 1 1 1 1 1
30 1 1 1 1 1 1 1 1 1
31 24
Con$irmation ", cre3mem"er. *est 6ime total. 4)0 !6 tota-. 40
'
a
t
u
r
d
a
,
'
u
n
d
a
,
=ack
C''M
F!*M M 13
Watch 0lan
*evision. 01/01/200( Approved ", D0 0age 1) o$ (
MV: 0 Year: 0
Master: 0 Month: 0
Master 0(00 7 1200 and 2000 7 2400
Ch/Mate 0400 7 (000 and 100 7 2000
2nd Mate 0000 7 0400 and 1200 7 100
3rd Mate 0(00 7 1200 and 2000 7 2400
Ch/ &ngr 000 7 1200 and 1(00 7 2400
2nd &ngr 1200 7 1(00 and 0000 7 000
&lectrician 0(00 7 1200 and 1300 7 1%00
=osun 000 7 0%30 and 0(00 7 1200 1300 7 1(00
A/=/ 000 7 0%30 and 0(00 7 1200 1300 7 1(00
A/=/ 0(00 7 1200 and 2000 7 2400
A/=/ 0400 7 (000 and 100 7 2000
!/'/ 0000 7 0400 and 1200 7 100
!/'/ 0(00 7 1200 and 1300 7 1(00
Fitter 0(00 7 1200 and 1300 7 1(00
!iler 0(00 7 1200 and 2000 7 2400
!iler 0400 7 (000 and 100 7 2000
Cook 000 7 0(30 and 0)00 7 1300 1500 7 2000
Messman 000 7 0(30 and 0)00 7 1300 1500 7 2000
T"' +%TC"(''PING SYST'M ON T"IS V'SS'# IS
%&&%NG'D %CCO&DING STC+ =>7 P%&T %7 C"%PT'& ?7
S'CTION 97 T"' $#%G ST%T' &')*I&'M'NTS %ND T"'
+O&(ING TIM' O$ T"' C&'+.
WA6C5 A;D W!*D+;4 6+M&' A*& A**A;4&D F!* '&A A;D MAK D+FF&* +; 65& 0!*6/ MA'6&* 6! =& *&'0!;'+=-& 6! 6AD& CA*&
65A6 *&'6 6+M&' W+-- =& 5!-D A' 0&* +-! *&4H-A6+!; M&;6+!;&D =&-!W/
+; ADD+6+!; 6! 65& A=!:& 4+:&; W!*D+;4 6+M&' 65& &;4+;&&* +' &;4A4&D A-'! +; CA'& !F A; &;4+;& A-A*M/ MA'6&* +'
A:A+-A=-& A6 A-- 6+M&'A !:&*6+M&' +F *&9H+*&D 6! =& CA**+&D !H6 H0!; MA'6&*' *&9H&'6/ *&'6 6+M&' 6! =& ACC!*D+;4
C1(0 '&AFA*&*L' 5!H*' !F W!*D
&:+D&;C& !F *&'6 6+M&' W+-- =& MAD& =K 65& !:&*6+M&' '5&&6 F!*M !; =!A*D A;D +' A:A+-A=-& A6 A-- 6+M&' A6 65&
MA'6&*' !FF+C&/
=ack
C''M
F!*M M 13
Watch 0lan
*evision. 01/01/200( Approved ", D0 0age 20 o$ (
'ignature Master
C''M
F!*M M 14
'ta"ilit, *eport
*evision. 01/01/200( Approved ", D0 0age 21 o$ (
MV: 0 Year: 0
Master: 0 Month: 0
Monthly Sta0ility &eport
Date :o,age 0ort o$ Departure
Draught Cargo loaded =allast Fuel 4M
F3d A$t 20? 40? others mt mt mt m
03#12 003 6allinn 5/45 /40 2 4 11% 110 24/5 3/0%
03#12 003 5elsinki
0#12 004 =remerhaven
0%#12 004 5am"urg
10#12 004 5elsinki
13#12 005 =remerhaven
14#12 005 5am"urg
1%#12 005 6allinn
1(#12 005 5elsinki
20#12 00 =remerhaven
22#12 00 5am"urg
2(#12 00 't/0eters"urg
6otal carried this month 2 4 0 11%
Master. C#!.
Copies. 'hip?s $ileM !3ner?s $ile
=ack
C''M
F!*M M 14
'ta"ilit, *eport
*evision. 01/01/200( Approved ", D0 0age 22 o$ (
C''M
Form M 15
Monthl, 'tatement
*evision. 01/01/200( Approved ", D0 0age 23 o$ (
MV: 0
Port:
0
Voyage No.: 0
Date: 12/0/201!
Monthl, 'tatement
5ere3ith the ship sta$$ has to con$irm to hold $ollo3ing re2uirements or has to give a clear statement 3h, it 3as
not possi"le to act accordingl,.
86 Voyage Planning 2 STC+ =>7 Se-tion %2VIII/97 Part 9
6he vo,age planning is done and documented according '6CW )5@ 'ection A7:+++#2@ 0art 2
in consideration o$ Form ! 11 :o,age 0lan
in consideration o$ relevant +M! Circulars
96 +at-h,eeping at sea 2 STC+ =>7 Se-tion %2VIII/97 Part @
6he navigational 3atchkeeping is done and documented according '6CW )5@ 'ection A7:+++#2@ 0art 3
70riciples
7-ookout 7 '6CW )5@ 'ection A7:+++#2@ 0art 371
7Watch arrangements 7 '6CW )5@ 'ection A7:+++#2@ 0art 371
76aking over the 3atch 7 '6CW )5@ 'ection A7:+++#2@ 0art 371
70er$orming o$ 3atch 7 '6CW )5@ 'ection A7:+++#2@ 0art 371
7;av/ Watchkeeping under di$$erent conditions 7 0art 371
A8= 7 Circular 7 0170017)(
A8= 7 Circular 7 0170027)( Badditional look out during darknessC
C!-*&4
'tanding orders o$ compan, # master $or deck department
Watch order "ook 7 deck
6he Watch Alarm on the "ridge is in use during sea trial and sa$ed against unauthori<ed s3itch o$$/
6he ke,s $rom the Watch Alarm are in master?s hands/
6he engineering 3atchkeeping is done and documented according '6CW )5@ 'ection A7:+++#2@ 0art 372
70rinciples
7Watch arrangements 7 '6CW )5@ 'ection A7:+++#2@ 0art 372
76aking over the 3atch 7 '6CW )5@ 'ection A7:+++#2@ 0art 372
70er$orming o$ 3atch 7 '6CW )5@ 'ection A7:+++#2@ 0art 372
7&ng/ 3atchkeeping under di$$erent conditions 7 0art 372
'tanding orders o$ compan, # chie$ engineer $or engine department
Watch order "ook 7 engine
6he radio 3atchkeeping is done and documented according '6CW )5@ 'ection A7:+++#2@ 0art 373
70rinciples
7Watch arrangements 7 '6CW )5@ 'ection A7:+++#2@ 0art 373
70er$orming o$ radio3atch 7 '6CW )5@ 'ection A7:+++#2@ 0art 373
@6 +at-h,eeping in port 2 STC+ =>7 Se-tion %2VIII/97 Part A
70rinciples
7Watch arrangements 7 '6CW )5@ 'ection A7:+++#2@ 0art 4
76aking over the 3atch 7 '6CW )5@ 'ection A7:+++#2@ 0art 4
76aking over the deck 3atch 7 '6CW )5@ 'ection A7:+++#2@ 0art 471
76aking over the engine 3atch 7 '6CW )5@ 'ection A7:+++#2@ 0art 472
70er$orming the deck 3atch 7 '6CW )5@ 'ection A7:+++#2@ 0art 473
70er$orming the engine 3atch 7 '6CW )5@ 'ection A7:+++#2@ 0art 474
7Watch in port on ships carr,ing ha<ardous cargo 7 0art 475
A6 ISM / ISPS System
76he 3atch on "ridge and in the engine 3as carried out according all mentioned re2uirements and rules
7All cre3mem"ers $ull, a3are o$ the 'M' o$ the compan, ?Dlingen"erg =ereederungs7 und =e$rachtungs !54?
>6 &emar,s
"Please make remarks #here or on se$erate $a$er%& if some facts not clear or rele'ant doc(ments not on )oard
"*(estions and comments are more than +elcome
Master Chie$ !$$icer Chie$
=ack
C''M
Form M 15
Monthl, 'tatement
*evision. 01/01/200( Approved ", D0 0age 24 o$ (
'tamp
C''M
F!*M M 1
6raining *eport
*evision. 01/01/200( Approved ", D0 0age 25 o$ (
MV: 0 Year: 0
Master: 0 Month: 0
:ideo +'M +'M annual e1ercise +'0' +'0' annual e1ercise MA*0!- &&=D M!= -aunching Free$all
0lace. At sea
Date. 01/12/2005
Description. 1111111111111111111111111111111111111111111111111111111111111111111111
'uggestions $or
'M' improvement
'ignatures. Mustermann Wil$ried Master NNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN
Meier
NNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN
Willi
NNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN
NNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN
NNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN
NNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN
NNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN
NNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN
NNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN
NNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN
NNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN
NNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN
NNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN
NNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN
NNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN
NNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN
Anton A=
=ack
C''M
F!*M 9 01
Maintenance 'a$et, &2uipment
2uarterl, other intervals
*evision. 01/01/200( Approved ", D0 0age 2 o$ (
MV: 0 0
Master: 0 0
200( 200) 2010
+ ++ +++ +: + ++ +++ +: + ++ +++ +:
)arterly
&es-e :oats
:isual inspection/ Check $or damages and correct operation@ retro7re$lective tapes /// 2#1#200( 1 1 1 1 1 1
Check # +nspect # Hpdate *escue "oat e2uipment 2#1#200( 1 1 1 1 1 1
&es-e :oat Davits7 #ifting "oo,s and +in-hes
Davits to "e lu"ricated B&nsure that the grease nipples are not paintedC 2#1#200( 1 1 1 1 1 1
Winches to "e lu"ricated/ Check gear"o1 oil level/ 2#1#200( 1 1 1 1 1 1
-o3ering o$ li$e "oat to 3ater@ disconnect and manoeuvre in the 3ater/ 2#1#200( 1 1 1 1 1 1
Check ladder and li$eline condition/ Changing drinking 3ater/ 2#1#200( 1 1 1 1 1 1
$ire and smo,e dete-tors
Check all sensors and i$ alarm trans$ered on "ridge 2#1#200( 1 1 1 1 1 1
%nnally
#iferafts2 3 "ydrostati- &eleases
'end li$e ra$ts 8 associated h,drost/ release units to an approved service station $or annual surve, 2#1#200( 1 1 1 1 1 1
Check marked la"le 8 validit, a$ter shore inspection 8 delivered documents 2#1#200( 1 1 1 1 1 1
:reathing %pparats 5-ompr. air e4ipment6
Complete =A 3ill "e checked ", an authori<ed service on shore Brecorded in the ships log "ookC 2#1#200( 1 1 1 1 1 1
6est certi$icate 3ill delivered "ack on "oard and =AOs should "e la"elled and stamped ", service 2#1#200( 1 1 1 1 1 1
$ire '!tingisher 5servi-e6
0eriodical service o$ all dr, po3der@ C!2 and $oam e1tinguishers ", an authori<ed shore service 2#1#200( 1 1 1 1 1 1
Checking o$ each e1tinguisher $or 3eight o$ C!2 c,linders@2ualit, o$ po3der 2#1#200( 1 1 1 1 1 1
Full report o$ all checked 8 la"eled e1tinguishers on "oard acc/-'A7plan to "e kept on "oard 2#1#200( 1 1 1 1 1 1
Check completeness a$ter shore service@ contents acc/-'A7plan incl/proo$ed spare capacit, 2#1#200( 1 1 1 1 1 1
Medi-ine -hest 3 medi-ine -a0inet 5servi-e6
'hore "ased e1amination Bpharmac,C o$ medicine locker and ca"inets i$ compulsar, 2#1#200( 1 1 1 1 1 1
*eplenishment o$ all used medicine incl/ check 8 re$ill@ i$ necessar,@ o$ li$e "oats $irst aid kids 2#1#200( 1 1 1 1 1 1
;e3 Medical Certi$icate issued 3ith ne3 date o$ e1pir, ", ha"our pharmac, $or ships docs on "oard 2#1#200( 1 1 1 1 1 1
'PI&: / &adar Transponder
'el$ test on &0+*= shall "e carried out 3ithout trans7mitting emergenc, signal
=atter, test is compulsor,@ check la"elled validit, o$ h,drostatic release 2#1#200( 1 1 1 1 1 1
*adartransponder7 general condition check 2#1#200( 1 1 1 1 1 1
*adartransponder7"atter, check7 neccessar, e1change is to $iled in ship?s log "ook 2#1#200( 1 1 1 1 1 1
$ire hoses
Check all hoses at A6M 3ater pressure 2#1#200( 1 1 1 1 1 1
8? Months
&0+*= general condition check 2#1#200( 1 1 1 1 1 1
M!= signal 7 replacing o$ "atteries 2#1#200( 1 1 1 1 1 1
'A*6 general condition check 2#1#200( 1 1 1 1 1 1
@B Months
6urn $alls end $or end
> Years
2#1#200(
5,drostatic pressure test to all dr, chemicals and $oam e1tinguishers/ 2#1#200(
6est o$ $i1ed $ire e1tinguishing s,stem C!2/ 2#1#200(
-ast
Maintenance
-i$e"oat 7 rene3 $alls Ba$ter 4 ,ears i$ not turned at 30 monthsC/ 4ear 3heel and "rake o$ li$e"oats li$ting
mechanisms to "e inspected/
=ack
C''M
F!*M 9 02
-ashing e2uipment inventor,
*evision. 01/01/200( Approved ", D0 0age 2% o$ (
MV: 0 Year: 0
Master: 0 Month: 0
N%M' Model N.
&e4.
Delivered #ossed
)antity
De-,
63istlock 6-74-#- 440 44 22 420 2
63istlock 6-7A#- (0 %2( 0
Midlock 6-7M#- %00 %04 0
6urn"uckle *'7F' 2( 2( 0
-ashing =ar *7D'#24%0 200 210 0
-ashing =ar *7D'#4)50 4 0
-ashing =ar *7D'#4(00#* 12 0
'panner !67*'#F 20 0
!67&#A#F 2 0
!*7A#103%0 3 0
!*7A#1(00 2 0
!*7A#4%20 2 0
!*7F#3(00 2 0
=in *ack 0-720>(#10 1 0
'torage =in 4 0
'torage =in 4 0
"old 0
+'71#115 132 0
+'716#- 544 0
'torage =in 2 0
*emarks.
)antity on
0oard
Previos
Inventory
Damage
&eport
&mergenc,
6ool
!perating
*od
!perating
*od
!perating
*od
!perating
*od
=+;
10%5>10%5>%
(0
=+;
10%5>10%5>%
(0
'ingle
'tacker
63ist
'tacker
=+;
10%5>10%5>%
(0
=ack
C''M
Form 9 03
Maintenance o$
'ecurit, &2uipment
*evision. 01/01/200( Approved ", C'! 0age 2( o$ (
MV: 0 Year: 0
Master: 0 Month: 0
Maintenan-e ;o0 Pi-e Mar ;ne Sep De-
5oses check o$ operational condition acc/ 'a$et, 0lan 1
A1es acc/ 'a$et, 0lan complete and usea"le acc/ 'a$et, 0lan 1
0lasticu$$s availa"le ade2uate 1
6orches =atter,7check@ $unction test at least pcs (
Walkie 6alkies =atter,7check@ $unction test at least 4 pcs 5
Deck lighting =ridge +n operational condition 2 pcs 2
Deck lighting mast a$t +n operational condition 2 pcs 2
Deck lighting mast $or3ard +n operational condition 1 pc 1
Deck lighting 3alk 3a,s +n operational condition ade2uate 1
'earchlight *escue =oat +n operational condition 1 pc 1
'earchlight Monke, +sland +n operational condition 1 pc 1
0orta"le 'earchlights +n operational condition 2 3ith 1 DW 2
!thers.
Maintenance details # de$iciencies remarks.
'ignature ''!.
Se-rity '4ipment
5#o-ation6
=ack
C''M
Form 9 03
Maintenance o$
'ecurit, &2uipment
*evision. 01/01/200( Approved ", C'! 0age 2) o$ (
C''M
F!*M Form 9 04
'ummar, o$ 6ank +nspections
*evision. 01/01/200( Approved ", D0 0age 30 o$ (
Master: 0 Month: 0
Vessel: 0 Year: 0
Smmary of Tan, Inspe-tions
CONDITION
4P4!!D # FPFA+* # *P*H'6K +; F # APAC6+!; CA**+&D !H6 # -P-&AD F*!M A0C # DP'5&-- +;6&*;A- DAMA4&
S'NSO& CONDITION
+ C +O&(ING / N+ C NOT +O&(ING
COMP%&TM'NT 8.INSP. / No. D 8.INSP. / No. D 8.INSP. / No. D 8.INSP. / No. D
9BB? 9BB= 9B8B 9B88
F!*&0&AD 1(7Qan703 W 4 27Fe"704 W 4 117Qun705 W 4
;!/1 D= 6A;D 127Fe"703 W 4 217!ct704 W 4 W
;!/1 A 0' '+D& 6A;D 137Apr703 W 4 237Ma,704 W 4 307Apr705 W 4
;!/1 A '= '+D& 6A;D 137Apr703 W 4 237Ma,704 W 4 307Apr705 W 4
;!/1 C D&&0 6A;D 137Apr703 W 4 (7Qun704 W 4 227Qul705 W
;!/2 0' D= 6A;D 247Ma,703 N+ 4 227Ma,704 W 4 2%7Ma,705 W 4
;!/2 '= D= 6A;D 247Ma,703 N+ 4 227Ma,704 W 4 2%7Ma,705 W 4
;!/2 A 0' '+D& 6A;D 1(7Qul703 W 4 307'ep704 W 4 17'ep705 W 4
;!/2 A '= '+D& 6A;D 1(7Qul703 W 4 307'ep704 W 4 17'ep705 W 4
;!/3 A 0' '+D& 6A;D 117;ov703 W 4 2(7Dec704 W 4 W
;!/3 A '= '+D& 6A;D 117;ov703 W 4 2(7Dec704 W 4 W
;!/ 3 C- D= 6A;D W 117;ov704 N+ 4 W
;!/ 3 0' D= 6A;D 1%7Mar703 W 4 17Qul704 W 4 237Mar705 W 4
;!/3 '= D= 6A;D 1%7Mar703 N+ 4 17Qul704 W 4 237Mar705 W 4
;!/4 A 0' '+D& 6A;D W (7Dec704 W 4 237Qul705 N+ 4
;!/4 A '= '+D& 6A;D W (7Dec704 W 4 W
;!/4 C 0' D&&0 6A;D 157Apr703 W 4 57Aug704 W 4 1)7Aug705 W 4
;!/4 C '= D&&0 6A;D 157Apr703 W 4 57Aug704 W 4 1)7Aug705 W 4
;!/4 C- D= 6A;D 47'ep703 W 4 207!ct704 W 4 W
;!/4 0' D= 6A;D 2)7Ma,703 W 4 1)7!ct704 W 4 W
;!/4 '= D= 6A;D 2)7Ma,703 W 4 1)7!ct704 N+ 4 W
;!/5 A 0' '+D& 6A;D 1%7Mar703 W 4 17Qan704 W 4 2(7Fe"705 W 4
;!/5 A '= '+D& 6A;D W 17Qan704 W 4 2(7Fe"705 W 4
;!/5 C- D= 6A;D 247Qul703 W 4 107;ov704 W 4 W
AF6&* 0&AD 6A;D 1)7Dec703 W 4 2(7'ep704 W 4 7Qul705 W 4
FW 6A;D ;!/ 40 247Mar703 W 4 )7Dec704 ;#A 4 117Aug705 ;#A 4
FW 6A;D ;!/ 41 227'ep703 W 4 %7Fe"704 ;#A 4 107Qan705 ;#A 4
II 65& *&MA+;+;4 6A;D' W+-- =& +;'0&C6&D A6 ;&>6 0!''+=-& !00!*6H;+6K
23/0%/05. 0ort side heeling 6ank sensor replaced ", another t,pe 3hich read dou"le o$ the actual sndg/
*e2?n sent $or same t,pe
3 D= '= '&;'!* *&0-AC&D !; 01/11/04
2 D= 08' '&;'!* *&0-AC&D !; 0(/11/04
3 C- D= '&;'!* *&0-AC&D !; 10/03/05 Chie$ Mate # Chie$ &ngineer
=ack
C''M
F!*M Form 9 04
'ummar, o$ 6ank +nspections
*evision. 01/01/200( Approved ", D0 0age 31 o$ (
4D= '= '&;'!* *&0-AC&D !; 11/03/05
C''M
F!*M Form 9 04
'ummar, o$ 6ank +nspections
*evision. 01/01/200( Approved ", D0 0age 32 o$ (
Smmary of Tan, Inspe-tions
4P4!!D # FPFA+* # *P*H'6K +; F # APAC6+!; CA**+&D !H6 # -P-&AD F*!M A0C # DP'5&-- +;6&*;A- DAMA4&
+ C +O&(ING / N+ C NOT +O&(ING
8.INSP. / No. D
9B88
C''M
F!*M Form 9 04
'ummar, o$ 6ank +nspections
*evision. 01/01/200( Approved ", D0 0age 33 o$ (
C''M
Form F 01
+M! Cre3 -ist
*evision. 01/01/200( Approved ", D0 0age 34 o$ (
+M! C*&W -+'6
0age
Arrival Departure
1/ ;ame o$ 'hip. 2/ 0ort o$ arrival # departure 3/ Date o$ arrival # departure
0 0 0 30#12#1()) 30#12#1())
4/ ;ationalit, o$ 'hip. 5/ 0ort arrived $rom#port o$ destination
0
0 0
%/#(/ Famil, name@ given names )/ *ank or rating 10/ ;ationalit, 11/ Date 8 place o$ "irth 'eamen?' =ook 0lace o$ +ssue
Mustermann Wil$ried Master 4erman
Meier
Willi
Anton A=
/ +dendit, document # seaman?s
passport
=ack
C''M
Form F 02
+M! 0assenger -ist
*evision. 01/01/200( Approved ", D0 0age 35 o$ (
+M! 0A''&;4&* -+'6
Arrival Departure 0age
1/ ;ame o$ 'hip. 2/ 0ort o$ arrival # departure 3/ Date o$ arrival # departure
0 0 0 30#12#1()) 30#12#1())
4/ ;ationalit, o$ 'hip.
0
5/ Famil, name@ given names / ;ationalit, %/ Date 8 plae o$ "irth (/ 0ort o$ em"arkation )/ 0ort o$ disem"arkation
Meier
MRller
Date and signature ", master@ authori<ed agent or o$$icer
=ack
C''M
Form F 03
'hip?s 'tores Declaration
*evision. 01/01/200( Approved ", D0 0age 3 o$ (
T"' D'P%&TM'NT O$ T"' T&'%S*&Y
:*&'%* O$ C*STOMS
S"IPES STO&'S D'C#%&%TION
> %rrival Departre 0age ;o/
1/ ;ame o$ ship. 0 2/ 0ort o$ arrival#departure. 3/ Date o$ arrival#departure.
0 0 30#12#1()) 30#12#1())
4/ ;ationalit, o$ ship. 0 5/ 0ort arrived $rom#0ort o$ destination. 0 0
/ ;um"er o$ persons on "oard 0 %/ 0eriod o$ sta, 0 (/ 0lace o$ storage I
)/ ;ame o$ article 10/ 9uantit, 11/ For !$$ical Hse
Ammunition@ 3( cal/ ;+- *ds/
*evolver@ 3( cal/ ;+- &a/
*ope@ Fi"er 4 Ft/
*ope@ Wire 4 Ft/
Diesel !il 3353 4al s/
Fuel !il %(5 ="l s/
Fresh Water 45 6ons
-u"e !il 1543 4al s/
Cereal 8 0aste 0 -"s/
Co$$ee 0 -"s/
Dair, 0 -"s/
&ggs 0 Do</
0 -"s/
0 -"s/
0 -"s/
0oultr, 0 -"s/
0 -"s/
'ugar 0 -"s/
Detergents 8 'oap 4) -"s/
4rease 1% -"s/
Derosene 8 'olvent 3% 4al s/
0aint 343 4al s/
0aint@ Additives %) 4al s/
=eer 0 Cases
Cigarettes 0 Ctns/
Cigars 0 &a/
4in 0 =tl s/
-i2uers 0 =tl s/
6o"acco 0 -"s/
Whiske, 0 =tl s/
Wine 0 =tl s/
'o$tdrinks 0 Cases
'parkling Wine 0 =tl s/
*um 0 =tl s/
N%&COTICS
Codeine 'ul$ate gr/ 0 6a"let
Morphine 'ul$ate gr/ 0 6u"e1
0aragoric 0 0ints
0heno"ar"ital gr/ 0 6a"let
Also such "roken and sundr, stores as linen@ crocker,@ silver@ spare parts@ tools@ instrument hospital
supplies and slop chest stores as re2uired ", la3 and#or necessar, $or the sa$e and e$$icientnavigation and operation o$ the vessel/
12/ Date and signature ", master@ authori<ed agent or o$$icer (#12#2014
I ;ot re2uired ", the Hnited 'tates
D'C(
'NGIN'
ST'+%&D
Fish Fro<en 7 Fresh 8 'alt
Fruit Fresh 7 Dried 8 Canned
Meat Fresh 7 Canned 8 'alt
:egeta"les Fresh 7 Fro<en 8 Canned
G'N'&%#
:OND'D
=ack
C''M
Form F 04
Cre3?s &$$ects Declaration
*evision. 01/01/200( Approved ", D0 0age 3% o$ (
T"' D'P%&TM'NT O$ T"' T&'%S*&Y
:*&'%* O$ C*STOMS
S"IPES STO&'S D'C#%&%TION
> %rrival Departre
0age ;o/
M: 0
3/ ;ationalit, o$ ship 0
4/;o/ 5/ Famil, name@ given names / *ank
C
i
g
a
r
e
t
t
e
s
6
a
"
a
k
'
p
i
r
i
t!thers
1
Mustermann Wil$ried Master
200 ;+- 1 -aptop@ Camera
2
Meier
3
Willi
4
5

%
(
)
10
11
12
13
14
15
1
1%
Anton A=
1(
1)
20
21
22
23
24
25
2
2%
2(
2)
30
31
32
33
)/ Date and signature ", master@ authori<ed agent or o$$icer (#12#2014
2/ Articles ac2uired a"road ", o$$icers and mem"ers o$ the cre3 Be1cept
those e1clusivel, $or use on vo,age or cleared through Customs
authoritiesC
%/ ;o/ o$ cre3
mem"ers?s
intended to "e
landed
Declaration o$
articles Bi$
none@ sho3
S;oneSC
=ack
C''M
Form F 05 +M!
4eneral Declaration
*evision. 01/01/200( Approved ", D0 0age 3( o$ (
+M! '5+0?' '6!*&' D&C-A*A6+!;
Arrival Departure
1/ ;ame and description o$ ship. 0 2/ 0ort o$ arrival # departure
0 0 30#12#1()) 30#12#1())
4/ ;ationalit, o$ 'hip. 5/ ;ame o$ Master / 0ort arrived $rom # port o$ destination
0 0 0 0
%/ Certi$icate o$ registr, Bport. date. num"erC (/ 0lace o$ storage
)/ 4ross tonnage 10/ ;et tonnage
0 5300
11/ 0osition o$ the ship in the port B"erth or stationC
12/ =rie$ particulars o$ vo,age Bprevious and su"se2uent ports o$ callM underline 3here remaining cargo 3ill "e dischargedC
13/ =rie$ description o$ the cargo
14/ ;um"er o$ cre3 Bincl/ masterC 15/ ;um"ers o$ passengers 1/ *emarks
4 2
Attached documents Bindicate num"er o$ copiesC
1%/ Cargo declaration 1(/ 'hipOs stores declaration
1)/ Cre3 list 20/ 0assager list
agent or o$$icer
22/ Cre3s e$$ects declaration B I C 23/ Maritime declaration o$ helth B I C
For o$$icial use.
BIC onl, on arrival
3/ Date#time o$
arr#dep
21/ Date and signature ", master@ authorised
=ack
C''M
Form F 05 +M!
4eneral Declaration
*evision. 01/01/200( Approved ", D0 0age 3) o$ (
C''M
Form F 0
:accination -ist
*evision. 01/01/200( Approved ", D0 0age 40 o$ (
V%CCIN%TION #IST
;ame o$ ship. 0 Date o$ arrival. 30#12#1()) 0ort arrived $rom.
0
;ationalit, o$ ship. 0 0ort o$ arrival. 0
Date o$ e1pir,
;o/ Famil, name@ given names *ank
;ationalit, Cholera Kello3 Fever
1
Mustermann Wil$ried Master 4erman
2
Meier
3
Willi
4
5

%
(
)
10
11
12
13
14
15
1
1%
Anton A=
1(
1)
20
21
22
23
24
25
2
2%
2(
2)
30
31
32
33
Date and signature ", master@ authori<ed agent or o$$icer (#12#2014
=ack
C''M
Form F 0% +M!
Declaration o$ 5ealth
*evision. 01/01/200( Approved ", D0 0age 41 o$ (
IMO D'C#%&%TION O$ "'%#T"
0 12#0(#2014
0
0
0
0
0
5530
Deratting or Dated.
Deratting &1emption
0
passengers
0

Ans3er
K&' or ;!
5/ +s there an, sick person on "oard no3T 4ive particulars in the 'chedule/
'igned BMasterC 0/00
Countersigned B'hipLs 'urgeonC
Date.
I +$ more than $our 3eeks have lapsed since the vo,age "egan@ it 3ill su$$ice to give particulars $or the last $our 3eeks/
0ort o$. Date.
;ame o$ ship. From. 6o.
;ationalit,. MasterLs name.
;et registered tonnage.
Certi$icate.
+ssued at.
;o/ o$ Ca"in. ;o/ o$ cre3.
Deck.
-ist o$ ports o$ call $rom commencement o$ vo,age 3ith dates o$ departure.
"'%#T" )*'STIONS
1/ 5as there "een on "oard during the vo,ageI an, case or suspected case o$ plague@ cholera or ,ello3 $everT
4ive particulars in the 'chedule/
2/ 5as plague occurred or "een suspected among the rats or mice on "oard during the vo,ageI or has there
"een an a"normal mortalit, among themT
3/ 5as an, person died on "oard during the vo,ageI other than as a result o$ accidentT 4ive particulars in the
'chedule/
4/ +s there on "oard or has there "een during the vo,ageI an, case o$ disease 3hich ,ou suspect to "e o$ an
in$ectious natureT 4ive particulars in the 'chedule/
;ote. +n the a"sence o$ a surgeon@ the Master should regard the $ollo3ing s,mptoms as grounds $or
suspecting the e1istence o$ disease o$ an in$ectious nature. $ever accompanied ", prostration or
persisting $or several da,s@ or attended 3ith glandular s3ellingM or an, acute skin rash or eruption 3ith or
3ithout $everM severe diarrhoea 3ith s,mptoms o$ collapseM Gaundice accompanied ", $ever/
/ Are ,ou a3are o$ an, other conditions on "oard 3hich ma, lead to in$ection or the spread o$ diseaseT
+ here", declare that the particulars and ans3ers to the 2uestions given in this Declaration o$ 5ealth Bincluding the 'cheduleC are
true and correct to the "est o$ m, kno3ledge and "elie$/
=ack
C''M
Form F 0) B'cheduleC
Declaration o$ 5ealth
'chedule
*evision. 01/01/200( Approved ", D0 0age 42 o$ (
+M! D&C-A*A6+!; !F 5&A-65


































Name Class or rating %ge Se! Nationality Port of em0ar,ation Date of em0ar,ation Natre of illness Date of its onset &eslts of illness< Disposal of -ase<<
<State 1hether re-overed7 still ill7 died.
<<State 1hether still on 0oard7 landed at 5give name of port67 0ried at sea.
=ack
C''M
Form ! 01
'hip Certi$icates
*evision. 01/01/200( Approved ", D0 0age 1 o$ (
M:. Master 1 Kear. 200(
Master. 9uarter. Qanuar,
No. Certifi-ates Pla-e issed Total validity &ene1al Date &emar,s
Periodi-al Certifi-ates
Continuous ',nopsis *ecord
5ang<hou 01/02/200(
1 'hip 'anitar, &1emption Certi$icate
5ang<hou 01/02/200( 0 0@5 U:A-H&A
2 Anal,sis 0orta"le Water
5ang<hou 01/02/200( 0 1 U:A-H&A
3 'anitar, Certi$icate # 6ai3an
5ang<hou 01/02/200( 1 U:A-H&A
4 0ort 'tate Control
5ang<hou 01/02/200( 0 0@5 U:A-H&A
4,ro@ annual service
5ang<hou 01/02/200( A 1 U:A-H&A
% -i$e7*a$ts
5ang<hou 01/02/200( A 1 U:A-H&A
( 0assenger # H'A
5ang<hou 01/02/200( 1 U:A-H&A
) +/6/F/ C=A
5ang<hou 01/02/200( A 1 U:A-H&A
10 C!2 Weight Check
5ang<hou 01/02/200( A 1 U:A-H&A
11 !0A +nsurance H'A '+4C!
5ang<hou 01/02/200( A 1 U:A-H&A
12 !il 'pill &nroll/ Canada
5ang<hou 01/02/200( A 1 U:A-H&A
13 !'*! Cali$ornia *M4
5ang<hou 01/02/200( 1 U:A-H&A
14 Certi$icate o$ entr, # 0 8 +
5ang<hou 01/02/200(
15 &mergenc, *esponse 'ervice
5ang<hou 01/02/200(
1 Certi$icate o$ Financial *esp/ # H'C4
5ang<hou 01/02/200( 0 3 U:A-H&A
1% Certi$icate o$ Financial *esp/ # Cali$ornia
5ang<hou 01/02/200( 0 2 U:A-H&A
1( Medical Chest
5ang<hou 01/02/200( A 2I # 1 U:A-H&A
1) C!2 Complete ',stem Check
5ang<hou 01/02/200( 0 2 U:A-H&A
20 Fire &1tinguishers
5ang<hou 01/02/200( 0 2 U:A-H&A
21 5,drostatic *eleases # &0+*= # -i$e *a$ts
5ang<hou 01/02/200( 0 2 U:A-H&A
22 'a$e Manning Certi$icate
5ang<hou 01/02/200( 0 5I# 2# 2E1II U:A-H&A
23 Flag 'tate # 4erman *egister
5ang<hou 01/02/200( 2 # 2 U:A-H&A =are "oat onl,
24 *adio 'tation -icence o$ Flag 'tate
5ang<hou 01/02/200( 0 5# 2# 0erm U:A-H&A
25 Magnetic Compass AdGustment
5ang<hou 01/02/200( 0 2 U:A-H&A
2 MA*0!- +/!/0/0/
5ang<hou 01/02/200( * 5 # * U:A-H&A
25a MA*0!- +/!/0/0/ +ntermediate
5ang<hou 01/02/200( + 2/5 U:A-H&A
2 0anama Canal '!0&0
5ang<hou 01/02/200( 3 # 3 U:A-H&A
2% 6in Free AF Certi$icate
5ang<hou 01/02/200(
2( 'e3age 0ollution Cert/ MA*0!- +:
5ang<hou 01/02/200( 5 # * U:A-H&A
2) 0revention o$ 0oll/ ", 4ar"age Marpol +:
5ang<hou 01/02/200( 5 # * U:A-H&A
30 'a$et, &2uipment Certi$icate
5ang<hou 01/02/200( * 5 # * U:A-H&A
30a 'a$et, &2uipment +ntermediate
5ang<hou 01/02/200( + 2/5 U:A-H&A
31 Cargo ship sa$et, inspection B A8= C
5ang<hou 01/02/200( 0 1 U:A-H&A
32 'a$et, *adio Certi$icate
5ang<hou 01/02/200( * 5 # * U:A-H&A
32a 'a$et, *adio Certi$icate +ntermediate
5ang<hou 01/02/200( + 2/5 U:A-H&A
33 4MD'' Maintenance Contract
5ang<hou 01/02/200( A 1 U:A-H&A
34 'a$et, Construction Certi$icate
5ang<hou 01/02/200( * 5 # * U:A-H&A
34a 'a$et, Construction V +ntermediate
5ang<hou 01/02/200( + 2/5 U:A-H&A
35 -oad -ine Certi$icate
5ang<hou 01/02/200( A 5 * U:A-H&A
3 Cargo gear
5ang<hou 01/02/200( A 475 U:A-H&A
3% Class 5ull # Machiner,
5ang<hou 01/02/200( A 5* U:A-H&A
3%a Class 5ull # Machiner, +ntermediate
5ang<hou 01/02/200( + 2/5 U:A-H&A
3( Cert/ Carr,ing dangerous goods
5ang<hou 01/02/200( 5 * U:A-H&A
3) Cert/ !$ *egistr,@ A 8 =
5ang<hou 01/02/200( 5 * U:A-H&A
40 -oading computers 'o$t3are 6est B 4- C
5ang<hou 01/02/200( A 5 U:A-H&A
41 'a$et, Management Certi$icate V 'MC
5ang<hou 01/02/200( * 5 U:A-H&A
41a 'MC +ntermediate
5ang<hou 01/02/200( + 2@5 U:A-H&A
42 Document o$ Compliance V D!C
5ang<hou 01/02/200( 5 U:A-H&A
43 +nternat/ 'hip 'ecurit, Certi$icate # +''C
5ang<hou 01/02/200( * 5 U:A-H&A
43a +''C +ntermediate
5ang<hou 01/02/200( + 2@5 U:A-H&A
44 'ailing 0ermit # Fahrterlau"nisschein
5ang<hou 01/02/200(
45 MA*0!- +/A/0/0/
5ang<hou 01/02/200( * 5 # * U:A-H&A
45a MA*0!- +/A/0/0/ +ntermediate
5ang<hou 01/02/200( + 2/5 U:A-H&A
Permanent Certifi-ates Pla-e issed Issed 0y Cert. ID &emar,s
*egistr,
5ang<hou
+nternational 6onnage Certi$icate
5ang<hou
'ue< C/ 6onnage 8 'hipLs *egister ;um"er
5ang<hou
0anama 6onnage
5ang<hou
' ! 0 & 0
5ang<hou
Cargo 'ecuring Manual
5ang<hou
6rim 8 'ta"ilit, =ooklet
5ang<hou
Certi$icate o$ Compliance +-! and +-C
5ang<hou
Approval o$ 'hip 'ecurit, 0lan
5ang<hou
Continious ',nopsis *ecord BC'*C
5ang<hou
Date of Isse/
'ndorsement
(ind of
srvey
=ack
C''M
Form ! 01
'hip Certi$icates
*evision. 01/01/200( Approved ", D0 0age 2 o$ (
'ignature !$ Master Date 8 'tamp
C''M
F!*M ! 02
Master *evie3
*evision. 01/01/200( Approved ", D0 0age 3 o$ (
MV: 0 Year: 0
Master: 0 Month: 0
%genda.
Master has to prepare $rom time to time a 3ritten report to Gudge the 'M'
during his sta, on "oard/5al$7,earl, 3ritten report is possi"le and#or i$
master is changing the command/ During +nternal and &1ternal Audits on "oard
as 3ell as veri$ication o$ reports ", the o$$ice sta$$ it came up that MasterLs
'M' *evie3 Baccording to the concerned FormC are $illed out impractica"l, or not
su$$icientl,/ +mproving proposals or ideas concerning 'M' are 3elcome to the Compan,
and D0/
Follo3ing topics o$ content are given to "ring this *evie3 in an accepta"le st,le@
so that Authorities@ Auditors and Compan,Ls Management are a"le to read the 'tatus
o$ 'a$et, Management on =oard /
;ote. 6he te1t in the 'tandard Form is an e1ample onl, and does not cover the entire
'M' veri$ication as to "e concerned/
6opics o$ MasterLs *evie3.
BDo not list all positive items@ give general overvie3 or list negative occurrences
i$ soA +$ some important positions have to "e considered@ give additional remarks
to relevant reports or $ormsA Do veri$, the time since the last MasterLs *evie3 onl,AC
74eneral 'tatement
0lease state that the 'M' is implemented and maintained as per +'M VCode and as per
Compan,Ls ',stem descri"ed in the +'M7documentation/ Mention out that environmental
protection is considered accordingl,/
7Condition o$ Cre3
0lease in$orm the compan, a"out condition o$ certi$icates@ condition o$ sa$et, training@
3orking "ehaviour and covering o$ rest time regulation///
7Accidents and serious occurrences
4ive a summar, i$ accidents are happened Bor near", happenedC/ 4ive in$ormation a"out
$ollo3 up veri$ication/
7+nternal and &1ternal Audits # 0'C # +mportant 'urve,s
4ive an !vervie3 a"out Audits@ 0ort 'tate Control or 'urve,s@ appearing maGor de$iciencies
and status o$ clearance since last revie3/
7Condition o$ Machiner, and &2uipment
0lease in$orm the Compan, a"out general status o$ machiner, and e2uipment BmaintenanceC/
+$ there is a permanent pro"lem@ please mention it/
7+mprovement o$ 'M'
+$ there are some proposals $or improvement o$ 'M'@ please give recommendations $or operation@
changing o$ manuals@ procedures@ $orms a/s/o/ Do it in a positive and use$ul 3a, to help us
$iguring out ho3 to react/
'ignature Master.
=ack
C''M
Form ! 03
;C *eport
*evision. 01/01/200( Approved D0 0age 4 o$ (
:essel. Master. Date.
+ncident. Accident. ;ear Miss. ;on Con$ormit,. Critical &2uipment Failure.

A +ncident Bto "e descri"ed ", masterC
= Corrective Action Bto "e de$ined ", D0AC
C 0reventive Action Bto "e de$in&d ", D0AC

Date o$ +mplemention on "oard.
B'ignature ", masterC
Date o$ Completion o$ +mplementation.
B'ignature ", masterC
=ack
C''M
Form ! 05
*e2uisition -ist
*evision. 01/01/200( Approved ", D0 0age 5 o$ (
&')*ISITION $O& SP%&' P%&TS
DA6& ;! *e$erence ;! Deck &ng
10#2%#200( &7200(701701 !
+ncoming !rder. &nvelope 0hone Fa1
;ame o$ :essel.
;ame o$ Machiner,. 111
6,pe. 111
'erial ;o.
Maker. 111
Address.
0art Description 0art ;o/ Dra3ing ;o *!= *&9
*emarks.
0-&A'& F!*WA*D 6! . Dlingen"erg =ereederungs7 und =e$rachtungs !54
ADD*&'' . A$ter de 5W$@ 2045) 5am"urg@ 4erman,
=ack
C''M
Form ! 0
Container Damages
*evision. 01/01/200( Approved ", D0 0age o$ (
Voyage No.: 0 MV: 0 Year: 0
Master: 0 Month: 0
C!;6A+;&* +;6&*C5A;4& *&C&+06 A;D DAMA4& *&0!*6
CONT%IN'& 2 No. 234444444444
6his container received in apparent good order e1cept as noted/ 6his interchange is made su"Gect to the terms and conditions
o$ the currentl, e$$ective interchange contract "et3een Q/ Dahrs
=ereederung 4m"5 8 Co/ D4 and.
9uesto container ricevuto in apparente "uona condi<ione 2uanto indicato/ 9uesto scam"io e regolato dai termini e condi<ioni del contratto di scam"io
attualmente in vigore tra il Q/ Dahrs =ereederung 4m"5 8 Co/ D4 e.
&ste container reci"ido en "uenas condiciones salvo lo 2ue se indica/ &ste intercam"io se hace suGeto a los terminos , condiciones del
contrato de intercam"io actualmante en vigencia entre el 6ransportador
Q/ Dahrs =ereederung 4m"5 8 Co/ D4 ,.
Ce container est reXu en "onne condition sau$ pour les e1ceptions indi2uees/ Cet echange est e$$ectue sous reserve des termes et conditions du contrat
d echance actuellement en vigueur entre le 6ransporteur Destinataire et.
1C 6AD&; F*!M 6&*M+;A-. &urokai 2C *&6H*;&D 6! 6&*M+;A-. hugiluhlkGio
Full7'eal ;o. 3333333 Full7'eal ;o. 333333333
&mpt, &mpt,
*AY; 6!0 =!66!M '+D& *A+- 6!0 12C
!H6&*
*+456 '+D&

5+;4&' C!*;&*
CA'6+;4
-!CD+;4 *&A* =!66!M
-A6C5 *A+- '+D& 0!'6'
-!CD+;4 +F F+66&D 'eal missing
-!CD+;4 5A;D-& F*!;6 -&F6
=A*75+;4& 6!0 '+D& F*!;6
-!CD+;4 -&F6 *A+-
=A* C!*;&* '+D& -&F6
0!'6 '+D&
'NG#IS" IT%#I%N SP%NIS" $&'NC"
1C 'cratch 4ra$$io *ascadura &gratignure
2C Cut 6aglio Corte &ntaille
3C 4ash '2uarcio Desgarro Dechirure
4C 5ole =uco 5ueco 6rou
5C Deep score 4ra$$io pro$ondo *escadura pro$unda &gratignure pro$onde
C 0unctured =ucato 5oradado 0erce
%C =roken *otto *ompido Casse
(C Distorted Contorto 6orcido 6ordu
)C =ent 0iegato &ncorvado 0lie
10C *ipped 'trappato -acerado Arrache
11C Dent Ammaccato Magullado Froisse
12C 0ushed in Ammaccatura rientrante magullado entrante Degat concave
13C 0ushed out Ammaccatura sporgente magullado saliente Degat conve1e
14C Caved in '$ondato 5undido &n$once
15C Missing Mancante Falta Man2uant
For receiving part, . For delivering part, .
=ack
C''M
Form ! 0
Container Damages
*evision. 01/01/200( Approved ", D0 0age % o$ (
DA6& . (#12#2014 0-AC&. DA6& . (#12#2014 0-AC&.
C''M
Form ! 0%
'tevedore Damage *eport
*evision. 01/01/200( Approved ", D0 0age ( o$ (
MV: 0 Year: 0
Master: 0 Month: 0
Call 'ign. 0 Flag. 0
M:. 0 6o. 5ead !$$ice ?Fleet Management?
Charterer. CMA # C4M *eport ;o. 3% # 200
D%M%G' &'PO&T
;otice o$ damage to ship or her $ittings ", stevedores or other charterer?s servants
To Messrs.
Stevedores Company / #o-al Charterers %gent
Port. Date. Voyage.
5ere3ith the undersigned@ Master o$ the M: 0 declared that the damage to ship and#or gear and#or
e2uipment as stated herunder@ 3as caused ", the stevedore?s personnel@ 3hilst handling cargo during the sta, o$ the vessel
in the a"ove mentioned port/
Des-ription of damage Case of damage

1(7Ma,72005 Midlock 6-7M#- damaged # lost 4 During cargo operations Bunlashing@ discharging@ loadingC
due o$ negligence o$ stevedores/
6urn"uckle *'7F' "adl, dent # damaged 1 During cargo operations Bunlashing@ discharging@ loadingC
due o$ negligence o$ stevedores/
63ist stacker +'16#-damaged # lost 1 During cargo operations Bunlashing@ discharging@ loadingC
due o$ negligence o$ stevedores/
ZZZZZZZZZZZZ ///////////////////////////////////// ///////////ZZZZZ//////////Z
Chie$ !$$icer # Dut, !$$icer Master For the agenc,#stevedores
Agent has "een in$ormed/
*emarks concerning repairs. A"ove stated damages cannot "e repaired ", ship?s cre3/
*emarks ", Master#'tevedores.
Date/time
of damage
6he damage is in no 3a, caused ", an, $ault in ship?s management during loading and#or unloading operation@ "ut solel, is
o3ing to the activities o$ the stevedores personnel/
6he Master o$ the vessel here3ith holds the a"ove compan, responsi"le $or all conse2uences arising $rom o$ the a"ove
stated damages/
=ack
C''M
F!*M ! 0(
'ummar, ship dammages
*evision. 01/01/200( Approved ", D0 0age ) o$ (
MV: 0 Year: 0
Master: 0 Month: 0
Port
Stats
01#02#0( 11 ,, open
Date
D&
Nm0er
Des-ription of damage7 Name of -ompany7 -ased damages.
"%S TO :' $I##'D O*T CONTNI*O*S#Y FF
%mont
G
%mont
H
ProIe!
D/N
&epaired /
&epla-ed 0y
=ack
C''M
F!*M ! 0(
'ummar, ship dammages
*evision. 01/01/200( Approved ", D0 0age 10 o$ (
C''M
F!*M ! 0)
:o,age 0lanning
*evision. 01/01/200( Approved ", D0 0age 11 o$ (
Passage Plan for Congested +aters
$rom. B to. B M:. B Call Sign. B
'ignature
Master. 0 6rack. *hum" line 4reat circle Comp/ great circle
C#!. 0osition $i1ing mode.
2nd !. D40' *adar.
C#& con$irmation $or su$$icient "unker@ FW 8 lu" oil Charterer?s speed re2uirement. kts
C#&. Hse o$ 3eather routeing. Kes ;o =, Whom.
'pecial notes.
+aypoint #atitde #ongitde Tre -orse Tra-, distan-e &adar mar,s Parallel inde! $re4en-y V"$ Tra-, error
*ad/ &/ch/ degrees n miles name 0- 0- ;o/1 ;o/2 minutes rep/ channel ma1 allo3ed
0 53 34/3 ; ( 32/1( & 5 0/1;M
=ack
C''M
F!*M ! 0)
:o,age 0lanning
*evision. 01/01/200( Approved ", D0 0age 12 o$ (
=ooks re2uired $or passage. &1ample
Charts used on passage. 1111 2222 3333 4444
C''M
F!*M ! 0)
:o,age 0lanning
*evision. 01/01/200( Approved ", D0 0age 13 o$ (
Tidal information
%rea "igh 1ater #o1 1ater ,otal $assage distance: 12- nm
Safe speed
Dangeros or %n-horage Ne-essary for
&emar,s
-ations areas 5plan 3 emergen-y6 V"$ &eports
C''M
Form ! 10
6ank *eport
*evision. 01/01/200( Approved ", D0 0age 14 o$ (
MV: ...
Master: ... Date: /12/201!
&eport No.. D >B
T%N( / NO. / TYP' . Dou"le =ottom 6ank 5 0ort
'urve,ed ", . =osun
Check -ist enclosed space
entr, o"served . K&'
'urve, date .
G'N'&%# CONDITION
0aint Condition . 0A+;6 W+65!H6 A;K D&F+C+&;CK
Corrosion . ;!
Mechanical Damages . ;!
'ediment 8 *esidual Water . 20 cm
P%&TI%# CONDITION
Deairation 0ipes . 4!!D
=allast 0ipes # Flanges 8
'uction 0ipe . 4!!D
6ankladders . 0artl, sign o$ corrosion
Manhole Covers # =olts # 0acking. 6ankside $ull rust, covered 3ith 3hite Fluid Film
*emote Control :alve o$ 6ank . ;#A
0ipe 5olders . !D
Foreign =odies . ;!
5eating Coils . ; # A
!ther *emark . 0ipe compensators !D
Attached 0ictures . DC0017=ottomM DC0027Flat"ars $rom pipe supportsM DC0037Coating
DC0047scallops "ottomM
Attached Dra3ing # 'ketch . 1C 6ank sketch 3ith corroded areas
T%N( &'PO&T
=ack
C''M
Form ! 10
6ank *eport
*evision. 01/01/200( Approved ", D0 0age 15 o$ (
Name 3 Signatre.
C''M
Form ! 11
6ank *eport
*evision. 01/01/200( Approved ", D0 0age 1 o$ (
MV: 0 Port: 0
Master: 0 Date of arri'al: -0/12/1//
PO&T ST%Y 'M'&G'NCY #IST
F!* ADD*&''&' !F C-A'' A;D 08+ C-H= '&& A-'! ADD*&''7-+'6
A4&;6 FH-- '6K-& FA> 6->
0+-!6'
F+*'6 A+D
F+*& =*+4AD&
AM=H-A;C&#5!'0+6A-
0!*6 AH65!*+6K
0!--H6+!; C!;6*!-
4A6&
0!-+C&
'6&:&D!*&'
AM=A''K
C-A'' '!C+&6K
08+ C-H=
M:. 0
0lace. 0
Date.
Chie$ !$$icer Master
6&-&05!;&
!$$ice hours A$ter
!$$ice hrs/
M!=+-& 05!;& #
:5F C5A;;&-
C5+;A '5+00+;4 ;!*65
AM&*+CA A4&;CK
111 W&'6 !C&A; =-:D@
'H+6 1%00
-!;4 =&AC5 CA )0(02
=ack
C''M
Form ! 12
;otice o$ *eadiness
*evision. 01/01/200( Approved ", D0 0age 1% o$ (
MV: 0 Year: 0
Master: Voyage No Month: 0
Notice of Readiness
Marsig m)0
1ischer+eg !0& 102/ Rostock
Please note that the shi$: 0
Nationality: 0 3all 4ign 0 arri'ed (nder my command
at the $ort: 0
anchored in the roadstead of: 4hanghai 5ay on: 1/12/200
at: 12:00 $.m.
+aiting for a loading / discharging )erth
and is ready in e'ery res$ect to commence loading / discharging cargo of:
in accordance +ith the terms& s($$lements& deletions and e6ce$tions of the
3harter Party dated as agreed.
7f it is intended to commence loading / discharging the cargo earlier thannamed
in the 3harter Party time is to co(nt from the time of act(al )eginning.
Place: 4hanghai
Date: 8/12/2002 0o(r: 12 $.m.
3harterer:
Master:
=ack
C''M
Form ! 12
;otice o$ *eadiness
*evision. 01/01/200( Approved ", D0 0age 1( o$ (
C''M
Form C 01
Arrival Deck
*evision. 01/01/200( Approved D0 0age 1) o$ (
MV: 0 Year: 0
Master: 0 Month: 0
Da, 1 2 3 4 5 % ( ) 10 11 12 13 14 15 1 1% 1( 1) 20 21 22 23 24 25 2 2% 2( 2) 30
0
o
t
i
;
o
v
o
r
o
s
s
i
,
s
k
!
d
e
s
s
a
C
o
n
s
t
a
n
t
a
:
a
r
n
a
0
i
r
a
e
u
s
C
a
g
l
i
a
r
i
M
a
r
s
a
1
l
o
k
k
+
s
t
a
n
"
u
l
6
r
a
"
<
o
n
0
o
t
i
;
o
v
o
r
o
s
s
i
s
,
k
!
d
e
s
s
a
C
o
n
s
t
a
n
t
a
To 0e filled in 0y the Dty Offi-er.
1 1
2 Check up $ollo3ing e2uipment and instruments. 1
&lectronical navigational aids 1
*adars set up and tuned 1
*adios@ Walk,76alkies@ +ntercom 1
0rimar, 8 emergenc, navigation lights and signals@ sound signal e2 1
'teering gear 1
+ndicators $or rudder@ engine revolutions 1
3 1
4 1
5 ;avigational $lags and lights e1hi"ited 1
1
% Comm channels o$ pilots#port authorities noted in naut charts 1
(
-atest 3eather reports and navigational messages availa"le 1
) 0ilot ladder prepared acc to pilots advice Bincl/ lightingC 1
To 0e filled in 0y the Master. 1
10 +n3ard clearance $ormalities prepared 1
11
12 'peci$ic regulations Bi$ an,C o$ the Compan, $or this port checked 1
13 +n$ormation to Chie$ &ngineer a"out $i1ed &!'0
14
15
1 Checked up navigational conditions as prepared ", Dut, !$$icer
1% Cre3 on deck and in engine on stand ", $or mooring manoeuvres
1( =ridge manned 3ith helmsman
1) Filling out o$ this check list recorded and signed in log "ook
0
!
*
6
'
+n$o to engine department a"out &6A appro1/ &!'0 and e1pected $irst
manoeuvre
Mooring ropes and necessar, e2uipment on
stations prepared
Anchoring e2uipment prepared@ "oth anchors read,
$or let go
Approaching cond as depths@ shoals@ tidal cond@ anchorage and prohi"ited
areas checked
Arrival and port re2/ given ", agents and pu"lished/ Admiralt, -ist o$
*adio 'ignals checked
&sta"lished :5F contact to :6'@ port authorities and pilots according
speci$ied port regulations
Hpdate o$ &6A given ", radio communications to pilots@ agents and
authorities
=ack
C''M
Form C 01
Arrival Deck
*evision. 01/01/200( Approved D0 0age 20 o$ (
'igned ", the Master 'igned ", the Dut, !$$icer
C''M
Form C 01
Arrival Deck
*evision. 01/01/200( Approved D0 0age 21 o$ (
31
:
a
r
n
a
C''M
Form C 01
Arrival Deck
*evision. 01/01/200( Approved D0 0age 22 o$ (
C''M
Form C 02
Departure Deck
*evision. 01/01/200( Approved D0 0age 23 o$ (
MV: 0 Year: 0
Master: 0 Month: 0
Da, 1 2 3 4 5 % ( ) 10 11 12 13 14 15 1 1% 1( 1) 20 21 22 23 24 25 2 2% 2( 2) 30 31
0
o
t
i
;
o
v
o
r
o
s
s
i
,
s
k
!
d
e
s
s
a
C
o
n
s
t
a
n
t
a
:
a
r
n
a
0
i
r
a
e
u
s
C
a
g
l
i
a
r
i
M
a
r
s
a
1
l
o
k
k
+
s
t
a
n
"
u
l
6
r
a
"
<
o
n
0
o
t
i
;
o
v
o
r
o
s
s
i
s
,
k
!
d
e
s
s
a
C
o
n
s
t
a
n
t
a
:
a
r
n
a
1 =inoculars@ 'e1tants@ "earing diopters availa"le
2
3
4
5 &lectronic nav/ aids availa"le

% 4eneral alarm tested


(
)
10
1
11 'ound signal e2uipment tested
1
12 0rimar, and emergenc, navigation lights checked
13 Checked $or drug smuggling and sto3a3a,s
14 'hip?s clocks compared@ s,nchronised
15
1
1%
1( Course7 and engine movement recorder availa"le
1) 0ropeller and rudder clear $or visi"le o"structions
20 *adarBsC set up@ tuned and read, $or operation
21 Cargo secured according Cargo 'ecuring Manual@
22 5atches properl, secured $or sea
23
24
25 Whistle@ signalling e2uipment tested
2
2%
2(
2)
30 Cre3 completed and health, as per sa$e manning
31
32
33
34
35
3
3%
3( 'teering gear 3orking@ s3itched to 3ing control
3) 0itch controller s3itched to 3ing control
40
'igned ", the Master 'igned ", the Dut, !$$icer
0
!
*
6
'
4,ro Compass and repeaters running
#s,nchroni<ed
Magnetic "earing and steering compasses
availa"le@ repeaters s,nchronised@ course
compared
&chosounder # echograph s3itched on and
checked
*adio communication components complete
according to '!-A' re2uirements s3itched on
and 3orking in satis$actor, condition
=ridge communications e2uipment B+ntercom@
porta"le :5FC tested
-atest 3eather report # actual 3eather chart
availa"le $or assessment
Charts@ $lags@ nautical pu"lications updated and
prepared $or ne1t part o$ the vo,age
'ignalling lamps and emergenc, ligthing tested@
availa"le
Actual and computed draughts recorded@ draughts
3ithin permissi"le limits
'ta"ilit,#reserve "uo,anc, attained 3ith due
consideration o$ sta"ilit, criteria Bsea3a,
conditionC
+MD4 cargo sto3ed # segregated according +MD4
Code
5olds@ hull and store openings properl, closed
and secured@ ventilation $laps on $orecastle and
main deck 3atertight closed Bi$ applica"leC
Windo3s 3ipers BheatingC@ clear vie3 screens
tested@ availa"le
-oading completed according loading plan@ cargo
operations completed recorded in log "ook
Cargo documents as =#-@ Mani$ests@ Master
'to3age 0lan@ +MD4 cargo documents on "oard
Bi$ applica"leC
Documents and clearances $or sailing o"tained
$rom the appropriate authorities@ shipLs certi$icates
on "oard
Fuel@ diesel and lu" oils in su$$icient 2uantit, and
instructed 2ualit, on "oard
Main engines read,@ telegraphes and remote
controls tested
Anchors and chains reported $ree o$ visi"le
o"structions and read, to let go
'moke7 and gas detecting device tested@
availa"le
+ndicators $or rpm@ pitch rudder 3orking Bi$
applica"leC
&ngine running on <ero pitch 3ith manoeuvring
speed
=o3 thruster pump 8 motor 3orking@ s3itched to
3ing control
Main7 and emergenc,7 and aut steering@ change
over arrangement@ rudder indicator tested and
availa"le@ reversing indicator s3itched on
=ack
C''M
Form C 03
Cre3 Familiari<ation
*evision. 01/01/200( Approved ", D0 0age 24 o$ (
MV: 0
Port:
0
Voyage No.: 0
Date: 12/0/201!
;ame. -ast vessel@ t,pe # si<e./
*ank. &1 V Cre3 o$ this vessel T date last sign o$$ .
responsi"ilit, to ensure that the ne3 emplo,ee is immediatel, $amiliarised and "rie$ed a"out the $ollo3ing.
1/ Cre3 mem"erLs ca"in@ assigned li$e "oat@ location o$ li$e Gacket and immersion suits@ nearest $ire e1tinguisher
and other $ire7$ighting e2uipment@ escape routes@ sa$et, plan and an, other personal li$e saving appliances
speci$ic to the vessel
2/ All on7"oard sa$et, in$ormation s,m"ols@ signs@ alarms@ signals
3/ 0ersonnel procedures $or [Man !ver"oard[
4/ +mmediate actions upon detection o$ $ire or smoke@ raising o$ alarms
5/ Actions a$ter hearing [A"andon 'hip[ or [4eneral Alarm[
/ All locations o$ muster stations@ station "ills and its content
%/ 'pecial duties assigned in case o$ li$e "oat launching
(/ Demonstration o$ vesselLs internal communication s,stem
)/ Assignment o$ station during mooring and un7mooring
10/ Familiarisation tour through vessel Bdeck@ engine@ accommodationC
11/ +ntroduction o$ ne3 emplo,ee to all cre3 mem"ers
12/ +nstruction in the drug 8 alcohol polic,
13/ -ocation o$ compan,Ls sa$et, manuals and standing orders $or all o$$icers
14/ Check o$ cre3 mem"erLs sa$et, 3orking clothes # uni$orm 7 ", Master
15/ Duties and responsi"ilities concerning 'a$et, and 'ecurit, on "oard
1/ Duties and responsi"ilities according rank@ sa$et, and securit, s,stem
1%/ 'peci$ic items $or deck o$$icers and cre3.
7Cargo handling e2uipment
7Cargo sa$et, arrangements@ cargo related sa$e 3orking practices
7Compan, sa$et, re2uirements during loading # discharging
7Dangerous cargo sa$et, precautions
75andling and maintenance o$ deck plants and $acilities to $ul$il the duties or agreed time $or 3ork in
1(/ 'peci$ic items $or engine o$$icers and cre3.
7&ngine room related sa$e 3orking practices
7'a$et, arrangements@ repair tools@ emergenc, alarms
7Compan, sa$et, re2uirements during assem"lings # mountings
7Dangerous su"stances@ chemicals and compan,?s precautions
75andling and maintenance o$ engine plants and $acilities to $ul$il the duties or agreed time $or 3ork in
1)/ :isit o$ ship@ especiall, 3orking area deck # engine
20/ &nvironmental 0rotection@ the procedure $or handling o$ gar"age@ ru""ish and 3astes
21/ Function 'peci$ic +ntroduction Bstate details can provided in "lanc spaceC
+@ 0 Master o$ M: 0 here", con$irm that the cre3 mem"er has
"een $ull, "rie$ed and $amiliarised in all the a"ove issues and + 3ill ensure that he#the, 3ill "e $urther trained
in accordance 3ith compan,Ls 2ualit,@ securit, and sa$et, management
6oda, 12#0(#2014 port o$ 0 Mr/ Muster 3as $amilliari<ed on "oard the vessel/
Designated o$$icer "rie$ and e1plain to him according to $amilliari<ation checklist/
Muster@ Marten
'ignature and name o$ $amiliari<ed cre3 mem"er
=ack
C''M
Form C 03
Cre3 Familiari<ation
*evision. 01/01/200( Approved ", D0 0age 25 o$ (
MV: 0
Port:
0
Voyage No.: 0
Date: 12/0/201!
;ame. -ast vessel@ t,pe # si<e./
*ank. &1 V Cre3 o$ this vessel T date last sign o$$ .
responsi"ilit, to ensure that the ne3 emplo,ee is immediatel, $amiliarised and "rie$ed a"out the $ollo3ing.
1/ Cre3 mem"erLs ca"in@ assigned li$e "oat@ location o$ li$e Gacket and immersion suits@ nearest $ire e1tinguisher
and other $ire7$ighting e2uipment@ escape routes@ sa$et, plan and an, other personal li$e saving appliances
speci$ic to the vessel
2/ All on7"oard sa$et, in$ormation s,m"ols@ signs@ alarms@ signals
3/ 0ersonnel procedures $or [Man !ver"oard[
4/ +mmediate actions upon detection o$ $ire or smoke@ raising o$ alarms
5/ Actions a$ter hearing [A"andon 'hip[ or [4eneral Alarm[
/ All locations o$ muster stations@ station "ills and its content
%/ 'pecial duties assigned in case o$ li$e "oat launching
(/ Demonstration o$ vesselLs internal communication s,stem
)/ Assignment o$ station during mooring and un7mooring
10/ Familiarisation tour through vessel Bdeck@ engine@ accommodationC
11/ +ntroduction o$ ne3 emplo,ee to all cre3 mem"ers
12/ +nstruction in the drug 8 alcohol polic,
13/ -ocation o$ compan,Ls sa$et, manuals and standing orders $or all o$$icers
14/ Check o$ cre3 mem"erLs sa$et, 3orking clothes # uni$orm 7 ", Master
15/ Duties and responsi"ilities concerning 'a$et, and 'ecurit, on "oard
1/ Duties and responsi"ilities according rank@ sa$et, and securit, s,stem
1%/ 'peci$ic items $or deck o$$icers and cre3.
7Cargo handling e2uipment
7Cargo sa$et, arrangements@ cargo related sa$e 3orking practices
7Compan, sa$et, re2uirements during loading # discharging
7Dangerous cargo sa$et, precautions
75andling and maintenance o$ deck plants and $acilities to $ul$il the duties or agreed time $or 3ork in
1(/ 'peci$ic items $or engine o$$icers and cre3.
7&ngine room related sa$e 3orking practices
7'a$et, arrangements@ repair tools@ emergenc, alarms
7Compan, sa$et, re2uirements during assem"lings # mountings
7Dangerous su"stances@ chemicals and compan,?s precautions
75andling and maintenance o$ engine plants and $acilities to $ul$il the duties or agreed time $or 3ork in
1)/ :isit o$ ship@ especiall, 3orking area deck # engine
20/ &nvironmental 0rotection@ the procedure $or handling o$ gar"age@ ru""ish and 3astes
21/ Function 'peci$ic +ntroduction Bstate details can provided in "lanc spaceC
+@ 0 Master o$ M: 0 here", con$irm that the cre3 mem"er has
"een $ull, "rie$ed and $amiliarised in all the a"ove issues and + 3ill ensure that he#the, 3ill "e $urther trained
in accordance 3ith compan,Ls 2ualit,@ securit, and sa$et, management
6oda, 12#0(#2014 port o$ 0 Mr/ Muster 3as $amilliari<ed on "oard the vessel/
Designated o$$icer "rie$ and e1plain to him according to $amilliari<ation checklist/
Muster@ Marten
'ignature and name o$ $amiliari<ed cre3 mem"er
=ack
C''M
Form C 03
Cre3 Familiari<ation
*evision. 01/01/200( Approved ", D0 0age 2 o$ (
MV: 0
Port:
0
Voyage No.: 0
Date: 12/0/201!
;ame. -ast vessel@ t,pe # si<e./
*ank. &1 V Cre3 o$ this vessel T date last sign o$$ .
responsi"ilit, to ensure that the ne3 emplo,ee is immediatel, $amiliarised and "rie$ed a"out the $ollo3ing.
1/ Cre3 mem"erLs ca"in@ assigned li$e "oat@ location o$ li$e Gacket and immersion suits@ nearest $ire e1tinguisher
and other $ire7$ighting e2uipment@ escape routes@ sa$et, plan and an, other personal li$e saving appliances
speci$ic to the vessel
2/ All on7"oard sa$et, in$ormation s,m"ols@ signs@ alarms@ signals
3/ 0ersonnel procedures $or [Man !ver"oard[
4/ +mmediate actions upon detection o$ $ire or smoke@ raising o$ alarms
5/ Actions a$ter hearing [A"andon 'hip[ or [4eneral Alarm[
/ All locations o$ muster stations@ station "ills and its content
%/ 'pecial duties assigned in case o$ li$e "oat launching
(/ Demonstration o$ vesselLs internal communication s,stem
)/ Assignment o$ station during mooring and un7mooring
10/ Familiarisation tour through vessel Bdeck@ engine@ accommodationC
11/ +ntroduction o$ ne3 emplo,ee to all cre3 mem"ers
12/ +nstruction in the drug 8 alcohol polic,
13/ -ocation o$ compan,Ls sa$et, manuals and standing orders $or all o$$icers
14/ Check o$ cre3 mem"erLs sa$et, 3orking clothes # uni$orm 7 ", Master
15/ Duties and responsi"ilities concerning 'a$et, and 'ecurit, on "oard
1/ Duties and responsi"ilities according rank@ sa$et, and securit, s,stem
1%/ 'peci$ic items $or deck o$$icers and cre3.
7Cargo handling e2uipment
7Cargo sa$et, arrangements@ cargo related sa$e 3orking practices
7Compan, sa$et, re2uirements during loading # discharging
7Dangerous cargo sa$et, precautions
75andling and maintenance o$ deck plants and $acilities to $ul$il the duties or agreed time $or 3ork in
1(/ 'peci$ic items $or engine o$$icers and cre3.
7&ngine room related sa$e 3orking practices
7'a$et, arrangements@ repair tools@ emergenc, alarms
7Compan, sa$et, re2uirements during assem"lings # mountings
7Dangerous su"stances@ chemicals and compan,?s precautions
75andling and maintenance o$ engine plants and $acilities to $ul$il the duties or agreed time $or 3ork in
1)/ :isit o$ ship@ especiall, 3orking area deck # engine
20/ &nvironmental 0rotection@ the procedure $or handling o$ gar"age@ ru""ish and 3astes
21/ Function 'peci$ic +ntroduction Bstate details can provided in "lanc spaceC
+@ 0 Master o$ M: 0 here", con$irm that the cre3 mem"er has
"een $ull, "rie$ed and $amiliarised in all the a"ove issues and + 3ill ensure that he#the, 3ill "e $urther trained
in accordance 3ith compan,Ls 2ualit,@ securit, and sa$et, management
6oda, 12#0(#2014 port o$ 0 Mr/ Muster 3as $amilliari<ed on "oard the vessel/
Designated o$$icer "rie$ and e1plain to him according to $amilliari<ation checklist/
Muster@ Marten
'ignature and name o$ $amiliari<ed cre3 mem"er
=ack
C''M
Form C 03
Cre3 Familiari<ation
*evision. 01/01/200( Approved ", D0 0age 2% o$ (
MV: 0
Port:
0
Voyage No.: 0
Date: 12/0/201!
;ame. -ast vessel@ t,pe # si<e./
*ank. &1 V Cre3 o$ this vessel T date last sign o$$ .
responsi"ilit, to ensure that the ne3 emplo,ee is immediatel, $amiliarised and "rie$ed a"out the $ollo3ing.
1/ Cre3 mem"erLs ca"in@ assigned li$e "oat@ location o$ li$e Gacket and immersion suits@ nearest $ire e1tinguisher
and other $ire7$ighting e2uipment@ escape routes@ sa$et, plan and an, other personal li$e saving appliances
speci$ic to the vessel
2/ All on7"oard sa$et, in$ormation s,m"ols@ signs@ alarms@ signals
3/ 0ersonnel procedures $or [Man !ver"oard[
4/ +mmediate actions upon detection o$ $ire or smoke@ raising o$ alarms
5/ Actions a$ter hearing [A"andon 'hip[ or [4eneral Alarm[
/ All locations o$ muster stations@ station "ills and its content
%/ 'pecial duties assigned in case o$ li$e "oat launching
(/ Demonstration o$ vesselLs internal communication s,stem
)/ Assignment o$ station during mooring and un7mooring
10/ Familiarisation tour through vessel Bdeck@ engine@ accommodationC
11/ +ntroduction o$ ne3 emplo,ee to all cre3 mem"ers
12/ +nstruction in the drug 8 alcohol polic,
13/ -ocation o$ compan,Ls sa$et, manuals and standing orders $or all o$$icers
14/ Check o$ cre3 mem"erLs sa$et, 3orking clothes # uni$orm 7 ", Master
15/ Duties and responsi"ilities concerning 'a$et, and 'ecurit, on "oard
1/ Duties and responsi"ilities according rank@ sa$et, and securit, s,stem
1%/ 'peci$ic items $or deck o$$icers and cre3.
7Cargo handling e2uipment
7Cargo sa$et, arrangements@ cargo related sa$e 3orking practices
7Compan, sa$et, re2uirements during loading # discharging
7Dangerous cargo sa$et, precautions
75andling and maintenance o$ deck plants and $acilities to $ul$il the duties or agreed time $or 3ork in
1(/ 'peci$ic items $or engine o$$icers and cre3.
7&ngine room related sa$e 3orking practices
7'a$et, arrangements@ repair tools@ emergenc, alarms
7Compan, sa$et, re2uirements during assem"lings # mountings
7Dangerous su"stances@ chemicals and compan,?s precautions
75andling and maintenance o$ engine plants and $acilities to $ul$il the duties or agreed time $or 3ork in
1)/ :isit o$ ship@ especiall, 3orking area deck # engine
20/ &nvironmental 0rotection@ the procedure $or handling o$ gar"age@ ru""ish and 3astes
21/ Function 'peci$ic +ntroduction Bstate details can provided in "lanc spaceC
+@ 0 Master o$ M: 0 here", con$irm that the cre3 mem"er has
"een $ull, "rie$ed and $amiliarised in all the a"ove issues and + 3ill ensure that he#the, 3ill "e $urther trained
in accordance 3ith compan,Ls 2ualit,@ securit, and sa$et, management
6oda, 12#0(#2014 port o$ 0 Mr/ Muster 3as $amilliari<ed on "oard the vessel/
Designated o$$icer "rie$ and e1plain to him according to $amilliari<ation checklist/
Muster@ Marten
'ignature and name o$ $amiliari<ed cre3 mem"er
=ack
C''M
Form C 03
Cre3 Familiari<ation
*evision. 01/01/200( Approved ", D0 0age 2( o$ (
MV: 0
Port:
0
Voyage No.: 0
Date: 12/0/201!
;ame. -ast vessel@ t,pe # si<e./
*ank. &1 V Cre3 o$ this vessel T date last sign o$$ .
responsi"ilit, to ensure that the ne3 emplo,ee is immediatel, $amiliarised and "rie$ed a"out the $ollo3ing.
1/ Cre3 mem"erLs ca"in@ assigned li$e "oat@ location o$ li$e Gacket and immersion suits@ nearest $ire e1tinguisher
and other $ire7$ighting e2uipment@ escape routes@ sa$et, plan and an, other personal li$e saving appliances
speci$ic to the vessel
2/ All on7"oard sa$et, in$ormation s,m"ols@ signs@ alarms@ signals
3/ 0ersonnel procedures $or [Man !ver"oard[
4/ +mmediate actions upon detection o$ $ire or smoke@ raising o$ alarms
5/ Actions a$ter hearing [A"andon 'hip[ or [4eneral Alarm[
/ All locations o$ muster stations@ station "ills and its content
%/ 'pecial duties assigned in case o$ li$e "oat launching
(/ Demonstration o$ vesselLs internal communication s,stem
)/ Assignment o$ station during mooring and un7mooring
10/ Familiarisation tour through vessel Bdeck@ engine@ accommodationC
11/ +ntroduction o$ ne3 emplo,ee to all cre3 mem"ers
12/ +nstruction in the drug 8 alcohol polic,
13/ -ocation o$ compan,Ls sa$et, manuals and standing orders $or all o$$icers
14/ Check o$ cre3 mem"erLs sa$et, 3orking clothes # uni$orm 7 ", Master
15/ Duties and responsi"ilities concerning 'a$et, and 'ecurit, on "oard
1/ Duties and responsi"ilities according rank@ sa$et, and securit, s,stem
1%/ 'peci$ic items $or deck o$$icers and cre3.
7Cargo handling e2uipment
7Cargo sa$et, arrangements@ cargo related sa$e 3orking practices
7Compan, sa$et, re2uirements during loading # discharging
7Dangerous cargo sa$et, precautions
75andling and maintenance o$ deck plants and $acilities to $ul$il the duties or agreed time $or 3ork in
1(/ 'peci$ic items $or engine o$$icers and cre3.
7&ngine room related sa$e 3orking practices
7'a$et, arrangements@ repair tools@ emergenc, alarms
7Compan, sa$et, re2uirements during assem"lings # mountings
7Dangerous su"stances@ chemicals and compan,?s precautions
75andling and maintenance o$ engine plants and $acilities to $ul$il the duties or agreed time $or 3ork in
1)/ :isit o$ ship@ especiall, 3orking area deck # engine
20/ &nvironmental 0rotection@ the procedure $or handling o$ gar"age@ ru""ish and 3astes
21/ Function 'peci$ic +ntroduction Bstate details can provided in "lanc spaceC
+@ 0 Master o$ M: 0 here", con$irm that the cre3 mem"er has
"een $ull, "rie$ed and $amiliarised in all the a"ove issues and + 3ill ensure that he#the, 3ill "e $urther trained
in accordance 3ith compan,Ls 2ualit,@ securit, and sa$et, management
6oda, 12#0(#2014 port o$ 0 Mr/ Muster 3as $amilliari<ed on "oard the vessel/
Designated o$$icer "rie$ and e1plain to him according to $amilliari<ation checklist/
Muster@ Marten
'ignature and name o$ $amiliari<ed cre3 mem"er
=ack
C''M
Form C 04
Change !ver 7 Master
*evision. 01/01/200( Approved ", D0 0age 2) o$ (
MV: 0 Port of 9rri'al De$art(re: 0
Voyage No.: 0 Date: /12/201!
Consma0les7 &O: in t
5F!. MD!. -u"oil. 'ludge.
Dring ta,e over of -ommand follo1ing matters have 0een thoroghly dis-ssed
Des-iption Dis-ssed 3 a--epted
Charterer
6rade areaBsC@ W0?s@ distances@ vo,age times
=asic port
+n$ormation to relia"le # e$$icient $uel "unkering
+n$ormation to relia"le # e$$icient $resh 3ater "unkering
+n$ormation to relia"le # e$$icient provision order
Which port $or 3hich deliveries
Change o$ command 7
Masters Cash Account closed and handed over 3ith $ollo3ing "alance
!ther messages@ reports@ dispatches
+nventor, and validit, o$ ship?s documents # certi$icates # last class surve,
Manoeuvering characteristics o$ vessel
',stem +'M@ +'0'
Cre3 2uali$ication@ a"ilities@ training status
Cre3list@ Cre3 Certi$icates
!utstanding Deliveries # 'parepart re2uirements
!pen 'hip@ F'C@ 0'C claims and e1t/#int/ ;C?s
6echnical $ailures@ summer, o$ Damage *eports
!utstanding repairs
*ecommendations o$ class
0lan o$ damages in vessel?s hull
+ntroduction to ship?s computers and "ridge installations
-ist o$ insurance representatives
-ast vo,age report@ ne1t vo,age details # planning
!3nerLs instructions # circulars
-ast 0rovision stock
Communication Folders B6l1ZC
:essel inspected Bsee *emarksC
&ngine plants 7 3eaknesses and their trou"le shooting
$ollo1ing do-ments / items re-eived -omplete and in good order
Des-iption Comments
'tatus o$ Class7 and Flag 'tate Ceri$icates
Hpdated list o$ outstanding orders # repair 3orks
+mprtant correspondence V compan,
+mprtant correspondence V charterer
+mprtant correspondence V cre3 manager
Deck log "ook@ oil record "ook@ deviation log "ook@ radio log "ook
Vessel inspe-tion
Des-iption Condition stats 582@6
:ridge/+heelhose
0articular conditions in ports o$ call@ circular trade@ ports 3ith peculiarities Bport
authorities@ agents@ ship chandler@ customs//C
Cargo@ Dangerous 4oods@ *ee$er@ 'pecial Containers@ =allast and 'ta"ilit,
in$ormation
Watch Arrangement # *est 6ime acc '6CW and Flag *e2uirements Bsee M12
?Monthl, statement?C
Clear and onl, !;& documentation o$ 3orking # rest hours on compan,?s $orm
;o M0
+s the navigation e2uipment such as.
"inoculars B2C@ se1tant B2C@ "arometer@ chronometer@ clocks@ stopper@ etc/
=ack
C''M
Form C 04
Change !ver 7 Master
*evision. 01/01/200( Approved ", D0 0age 30 o$ (
;autical charts and pu"lications corrected untilT
+s the g,ro compass !DT
&cho7sounder opera"leT
'atellite navigator B40'C opera"leT
Watch alarm s,stem opera"leT
6,phoon signal automate opera"leT
*adar 1 BA*0AC
*adar 2
A+'
''A'
'cale o$ pitch o$ propeller to speed
=ehaviour o$ ship in general
+n$ormation to relia"le # e$$icient provision order
*adio 'tation
Are the 4MD'' operators $amiliar 3ith the e2/T
Are radio 7 tele1 and satellite tele1 opera"leT
*adio $acsimile receiver opera"leT
:5F 2 pcs opera"leT
+;MA*'A6 C 7 set opera"leT
4MD'' manuals $or installed e2/ on "oard
;A:6&> *eceiver opera"leT
63o 3a, 3alkie talkie min 3pcs opera"leT
'hipLs intercom opera"leT
De-,
0ontons@ hatch ru""ers
Cargo Crane 1 # 2
Anchor 3indlass conditionT
Are there an, pro"lems dropping the anchorT
;um"er and condition o$ the mooring ropes
0ainting o$ vesselT
Are there an, pro"lems 3ith manoeuvring and steeringT
Sperstr-tre
'tores
Deck stores
Dispensar,
'ngine Department 2 general vie1
&mergenc, generator
'teering gear@ em/ handling
6anks
=o3 thruster
Ship
'ta"ilit,
0ort$acilities and specials $or present trade
-oading@ unloading activities
'a$et,@ 'ecurit, conditions @ 'to3a3a,s
"anding over of.
De, =o1@ De, procedure@ set o$ MasterLs ke,
Digital camera E e2uipment Bcharger@ ///C
Mo"ile telephone E e2uipment Bcharger@ spare accu@ ///C
!ne set o$ shipLs plans and dra3ing 3ith muster7map
5anded over shipLs log "ook no.
+'M Manuals
;avigational lights@ 6,phoon@ Aldis lamp@ 5and sound7meter@ navigational marks
B"alls@ conesC opera"leT
*adio log "ook no@ B3ith Antigua 6elecom instruction
and documentation o$ vesselLs correspondenceC
C''M
Form C 04
Change !ver 7 Master
*evision. 01/01/200( Approved ", D0 0age 31 o$ (
'ecurit, 0lan
'ignature@ leaving Master 'ignature@ signing on Master
C''M
Form C 05
Welding Work
*evision. 01/01/200( Approved ", D0 0age 32 o$ (
MV: 0 Date: 12/0/201!
Master: 0
Work description.
Work location.
'erio5 of va%i5ity of the permit 7shou%5 not e8cee5 2& hours9:
;uthori6e5 person in chare of the -ork:
Dration of Period
From. 5rs. Date.
6o. 5rs. Date.
S%$'TY C"'C(S.
Fire e2uipment made read,
5as the surrounding area "een made sa$eT
Fire 3atchmen posted # instructed
Communication esta"lished "et3een $ire 3atchmen and "ridge
&mergenc, procedures discussed
5as an enclosed space entr, permit "een issued B+$ the 3ork is in enclosed spaceC
+s the e2uipment isolated electricall,
;ame7'urname#'ignature Date and 6ime
0&*'!; *&'0/ F!* 'AF&6K
;ame7'urname#'ignature Date and 6ime
*emark
Permit athorised
Chie$ &ngineer
B'ignatureC
Master
B'ignatureC
Permit Can-elled 0y
Chie$ &ngineer
B'ignatureC
Master
B'ignatureC
&emar,s.
The $rom mst 0e filled 0efore every hot 1or,. %--ording to -ompany reglations Chief Offi-er is responsi0le for this -he-,list. "e is also
responsi0le for the hot 1or, done in the engine room. "e is athorised to isse the permit together 1ith -hief eng
0&*'!; *&'0!;'+=-& F!*
5!6 W!*D
If 1or, is interrpted for any period e!-eeding 9 hors 7 this permit 0e-omes invalid. This permit is only valid in -onIn-tion
1ith safe entry permits if the 1or, is in en-losed spa-e.
=ack
C''M
Form C 0
Alo$t !ut"oard 3ork
*evision. 01/01/200( Approved ", D0 0age 33 o$ (
MV: 0 Date: 12/0/201!
Master: 0
Work description.
Work location.
'erio5 of va%i5ity of the permit 7shou%5 not e8cee5 2& hours9:
;uthori6e5 person in chare of the -ork:
P&OT'CTIV' C#OT"ING/S%$'TY ')*IPM'NT.
17'AF&6K =&-6'#C-!65#5&-M&6#'5!&'#4-!:&'
2/4!4-&'
37&A* 0*!6&C6+!;# DH'6 MA'D
4/!65&* &9H+0M&;6
+O&(ING %#O$T7OV'&SID'7ST%GING O& IN 'JPOS'D POSITIONS
;&A* 65& W5Y'6-&. 'ource o$ po3er isolated and 3arning notice is displa,ed
!; 65& FH;;&-. &ngineers in$ormed to limit smoke@ soot and steam emission
;&A* 65& *6 A&*+A-'. *adio operator in$ormed not to use *6 s,stems
;&A* *ADA* A&*+A-8'CA;;&*'. Deck !$$icer in$ormed and 3aring notice displa,ed
:+C+;+6K !F 0*!0&--&*'. &ngineers in$ormed and 3arning notice displa,ed
'a$et, harness and li$eline 3orn B3here toe guards and guard rails not $ittedC
-i$e Gackets 3orn Bout"oard 3orks@ 3hen the, are permittedC
'taging e1aminedand properl, secured
Containers $or tools@ to "e properl, $astened@ are provided
V%#I. P'&IOD
From. 5rs. Date.
6o. 5rs. Date.
*esponsi"le !$$icer.
B'ignatureC
+. O*T"O&ITY
0&*M+''+!; 6! CA**K !H6 65& Q!= +' 4*A;6&D 'H=Q&C6 6! 65& C!;D+6+!;' A=!:&/
MA'6&*#C5/!FF#C5/&;4.
B'ignatureC
C%NC'#%TION
65& 0&*M+6 +' 5&*&=K CA;C&-&D@ A-- 'AF&6K 0*&C!H6+!;' F!* 65& C!M0-A6+!; !F 65& Q!= 5A:& =&&; CA**K&D !H6/
0&*'!; +; C5A*4&.
B'ignatureC
&emar,s.
65& A=!:& 5A:& =&&; C5&CD&D A;D 65& C!;D+6+!;' F!* 65& Q!= 6! =& CA**+&D !H6 +' C!;'+D&*&D 6! =& 'AF& H;D&* 65&
M&;6+!;&D C!;D+6+!;' F!* 65& F!--!W+;4 0&*+!D/
=ack
C''M
Form C 0%
&nclosed spaces
*evision. 01/01/200( Approved ", D0 0age 34 o$ (
MV: 0 Date: 12/0/201!
Master: 0
Work description.
Work location.
'erio5 of va%i5ity of the permit 7shou%5 not e8cee5 2& hours9:
;uthori6e5 person in chare of the -ork:
This form is valid for the spe-ified time.
From. 5rs. Date.
6o. 5rs. Date.
6ank ;o # name o$ enclosed space#tank .
0recautions have "een e1plained to all personnel involved
Hsage o$ &nclosed 'pace .
;ame o$ su"contractor in case used.
;ame and signature o$ person entering enclosed space.
0erson entering.
B'ignatureC
%ll the -he-,s have 0een performed 0efore entering en-losed spa-e/tan,
6he space has "een segregated thoroughl,
'pace cleaned
'pace ventilated thoroughl,
6he atmosphere has "een tested and $ound to "e sa$e
!1,gen. B21FC
C!. B30 ppmC
A person standing ", at entrance B;ame7surnameC
!ther stand ", personBsC.
All li$esaving and evacuation e2uipment are read,
B:5FC # All communication e2uipment are read, B:5FC
Access 3a, is open and lighting is su$$icient
Work plan made
*escue and resuscitation e2uipment are availa"le
&mergenc, procedure agreed
All relevant personnel ackno3ledged
The 0elo1 -he-,list 1ill 0e filled 0y the 1or, leader
All the a"ove part completel, $illed
6he space 3ill "e evacuated urgentl, in case o$ ventilation $aults
Agreed on communication BWrite do3n :5F channelC
Communication period agreed BMust "e statedC
&mergenc, procedure agreed
0erson entering.
;ame7'urname#'ignature Date and 6ime
'tnd ", person
;ame7'urname#'ignature Date and 6ime
0erson in charge
;ame7'urname#'ignature Date and 6ime
&emar,s.
%--ording to the -he-,s and preparations made the spa-e fond to 0e safe to enter
T"IS P'&MIT IS ON#Y V%#ID $O& T"' SP'CI$I'D TIM'. IT M*ST :' &'N'+'D
IN C%S' O$ V'NTI#%TION $%I#*&' O& %NY OT"'& CONDITION C"%NG'.
=ack
C''M
Form C 0(
Change !ver *eport 7 '!
*evision. 01/01/200( Approved ", D0 0age 35 o$ (
MV: 0 Port of 9rri'al De$art(re: 0
Voyage No.: 0
Dring ta,e over of -ommand follo1ing matters have 0een thoroghly dis-ssed
Des-iption Dis-ssed 3 a--epted
Charterer
6rade areaBsC@ W0?s@ distances@ vo,age times
=asic port
!ther messages@ reports@ dispatches
',stem +'M@ +'0'
0ort documents 8 $ormalities
Arrival # Departure in$ormation
'a$et, e2uipment inventor,
'a$et, e2uipment checklist
Charts # pu"lications and their correction status
Deviation ta"les
;avigational e2uipment
:o,age 0lanning
+ntroduction to ship?s computers and "ridge installations
-ast vo,age report@ ne1t vo,age details # planning
Communication Folders B6l1ZC
'a$et, euipment 7 inspection 8 maintenance status
Familiari<ation 3ith state o$ controls o$ sa$et, e2uipment
Familiari<ation 3ith location 8 use o$ sa$et, e2uipment
Familiari<ation 3ith use o$ emergenc, $ire pump 8 generator/
Familiari<ation 3ith state o$ drills and lectures to the cre3
*adio -og"ook
4MD'' -og"ook
Muster -ist
Medicine chest # hospital e2 7 inventor,
5andling o$ medical e2uipment
Medical log"ook # Medical guide # M$A4
'ignature@ leaving '! 'ignature@ signing on '!
0articular conditions in ports o$ call@ circular trade@ ports 3ith
peculiarities Bport authorities@ agents@ ship chandler@ customs//C
+nventor, and validit, o$ ship?s sa$et, e2/ # certi$icates # last class
surve,
Familiari<ation 3ith manoeuvring station related to mooring #
unmooring o$ the vessel
Familiari<ation 3ith cargo dut, under o"servation o$ Chie$
!$$icerLs advises
Familiari<ation 3ith state o$ order and suppl, lists Bnautical
pu"licationsC
=ack
C''M
Form C 0)
Change !ver *eport 7 C!
*evision. 01/01/200( Approved ", D0 0age 3 o$ (
MV: 0 Port of 9rri'al De$art(re: 0
Voyage No.: 0
Dring ta,e over of -ommand follo1ing matters have 0een thoroghly dis-ssed
Des-iption Dis-ssed 3 a--epted
Charterer
6rade areaBsC@ W0?s@ distances@ vo,age times
=asic port
+n$ormation to relia"le # e$$icient $uel "unkering
+n$ormation to relia"le # e$$icient $resh 3ater "unkering
Manoeuvering characteristics o$ vessel
',stem +'M@ +'0'
Cre3 2uali$ication@ a"ilities@ training status
!utstanding Deliveries # 'parepart re2uirements
6echnical $ailures@ summer, o$ Damage *eports
!utstanding repairs
0lan o$ damages in vessel?s hull
+ntroduction to ship?s computers and "ridge installations
-ast vo,age report@ ne1t vo,age details # planning
:essel inspected
Vessel inspe-tion
Des-iption Condition stats 582@6
'hip # 'ta"ilit, # 5ull in$ormation
6ank conditions
Cell guide conditions
Cargo hold conditions
'tack 3eight # limits
Container sto3age limitations
C'M
'ta"ilit, "ooklet@ emergenc, sta"ilit,
6ank ta"les
-ashing e2uipment inventor,
=allast Water ',stem # condition o$ sensors
Cargo Computer@ cargo program 7 calculation
Charters cargo e2uipment Bspreader # hoacks # slingsC
*adio 'tation
*adio $acsimile receiver opera"leT
:5F 2 pcs opera"leT
+;MA*'A6 C 7 set opera"leT
4MD'' manuals $or installed e2/ on "oard
;A:6&> *eceiver opera"leT
63o 3a, 3alkie talkie min 3 pcs opera"leT
Deck
5atch ru""ers
0ontons
Cargo Crane 1 # 2
*unner 7 greasing
*unner 7 last rene3
Crane gear
Crane ca"in
0articular conditions in ports o$ call@ circular trade@ ports 3ith
peculiarities Bport authorities@ agents@ ship chandler@ customs//C
Cargo@ Dangerous 4oods@ *ee$er@ 'pecial Containers@ =allast
and 'ta"ilit, in$ormation
Watch Arrangement # *est 6ime acc '6CW and Flag
*e2uirements Bsee M12 ?Monthl, statement?C
Clear and onl, !;& documentation o$ 3orking # rest hours on
compan,?s $orm ;o M0
=ack
C''M
Form C 0)
Change !ver *eport 7 C!
*evision. 01/01/200( Approved ", D0 0age 3% o$ (
0o3er suppl,
0rovision CraneBsC
Crane gear
0o3er suppl,
-ashing storeBsC
=osun store
0aint store
Anchor 3indlass conditionT
Are there an, pro"lems dropping the anchorT
Manual sto3age o$ anchor chain re2uiredT
;um"er and condition o$ the mooring ropes
Are the pilot ladders in good conditionT
5o3 is the condition o$ vesselLs gang3a,Ls
0ainting o$ vesselT
'uperstructure
'tores
!ther stores@ lavatories@ rooms
=ord organisation
Drills@ meetings 7 3eaknesses
5anding over o$.
De, =o1@ De, procedure
Cargo documents
Digital camera E e2uipment Bcharger@ ///C
!ne dut, helmet@ li$eGacket
+'M Manuals
'ecurit, 0lan
C'M
0aint inventor,
4ar"age Management 0lan
4ar"age -ook =ook
Cargo 4ear =ook
=allast Water Management 0lan
'ignature@ leaving C! 'ignature@ signing on C!
C''M
Form + 01
Declaration o$ 'ecurit,
*evision. 01/01/200( approved ", C'! page 3( o$ (
Form $or a Declaration o$ 'ecurit, "et3een a ship and a port $acilit, I
D'C#%&%TION O$ S'C*&ITY
;ame o$ ship.
0ort o$ registr,.
+M! ;um"er.
;ame o$ port $acilit,.
6his Declaration o$ 'ecurit, is valid $rom ZZZZZ///ZZZ// until ZZZZZZZ/ZZ//
$or the $ollo3ing activities.
ZZZZZZZZZZZZ//ZZZZZZZ///ZZZZZZZ/
Blist the activities 3ith relevant detailsC
under the $ollo3ing securit, levels
'ecurit, levelBsC $or the ship.
'ecurit, levelBsC $or the port $acilit,.
6he port $acilit, and the ship agree to the $ollo3ing securit, measures and responsi"ilities to ensure
compliance 3ith the re2uirements o$ part A o$ the +nternational Code $or the 'ecurit, o$ 'hips and o$
0ort Facilities/
%-tivity The port fa-ility. The ship.
&nsuring the per$ormance o$ all securit, duties
Controlling access to the port $acilit,
Controlling access to the ship
5andling o$ the cargo
Deliver, o$ ship?s stores
5andling o$ unaccompanied "aggage
6he a$$i1ing o$ the initials o$ the ''! or the 0F'! under
these columns indicates that the activit, 3ill "e done@ in
accordance 3ith relevant approved plan@ ",
Monitoring restricted areas to ensure that onl,
authori<ed personnel have access
Monitoring o$ the port $acilit,@ including the "erthing
areas and areas surrounding the ship
Monitoring o$ the ship@ includin$ "erthing areas and
areas surrounding the ship
Controlling o$ the em"arkation o$ persons and their
e$$ects
&nsuring that securit, communication is readil,
availa"le "et3een the ship and the port $acilit,
=ack
C''M
Form + 01
Declaration o$ 'ecurit,
*evision. 01/01/200( approved ", C'! page 3) o$ (
C''M
Form + 01
Declaration o$ 'ecurit,
*evision. 01/01/200( approved ", C'! page 40 o$ (
6he signatories to this agreement certi$, that securit, measures and arrangements $or "oth the port
$acilit, and the ship during speci$ied activities meet the provisions o$ chapter >+72 and part A o$ the
Code that 3ill "e implemented in accordance 3ith the provisions alread, stipulated in their approved
plan or the speci$ic arrangements agreed to and set out in the attached anne1/
Dated at ZZZZZZZZZZ//ZZZZ/ on the ZZZZZZZZZZZZZZZZZ//
'igned $or and on "ehal$ o$
the port $acilit,. the ship.
5Signatre of port fa-ility offi-er6 5Signatre of master or ship se-rity offi-er6
;ame and title o$ person 3ho signed
;ame. ;ame.
6itle. 6itle.
$or the port $acilit,. $or the ship.
0ort $acilit, Master
0ort $acilit, securit, o$$icer 'hip securit, o$$icer
Compan,
Compan, securit, o$$icer
I 6his $orm o$ Declaration o$ 'ecurit, id $or use "et3een a ship and a port $acilit,/ +$ the Declaration
o$ 'ecurit, is to cover t3o or more ships@ this model should "e appropriatel, modi$ied/
Contact details
5to 0e -ompleted as appropriate6
5indi-ate the telephone nm0ers or the radio -hannels or fre4en-ies to 0e ses6
C''M
F!*M +02
+'0' Familiarisation
*evision. 01/01/200( Approved ", C'! 0age 41 o$ (
MV: 0
Master: 0 Date: /12/201!
VesselKs spe-ifi- ship0oard Introd-tion and '!planation of Ship Se-rity Pro-edres
Follo3ing ne3 cre3 mem"ers 3ere "rie$ed and $amiliari<ed and introduced to the 'hipLs 'ecurit, in
accordance 3ith the +'0' Code understanding the necessit, and the measures o$ this ship/ 'pecial
securit, duties Bpart A and = o$ this codeC@ changing o$ 'ecurit, -evel@ gang3a, 3atch@ search@
protection o$ *estricted Areas and others 3ere e1plained@ accepted and can "e per$ormed/
;o/ Cre3 mem"er# ;ame *ank on "oard 'ignature
*emarks
'ignature ''!.
=ack
C''M
F!*M +02
+'0' Familiarisation
*evision. 01/01/200( Approved ", C'! 0age 42 o$ (
C''M
Form + 03
-ast 10 0orts o$ Call
*evision. 01/01/200( Approved ", C'! 0age 43 o$ (
MV: 0 Year: 0
Master: 0 Month: 0
No Port Name Port $a-ility Port Se-rity #evel %rrival Departre
1
2
3
4
5

%
(
)
10
*emarks
'ignature ''!.
=ack
C''M
Form + 03
-ast 10 0orts o$ Call
*evision. 01/01/200( Approved ", C'! 0age 44 o$ (

You might also like