SURVEY REPORT

UNIT ID: CLAIMS REF. NO. MEMBER NAME:

ISO TYPE: PORT/COUNTRY: DEPOT NAME:

CSC PLATE: Yes No VESSEL/VOY NO: SURVEY DATE:

ACEP/PES: Yes No MANUFACTURER: MANUFACTURED DATE:

TOP FRONT DOOR PANELS INTERIOR VIEW

back 1 2 3 4 5 6 7 8 9 0 front
4 3 2 1 1 2 3 4
RIGHT SIDE
BOTTOM - CROSS MEMBERS

back 1 2 3 4 5 6 7 8 9 0 front _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____

CROSS MEMBER NO. FROM REAR

LEFT SIDE
FLOOR INTERIOR FLOOR POCKETS
4

front 1 2 3 4 5 6 7 8 9 0 back 1 2 3 4 5 6 7 8 9 0 1 2 3 4

ESTIMATE CURRENCY
ORIGINAL ESTIMATE TOTAL: LABOUR HOURS: MATERIAL: TOTAL:
REVISED ESTIMATE TOTAL: LABOUR HOURS: MATERIAL: TOTAL:
TT EXCLUSIONS: W&T: TOTAL:
(Indicate Repair Items No.)
PTI: TOTAL:
I/R: TOTAL:
CLEANING: TOTAL:
ACC VOYAGE DAMAGE: TOTAL:
TOTAL EXCLUSIONS:
IMPACT DAMAGES:
(Including missing components)

1st INCIDENT ITEMS NOs

2nd INCIDENT ITEMS NOs
3rd INCIDENT ITEMS NOs
CAUSE OF DAMAGES: (Please cross appropriate cause)
HIT BRIDGE FIRE HANDLING DAMAGE CONTAMINATION ROLLED OVER
CARGO DMG AND/OR OVERLOAD WAVE OTHER* (please specify in remarks)

MACHINERY SURVEYED? Yes No PTI CARRIED OUT? Yes No (If No, please detail in Remarks)

HALIDE FLAME TEST CARRIED OUT? Yes No

ARE CONTAINER SHELL & MACHINERY DAMAGES AS A RESULT OF SAME SINGLE INCIDENT? Yes No (If No, please detail in Remarks)

REMARKS:

TTSR0215