A. Checklist Cargo Ops OK

F/SMSO/1/1-V2
PT DIMENSI SURYA BAHARI
THE SHIP/SHORE SAFETY CHECK-LIST
Ship's Name Port

Berth Date of arrival Time of Arrival
Coding of Item : Letter 'A', "p" or 'R' in the column entitle 'Code' indicates the following :
A (Agreement) This indicates an agreement or procedure that should be identified in the
Remarks' column of the Check-list or communicated in some other mutually accepted form.
P (Permission) In the case of a negative answer to the statement code 'P' operations should
not be conducted without the written permission form the appropriate authority.
R (Re-Check) This indicates items to be re-checked at appropriate intervals, as agreed
between both parties, at periods stated in the declaration.
Part 'A' Bulk Liquid General - Physical Checks

Bulk Liquid - General Ship Terminal Code Remarks
1. There is safe access between the ship
R
and shore
2. The ship is securely moored. R
3. The agreed ship/shore communication system System :
AR
is operative. Backup system :
4. Emergency towing-off pennants are correctly
R
rigged and positioned
5. This ship fire hoses & fire-fighting equipment
R
are positioned and ready for immediate use.
6. The terminal's fire-fighting equipment are
R
positioned and ready for immediate use.
7. The ship's cargo and bunker hoses, pipelines
and manifold are in good condition, properly
rigged & appropriate for the service intended.
8. The Terminal's cargo & bunker hoses,
pipe lines and manifolds are in good condition,
properly rigged & appropriate for the service
intended.
9. The cargo transfer system is sufficently isolated
and drained to allow safe removal of blank
flanges prior to connection
10. Scupper plug and safe-alls on board are
effectively plugged and drip trays are in R
position and empty.
11. Temporarily removed scupper plugs
R
will be constantly monitored.
12. Shore spill containment and sumps are
R
correctly managed
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13. The ship' unused cargo & bunker connections
are properly secured with blank flanges fully
bolted.
14. The terminal's unused cargo and bunker
connections are properly secured with blank
flanges fully bolted.
15. All cargo,ballast and bunker tank lids are
closed
16. Sea and overboard discharge valves,when
not in use, are closed and visibly secured.
17. All external doors, ports & windows in the
accommodation,stores & machinery spaces R
are closed. Engine room vents may be open.
18. The ship's emergency fire control plans are
located externally.
If the ship fitted, or required to be fitted , with an Inert Gas System (IGS) the following
points should be physically checked :
Inert Gas System Ship Terminal Code Remarks
19. Fixed IGS pressure and oxygen content
R
recorders are working.
20. All cargo tank atmospheres at at positive
pressure with oxygen content of 8% or less by PR
volume.
Part 'B' Bulk Liquid General - Verbal Verification

21. The ship is ready to move under its own power. PR
22. There is an effective deck watch in
attendance onboard and adequate R
supervision of operations.
23. There are sufficient personnel onboard and
R
ashore to deal with an emergency.
24. The procedures for cargo, bunker & ballast
AR
handling have been agreed.
25. The emergency signal and shutdown
procedures to be used by the ship and shore A
have been explained & understood
26. Material Safety Data Sheets (MSDS) for the
cargo transfer have been exchange, where
requested.
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F/SMSO/1/1-V2

27. The hazards associated with toxic H2S content .....
substances in the cargo being handled have Benzene
been identified and understood. content .....
28. An International Shore Fire connection has
been provided.
29. The agreed tank venting system will be used AR Method ........
30. The requirement for closed operations have
R
been verified.
31. The operation of P/V system has been verified
32. Where a vapour return line is connected
AR
operating parameters have been agreed.
33. Independent high level alarms, if fitted are
operational and have been tested.
34. Adequate electrical insulating means are in
place in the ship/shore connection.
35. Shore lines are fitted with a non-return valve,
or procedures to avoid back filling have been
discussed.
36. Smoking rooms have been identified and nominated
AR
smoking requirements are being observed. smoking room :
37. Naked light regulations are being observed. AR
38. Ship/shore telephones, mobilphones and
AR
pagers requirements are being observed.
39. Hand torches (flashlights) are of an approved
type.
40. Fixed VHF/UHF transceivers and AIS
equipment are on the correct power mode or
switched off.
41. Portable VHF/UHF transceivers are of an
approved type.
42. Ship's main radio transmitter aerials are
earthed and radars are swiched off.
43. Electric cables to portable electrical
equipment within the hazardous area are
disconnected from power (also lifeboat
charger to be disconnected from power).
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F/SMSO/1/1-V2

44. Window type air conditioning units are
disconnected.
45. Positive pressure is being maintained inside
the accommodation, and air condition intakes,
which may permit the entry of cargo vapours,
are closed.
46. Measures have been taken to ensure
sufficient mechanical ventilation in the R
pumproom.
47. There is a provision for an emergency
escape.
48. The maximum wind and swell criteria for stop cargo at : ..
operations has been agreed. A disconnect at : ..
unberth at : ......
49. Security protocols have been agreed
between the Ships Security Officer and the A
Port Security Facilities Officer , if appropriate.
If the ship is fitted, or required tobe fitted, with an Inert Gas System (IGS) the following
statements should be addressed.
Inert Gas System Ship Terminal Code Remarks

50. The IGS is fully operational and in good
R
working order
51. Deck seal, or equivalent, are in good working
R
order
52. Liquid levels and pressure/vacuum breaker
R
are correct.
53. The fixed adn portable oxygen analysers
have been calibrated and are working R
properly.
54. All the individual tank IGS valves (if fitted)
R
are correctly set and locked.
55. All personnel in charge of cargo operations
are aware in the case of failure of the Inert
Gas Plant, discharge operations should
cease, and the terminal be advised.
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If the ship fitted with a Crude Oil Washing (COW) system, and intends to COW, the
following statements should be addressed.
Crude Oil Washing Ship Terminal Code Remarks

56. The pre-arrival COW checklist, as contained
in the approved COW manual, has been
satisfactorily completed.
57. The COW checklist s for use before, during
and after COW, as contained in the approved R
COW manual, are available and being used.
If the ship is planning to tank clean alongside, the following statements should be
addressed :
Tank Cleaning Ship Terminal Code Remarks

58. Tank cleaning operations are planned during
Yes/No* Yes/No*
the ship's stay alongside the shore installation
50. If 'Yes' the procedures and approvals for tank
cleaning have been agreed.
51. Permission has been granted for gas freeing
Yes/No* Yes/No*
operations
* Delete Yes or No as applicable
NOTE
The joint declaration should not be signed until both parties have checked and
accepted their asigned responsibilities and accountabilities.
DECLARATION
We the undersigned, have checked the above items in Part A and part B and where appropriate
Part C and D, in accordance with the instructions, and have satisfied ourselves that the entries
we have made are correct to the best of our knowledge.
We have also made arrangements to carry out repetitive checks as necessary and agreed that
those items with code 'R' in the Check-list should be re-checked at intervals not exeeding
_______________ hours.
If to our knowledge the status of any item changes, we will immediately inform the other party.
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F/SMSO/1/1-V2
For Ship For Shore
Name ________________________ Name ________________________
Rank_________________________ Rank_________________________
Signature______________________ Signature______________________
Date__________________________ Date__________________________
Time__________________________ Time__________________________
Record of repetitive check :
Date :
Time :
Initial for Ship :
Initial for shore :

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F/SMSO/1/9-V2
PT. DIMENSI SURYA BAHARI
SHIP-TO SHIP TRANSFER

CHECK-LIST 3 - RUN-IN AND MOORING
Discharging Ship's Name :
Receving Ship's Name :
Date of Transfer :
Discharging Receiving
Remarks
Ship Checked Ship Checked
1. Check-list 2 has been satisfactorily completed ?
2. Primary fenders are floating in their proper place ?
Fender pennants are in order
3. Secondary fenders are in place, if required ?
4. Over side protrusions on side of berthing are
retracted ?
5. A proficient helmsman is at the wheel ?
6. Cargo manifold cennections are ready and marked ?
7. Course and speed information has been exchanged
and is understood ?
8. Ship's speed adjustment is controlled by changes [Specify]
to revolutions and/or propeller pitch ?
9. Navigational signals are displayed ?
10. Adequate lighting available ?
11. Power is on winches and windlass and they are in
good order ?
12. Rope messengers, rope stoppers and heaving lines
are ready for use ?
13. All mooring lines are ready ?
14. All mooring personnel are in position ?
15. Communications are established with mooring
personnel ?
16. The anchor on opposite side to transfer is ready for
dropping?
17. The other ship has been advised that Check-list 4
is satisfactorily completed ?
FOR DISCHARGING SHIP/ RECEIVING SHIP (Delete as appropriate)
Name :
Rank :
Signature : Date :
This Form should not be substituted for other requred check-lists. If this form is used, it should be used in its
entirety
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PT. DIMENSI SURYA BAHARI F/SMSO/1/9-V2

CHECK-LIST 2 - BEFORE OPERATIONS COMMENCE
Date of Transfer :
Remarks
1. The two ships have been advised by shipowners
that Check-List 1 has been completed satifactorily ?
2. Personnel comply with rest requirements ILO 180.
STCW or national regulations as appropriate ?
3. Radio communications are established ?
4. Language of operations has been agreed ?
5. Redezvous position off the transfer area is agreed ?
6. Berthing and mooring procedures are agreed,
including fender positions and number/type of ropes to
be provided by each ship ?
7. The system and method of electrical insulation
between ships has been agreed ?
8. The ships are upright and at a suitable trim without any
overhanging prejections ?
9. Engines, steering gear and navigationl equipment have
tested and foiund in good order ?
10. Ship's boilers and tubes have been cleared of soot
and its understood that during STS operations,
tubes must not be blown
11. Engineers have been briefed on engine speed (and
speed adjustment) requirement ?
12. Weather forecasts have been obtained for the transfer
area ?
13. Hose lifting equipment is suitable and ready for use ?
14. Cargo transfer hoses are properly tested and
certified and in apparent good condition ?
15. Feders and associated equipment are visually in
apparent good order ?
16. The crew have been briefed on the mooring procedure ?
17. The contingency plan is agreed ?
18. Local authorities have been advised about the
operation ?
19. A navigational warning has been broadcast ?
20. The other ship has been advised that Check-List 2 is
satisfactorily completed ?
Name :
Rank :
Signature : Date :
entirety
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F/SMSO/1/9-V2

CHECK-LIST 1 - PRE-FIXTURE INFORMATION (FOR EACH SHIP)
(BETWEEN SHIP OPERATOR/CHARTERER AND ORGANISER)
Ship's Name : IMO No.
Ship Operator : Ship Charterer : STS Organiser :

Preferred Contact No. Ship Operator's
Remarks
(e.g. INMARSAT) Confirmation
1. What is the LOA ?
What is parallel body length at loaded and
ballast draughts ?
2. Will the transfer be conducted underway
if so, can the ship maintain about
five knots for a minimum of two hours ?
3. Is the ship's manifold arrangement in accordance with
OCIMF Recomendations for Oil Tanker Manifolds
in Associated Equipment ?
4. Is the ship's lifting equipment in accordance with
and Associated Equipment ?
5. What is the maximum and minimum expected
and Associated Equipment ?
6. Sufficient manpower will be provided for all stages
of the operation ?
7. Are enclosed fairleads and mooring bitts in
accordance with OCIMF Mooring Equipment
guidelines and are they of a sufficient number ?
8. Can the ship supplying the moorings provide
all lines on winch drums ?
9. If mooring are wires or high modulus synthetic
fibre ropes, re they fitted with synthetic tails at least
eleven metres in lenght ?
10. Full-sized mooring bitts of sufficient strength are
suitably located near all enclosed fairleads to receive
mooring rope eyes ?
11. Both sides of the ship are clear of any overhanging
projections including bridge wings ?
12. The transfer area has been agreed ?
Name :
Rank :
Signature : Date :
entirety
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F/SMSO/1/9-V2

CHECK-LIST 4 - CARGO TRANSFER
Date of Transfer :
Remarks
1. The ISGOTT Ship/Shore Safety Check-List has
been satisfactorily completed ?
2. Procedures for transfer of personnel have been
agreed ?
3. The gangway (if used) is in good position and well
secured ?
4. An inter-ship communication system is agreed ?
5. Emergency signals and shutdown procedures are
agreed ?
6. An engine room watch will be maintained throughout
transfer and the main engine ready for immediate use ?
7. Fire axes or suitable cutting equipment is in
position at fore and aft mooring station ?
8. A bridge watch and/or anchor watch are
established ?
9. Officers in charge of the cargo transfer on both
ships are identified and posted ?
10. A deck watch is established to pay particular attention
to moorings, fenders, hoses, manifold, observation
and cargo pump controls ?
11. The initial cargo transfer rate is agreed with other
the ship ?
12. The maximum cargo transfer rates agreed with other
the ship ?
13. The topping-off rate is agreed with other ship ?
14. Cargo hoses are well supported ?
15. Tools required for rapid disconnection are located at
the cargo manifold ?
16. Details of the previous cargo of the receiving ship have
been given to the discharging ship ?
17. The other ship has been advised that Check-list 4
Name :
Rank :
Signature : Date :
entirety
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F/SMSO/1/9-V2
FENDER SELECTION ASSISTANCE REQUEST FORM

For ship-to-ship use
To be filled out prior to contacting fender providers
Location of Site
Potential Sea State Potential Beaufort Scale
Ship A Ship B
Type of ship
Eg. Tanker, ore carrier, gas carrier, etc
Displacement Tonnage (at start of STS ops.)
Gross Tonnage
Deadweight Tonnage
Length Overall
Length Between Perpendiculars
Loaded Draft
Beam
Freeboard when coming into contact
Relative approach velocity of ships
Other relevant information

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F/SOPM/1/9-V2

CHECK-LIST 5 - BEFORE UNMOORING
Date of Transfer :
Remarks
1. Cargo hoses are properly drained prior to hose
disconnected ?
2. Cargo hoses or manifolds are blanked ?
3. The transfer side of the ship is clear of
obstructions (including hose lifting equipment) ?
4. Secondary fenders are correctly positioned and
secured for departure ?
5. The method of unberthing and of letting go
moorings has been agreed with the other ship ?
6. Fenders, including fender pennants, are in
good order ?
7. Power is on winches and windlass ?
8. There are rope messengers and rope stoppers
at all mooring stations ?
9. The crew are standing by at their mooring station ?
10. Communications are established with mooring
personnel and with the other ship ?
11. Shipping traffic in the area has been checked ?
12. Main engine(s) and sterring gear have been tested
and are in a state of readiness for departure ?
13. Mooring personnel have been instructed to let go
only as requested by the manoeuvring ship ?
14. Navigational warnings have been cancelled
(when clear of other ship) ?
15. The other ship has been advised that Check-List 5
Name :
Rank :
Signature : Date :
entirety
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F/SMSO/1/2-V2

AGREED LOADING / DISCHARGING PLAN
AND
CARGO COMPARTMENTATION
VESSEL : TERMINAL, PORT :
VOY NO : BERTH :
DATE : DESTINATION :
1C 2C 3C 4C 5C 6C 7C 8C SLOP
CARGO INFORMATION GRADE I GRADE 2 GRADE 3
Grade of Cargo ______________ ______________ ______________

QTY NKL or NBBL ______________ ______________ ______________
QTY MT ______________ ______________ ______________
Density ______________ ______________ ______________
Average Temperature (degC)______________ ______________ ______________
LOADING / DISCHARGING SEQUENCE
PRODUCT MANIFOLD / LINE LOAD/DISCHARGE
_______________________ _______________________ _______________________

_______________________ _______________________ _______________________
_______________________ _______________________ _______________________
_______________________ _______________________ _______________________
SHIP TO GIVE ___________ MINS STANDBY BEFORE COMPLETION OF EACH GRADE
REMARKS :
SHORE / SHIP TO PROVIDE __________ MINS LINE BLOWING / LINE DRAINING
MASTER / CHIEF OFFICER SHORE REPRESENTATIVE

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F/SMSO/1/3-V2

LOADING REPORT
Load Port :
Discharge Port : Date : _______________
MEASUREMENT DRAFT : FORWARD m AFT m

TANK Density OBS
CARGO GRADE Corrected Gross Net K/L
NO @15C TEMP Water V.C.F.
Ullage Volume @ 15C TRIM : m
CARGO
GRADE
NET K/L @
15C (table
53 & 54)
WCF
(table 57)
LONG
TONS
METRIC
TON (table
56/1)
N/BBLS
TABLE USED FOR CALCULATOR : @ 60F (table
52)
SHIP OR SHORE STOP OF LOADING :
Shore Representative Master/Chief Officer

Remarks :
Name : _____________ Name : ____________
F/SMSO/1/4-V2

DISCHARGING REPORT
Load Port :
Discharge Port : Date : _______________
MEASUREMENT DRAFT : FORWARD m AFT m

TANK Density OBS
CARGO GRADE Corrected Gross Net K/L
NO @15C TEMP Water V.C.F.
Ullage Volume @ 15C TRIM : m
CARGO
GRADE
NET K/L @
15C (table
53 & 54)
WCF
(table 57)
LONG
TONS
METRIC
TON (table
56/1)
#1 #2 #3 #4 #5 N/BBLS
Cargo Grade B/L Figure After Load Fig Before Disch Fig. (#3 - #4)/#2 X 100%@ 60F (table
52)
Figures to be rechecked if the loss in #5 exceeds 0.1% Shore Representative Master/Chief Officer
Remarks :
Name : _____________ Name : ____________
MSO/1/3-V2
ster/Chief Officer
e : ____________
1 of 1
MSO/1/4-V2
m
ster/Chief Officer
e : ____________
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F/SMSO/1/5-V2
Vessel : Date :
Port :
CARGO RECEIVER'S DECLARATION

(to be signed before cargo discharge)
I/We, the udersigned representative(s) of ______________________________

(Company)
declare that we are the rightful receivers of the cargo to be discharge by the
above-mentioned
vessel at _____________________________________
(Company)
Cargo Description
Product/Grade B/L Quantity
Receiver's Representative(s)
Name Designation Signature
__________________ ___________________ _____________________
__________________ ___________________ _____________________
__________________ ___________________ _____________________
_____________________
Company's Stamp
Witnessed by :
_____________________
Local Agent
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F/SMSO/1/6-V2
TANK CLEANING CHECKLIST
GAS FREEING OPERATIONS :
1. Are all external doors closed and air-condition intakes adjusted to

Y N
maintain positive pressure inside accommodation
2. Are smoking regulations posted and being adhere to Y N
3. Have all departments been informed of the Gas Freeing Operations Y N
4. Have the hazards associated with toxic substances in the cargo being
handled been identified and understood (appropriate toxic gas detection Y N
tubes available)
5. Are the cargo tanks well stripped and all cargo lines been well drained Y N
6. Have spool pieces/spectacle Y N
7. Gas free all cargo taks before washing (HC gas not to exceed 10% LEL) Y N
_________________ ________________
Chief Officer / date Master / date
TANK WASHING OPERATIONS :
8. Suitable weather for tank cleaning Y N

9. Test hoses for electrical continuity and record results (resistance less
Y N
than 6 ohms / m)
10. Check Butterworth machines free to turn / rotate Y N
11. Have lines and pumps been set to facilitate stripping while washing Y N
12. Check deck water presure at least 4.5 kg/cm2 Y N
13. Are overboard valves connected to the cargo system lashed and locked Y N
14. is there sufficient ullage in the slop tanks to hold the washings Y N
15. Does hot water, where used, exceed 60 degrees C Y N
16. Non-recirculated (fresh charge) water used for washing Y N
17. Have the deck crew been briefed on the washing sequence / duration Y N
18. Have cargo tanks been checked for HC gas (less than 10% LEL) Y N
19. Commence wash and simultaneous strip all washing to the slop tank Y N
20. On completion of washing, ensure all tanks lines & pumps well stripped Y N
21. Flush butterworth machines with fresh water and grease as required Y N
22. Re-start gas freeing operations and gas free all tank till 0% LEL Y N
_________________ ________________
Chief Officer / date Master / date
Y = Yes
N = No
This checklist is to be completed prior Gas Freeing and Tank Washing Operations 1 of 1
This checklist should be laminated & displayed in the CCR. No other copies need to be retained.
F/SMSO/1/7-V2
CARGO OPERATION CHECKLIST (To be complied with before commenced of cargo operation)
Port/Terminal : ................................................................ Date : ......................................
Loading/Dischaging
Check point Result/Remarks
Is the gang way rigged properly ? Ship's/Shore's Safety net Warning Boards
Life buoy with S/L A line standby in place
Is the P/Room fan running (entry
permit issued) ?
Is the deck air supply on ?
Are the scuppers plugged on
main and poop deck ?
A cargo and bunker drip trays
(including oil containment tray at
poop dk) dry and drains closed ?
Are oil spill response equipment
in place and ready for use ?
Are FFA ready ? 2 Foam Extinguisher 2 Fire hoses charged
at M/fold Foam monitors hoisted
Are fire wires rigged correctly ? Fwd Aft Height above W L ...................
Are doors and vents around the
accommodation/for'd closed ?
Are CoT H. & H.H Level alarms SLPS
tested? Are P/V V/Vs tested 1C 2C 3C 4C 5C 6C 7C 8C Remark
manually ? SLPP
Are emergency stops for cargo Tested location - CCR MP(S) MF(P)
pump tested (b4 discharge) ? Remark ..............................
Are MMC tapes tested (B4 Ldg) ? MMC Battery Alarm Light Bonding Temp (Thm) Temp(MMC)
Are all CoT openngs closed tight ?

Is the shore connection to Grade M/fold Type & size of connection Gasket type
correct M/fold & appropriate ANSI/JIS
gas ket used ? ANSI/JIS
ANSI/JIS
Are covers to the cargo lines
press gauges open ?
Is the communication procedure Call Sign : Tel.No :
(with Trml) including stand-by W/Talkie Channel
means understood & established? VHF Channel
Is the stowage plan, load/disch, Seq :
ballast/deballast sequence
understood ? Initial Rate/Press :
Additional Ship Specific Items :
Duty Officer (Sign/Rank) Chief Officer
ship specific check items are to be added to this list as required 1 of 3
arning Boards
F/SMSO/1/7-V2
CARGO OPERATION CHECKLIST PT DIMENSI SURYA BAHARI

Handing Over/Taking Over Note
Port/Terminal : Loading/Discharging Voyage :
Date
Time On ................. Min notice On ................. Min notice On ................. Min notice On ................. Min not
Engine ready
Smoking reg'n obs'ved
Safety Check
Naked light reg'n obs'ved

Cooking equip safe
Tnkr safety C/L complied
Crew ashore (state
names or rank)
Shore Radio
Equip H/ovr
Spare battery
Personal Gas Detector
Ship's hand phone
Grade(s)/Parcels
Completed
Operational Info
Grade(s)/Parcels
in progress
Completed Tank(s)
Tank(s) Progress
Ballast ops in progress
Rcving FW
Tidal (rising/Falling)
COT # P/S Ullage
COT # P/S Ullage
Cargo Oil Tank
COT # P/S Ullage

COT # P/S Ullage
COT # P/S Ullage
COT # P/S Ullage
COT # P/S Ullage
COT # P/S Ullage
FPT Oty (m3)
DWBT P/S Oty (m3)
WBT # P/S Oty (m3)
WBT # P/S Oty (m3)
Ballast Tank
WBT # P/S Oty (m3)

WBT # P/S Oty (m3)
WBT # P/S Oty (m3)
WBT # P/S Oty (m3)
WBT # P/S Oty (m3)
WBT # P/S Oty (m3)
Displacement (mt)/GM (m)
SF/BM
Stability
Calul'd Dft Fwd/Aft (m)

Gauge Drf Fwd/Aft (m)
Visual Dft Fwd/Aft (m)
Additional information
Officer Handing over

Others
Officer Taking Over

Remark and sign (All items
above shall be verified,
checks shall be made as
per tanker Safety C/list
B4 T/over
................. Min notice
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F/SMSO/1/7-V2
CARGO OPERATION CHECKLIST (Hourly Safety Checklist)
Poert/Tmnl :
Loading/Discharging Date : Voyage :
Time
Item
A. On deck
1. Any oil slick present ?
2. Is there any signs of leakage from the cargo lines ?
3. Are the drip trays dry and the drain valve closed?
4. Are all scuppers effectively plugged ?
5. Is there any standing water near the scuppers ?
6. Are the position of Gangway, Loading Arm/Hose
in order ?
7. Is the arrangement of mooring line satisfactory
adjusted as necessary ?
8. Is the fire wire maintained at required height ?
9. Are the openings around the accommodation,
pumproom, fwd store closed ?
10. Are the cargo pumps running normally, no
abnormal noise ?
11. Are the oil spill response equipment ready ?
12. Are all cargo V/Vs not in use shut and lashed ?
13. Is the effective deck watch being maintained ?
14. Is the deck air supply on ?
B. In the Pumproom
1. Are cargo and ballast pumps running normally ?
2. Is the vent fan working normally and taking suction
from the lowest point ?
3. Are bearing temperatures for the ballast and cargo
pumps within operating limits ?
4. Is the level of bilge confirmed to be normal ?
C. Cargo Tank
1. Are level gauge working normally ?
2. Is the loading/discharging rate being monitored ?
3. Is the ullage of tanks not in use constant ?
4. Is the pressure in the cargo tank being monitored ?
5. Are all tank lid closed, free form gas leaking ?
6. Are the P/V V/Vs correctly set ?
D. Other
1. Any oil on the sea surface ?
2. Is water pressure on fire line maintained ?
3. Are the fire extinguishers placed at the manifold ?
4. Are the fire extinguishers placed at the manifold ?
5. Is the ship-shore communication tested ?
6. Is the cargo & ballast handling plan being followed ?
7. Is the minimum required UKC maintained ?
8. Is the list and trim within safe operating limit ?
9. Is there any indication of combustible gas within
the accommodation spaces/pumproom ?
10. Is sufficient crew on board to deal with an
emergency ?
11. any un-authorised craft near the ship ?
12. any person who have no legitimate business
on board ?
Duty Officer's Sign/Rank
Ship specific check items are to be added to this list as required 3 of 3
F/SMSO/1/8-V2
KPIs QUARTERLY REPORT

Vessel's Name : ___________________ Date : __________________
No No. Of Occassions of
Description Remarks
KPI Failure This Quarter
Date of Incident / Near miss Or Personal accident Report
1. Cargo Tanks Fitness to load

2. Cargo Over / Under Loading

3. Cargo Sillage/Overflow

4. Cargo Losses (in-transit)



Name of Supt : Date : Purpose Of Visit :

8. Ship Visits
(By Ops Supt Only)
1 of 1

A. Checklist Cargo Ops OK

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A. Checklist Cargo Ops OK

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F/SMSO/1/1-V2

PT DIMENSI SURYA BAHARI

THE SHIP/SHORE SAFETY CHECK-LIST

Ship's Name Port

Part 'A' Bulk Liquid General - Physical Checks

PT DIMENSI SURYA BAHARI

Part 'A' Bulk Liquid General - Physical Checks

Part 'B' Bulk Liquid General - Verbal Verification

PT DIMENSI SURYA BAHARI

Part 'A' Bulk Liquid General - Physical Checks

PT DIMENSI SURYA BAHARI

Part 'A' Bulk Liquid General - Physical Checks

Inert Gas System Ship Terminal Code Remarks

PT DIMENSI SURYA BAHARI

Crude Oil Washing Ship Terminal Code Remarks

Tank Cleaning Ship Terminal Code Remarks

* Delete Yes or No as applicable

PT DIMENSI SURYA BAHARI

For Ship For Shore

Name ________________________ Name ________________________

Record of repetitive check :

Initial for Ship :

Initial for shore :

SHIP-TO SHIP TRANSFER

SHIP-TO SHIP TRANSFER

SHIP-TO SHIP TRANSFER

Ship Operator : Ship Charterer : STS Organiser :

SHIP-TO SHIP TRANSFER

FENDER SELECTION ASSISTANCE REQUEST FORM

Displacement Tonnage (at start of STS ops.)

Length Between Perpendiculars

Freeboard when coming into contact

Relative approach velocity of ships

Other relevant information

SHIP-TO SHIP TRANSFER

PT DIMENSI SURYA BAHARI

CARGO INFORMATION GRADE I GRADE 2 GRADE 3

Grade of Cargo ______________ ______________ ______________

LOADING / DISCHARGING SEQUENCE

PRODUCT MANIFOLD / LINE LOAD/DISCHARGE

_______________________ _______________________ _______________________

SHIP TO GIVE ___________ MINS STANDBY BEFORE COMPLETION OF EACH GRADE

SHORE / SHIP TO PROVIDE __________ MINS LINE BLOWING / LINE DRAINING

MASTER / CHIEF OFFICER SHORE REPRESENTATIVE

PT DIMENSI SURYA BAHARI

MEASUREMENT DRAFT : FORWARD m AFT m

SHIP OR SHORE STOP OF LOADING :

Shore Representative Master/Chief Officer

PT DIMENSI SURYA BAHARI

MEASUREMENT DRAFT : FORWARD m AFT m

PT DIMENSI SURYA BAHARI

CARGO RECEIVER'S DECLARATION

I/We, the udersigned representative(s) of ______________________________

Name Designation Signature

__________________ ___________________ _____________________

__________________ ___________________ _____________________

__________________ ___________________ _____________________

PT DIMENSI SURYA BAHARI

TANK CLEANING CHECKLIST

GAS FREEING OPERATIONS :

1. Are all external doors closed and air-condition intakes adjusted to

TANK WASHING OPERATIONS :

8. Suitable weather for tank cleaning Y N

Name Name

Grade of Cargo __

___________ _ _____________

________ _ _____________

________ _ _____________

________ _ _____________