DEPARTMENT OF MARINE SERVICES AND MERCHANT SHIPPING

ANTIGUA AND BARBUDA W.I.

REPORT OF SAFETY INSPECTION (for internal use only)

1 NAME OF VESSEL IMO NO. TYPE DATE KEEL WAS LAID

GROSS TONS NET TONS Official No. Call Sign CLASS NOTATION KW

NAME AND ADDRESS OF COMPANY (ISM-CODE 1.1.2 AND 3.1 / SEE COPY OF DOC)

IMO UNIQUE COMPANY IDENTIFICATION NO:

TEL: FAX:
TELEX: E-MAIL:
2 INSPECTION PORT
INITIAL ANNUAL SPECIAL

DATE INSPECTED LAST INSPECTION NEXT PORT OF CALL TRADING AREA

3 SHIP DOCUMENTS / STATUTORY CERTIFICATES

Name of Certificate Comments
(according to SOLAS Annex 2)
1. Certificate of Registry
2. International Tonnage Certificate
3. International Load Line Certificate
4. Minimum Safe Manning Document
5. International Oil Pollution Prevention Cert. ALL
6. IOPP Supplement
Certificates to
7. Int. Sewage Pollution Prevention Certificate
be checked,
8. Copy of Document of Compliance (DOC)
9. Safety Management Certificate (SMC) discrepancies
10. International Ship Security Certificate (ISSC)
to be noted
under
11. Continuous Synopsis Record
comments
12. Cargo Ship Safety Construction Certificate
13. Cargo Ship Safety Equipment Certificate
14. Cargo Ship Safety Radio Certificate
15. Ships Radio Communication License

FO-I 04 Report_Safety_Inspection (Rev. 15 - 08 / 2017) Page 1 of 8

 DEPARTMENT OF MARINE SERVICES AND MERCHANT SHIPPING
ANTIGUA AND BARBUDA W.I.

3 SHIP DOCUMENTS / STATUTORY CERTIFICATES (continued)

Name of Certificate Comments
(according to SOLAS Annex 2)
16. International Air Pollution Prevention Cert.
17. IAPP Supplement
18. Engine International Air Pollution Prevention Cert.

19 International Anti-fouling System Certificate

20. International Ballast Water Management Cert.
Certificate of Insurance or other Financial Security in Respect
21. to Civil Liability for Bunker Oil Pollution Damage
(BCLC Certificate / see A&B Circular MARPOL 2013-002)

Certificate of Insurance or other Financial Security in Respect

22. of Civil Liability for Oil Pollution Damage (CLC Certificate)

23. Nairobi Convention Wreck Removal Certificate

24. Ship Sanitation Control (Exemption) Certificate
25. Maritime Labour Certificate (MLC 2006)
26. Intact Stability Booklet
Damage Control Plan
27. Damage Control Booklet
dry cargo ships > 100 m 01.02.92;
dry cargo ships > 80 m 01.07.98; all ships after 01.01.09
ALL
28. Emergency Towing Booklet (ETB) Certificates and
29. Bulk Cargo Booklet
Plans to be
checked,
30. SOPEP (Date of Contact List / Annex II)
31. Oil Record Book
32. Ballast Water Record Book
discrepancies
to be noted
33. Garbage Management Plan (acc. to rev. Annex V)
under
34. Garbage Record Book (acc. to rev. Annex V)
comments
35. GMDSS Log Book
36. International Energy Efficiency Certificate
Document of Compliance for the Carriage of Solid
37. Bulk Cargoes

38. Document of Authorization for the Carriage of Grain

International Certificate of Fitness for the Carriage of

39. Dangerous Chemicals in Bulk

International Pollution Prevention Certificate for the

40. Carriage of Noxious Liquid Substances in Bulk

Int. Certificate of Fitness for the Carriage of Liquefied

41. Gases in Bulk

Document of Compliance with Special Requirements

42. for Ships carrying Dangerous Goods

International Certificate of Fitness for the Carriage of

43. INF Cargo

44. Statement of Compliance with CAS

(as a supplement to the ship’s IOPP Cert.)
Voyage Data Recorder System – Changes in
45. equipment providing data? Cert. of Compliance
(Annual Performance Test Report)
46. LRIT Conformance Test Report
Do manual/ equipment on
47. Cargo Securing Manual board correspond?

48. Cargo Record Book

49. A&B Merchant Shipping Act, 2006 Copy to be carried on board.

50. A&B Flag State Circulars available Relevant to vessel

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 DEPARTMENT OF MARINE SERVICES AND MERCHANT SHIPPING
ANTIGUA AND BARBUDA W.I.

4 PUBLICATIONS
see current "List of Publications"

Name of Publication Yes No Edition

1. MARPOL
MARPOL Annex V implementation; Annex VI and NOx Technical Code 2008 +
Errata February 2014, Errata May 2015, Supplement Sept. 2015 + Dec. 2016

2. SOLAS (Consolidated Edition 2014)

Supplement December 2014, Erratum Feb. 2015, Supplement Dec. 2015 + 2016

3. Life Saving Appliances including LSA Code

Errata May 2017

4. ISM Code and guidelines on the implementation of the ISM Code

5. ISPS Code
6. STCW incl. 2010 Manila Amendments
7. Maritime Labour Convention, 2006
8. COLREG
Supplement 2010, Supplement January 2016

9. IAMSAR Manual III – Mobile Facilities

10. International Code of Signals
11. IMDG Code + Erratum February 2015, Err. and Corr. December 2015
12. International Maritime Solid Bulk Cargoes Code
Code of Safe Practice for Ships Carrying Timber Deck Cargoes
13.
+ Erratum May 2014

Code of Safe Working Practice for Merchant Seamen COSWP

14.
MCA (no alternative!) + Amendment October 2016

15. ICS Tanker Safety Guide (Gas)

16. ISGOTT
International Code for the Construction and Equipment of Ships carrying
17.
Dangerous Chemicals in Bulk (IBC Code), 2007 Edition
International Code for the Construction and Equipment of Ships Carrying Liquefied
18.
Gases in Bulk (IGC Code), 1993 Edition
Int. Code for the Safe Carriage of Packaged Irradiated Nuclear Fuel, Plutonium
19.
and High-Level Radioactive Wastes on Board Ships (INF Code)

5 MEDICINE CHEST AND MEDICAL PUBLICATIONS

Yes No
1. Medicine List / Instructions (Pharmacy Cert.) Last inspection:
Edition:
2. Medical Guide
Language:
Specific name of edition
3. Medical Log Book Last entry:
4. IMDG Code Supplement 2014 + Suppl. Oct 2016 Edition:
5. Cert. of Designated Medical Care Provider Officer in charge:

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 DEPARTMENT OF MARINE SERVICES AND MERCHANT SHIPPING
ANTIGUA AND BARBUDA W.I.

6 MANNING
1. Ship’s Complement
OFFICERS Manning Requirements Current Number
Deck
Engine
Others
RATINGS
Deck
Engine
Others
2. Watch schedules posted (Sect. A-VIII/1.5) Yes No
3. Record of hrs of work (Sect. B-VIII/1.4)

4. Officers / Ratings required by Minimum Safe Manning Doc., but not on board?
7 LICENCES / CERTIFICATES
1. Capacity A&B CRA Competency
A&B
Name National Cert. No. Endorsement (Date of Issue) (Manag. / Oper. GMDSS
Grade (Date of Expiry) if no endorsement / Sup.) Endorsement
(Date of Expiry)

Master

Chief Mate

Deck Officer

Deck Officer

Deck Officer

Chief Eng.

2nd Engineer

Eng. Officer

Eng. Officer

2. Ship Security Officer: State names and

numbers of certificates
incl. numbers of A & B
Alternate / Deputy SSO: Endorsements.

Security training required for seafarers as per A & B STCW circ. 2013-001 (Rev 2)? Yes No

3. Are the minimum numbers of persons on board holding valid national special qualifications as required
by the Minimum Safe Manning Document and the type of vessel? Yes No
Deck Survival Craft / Tankerman Tankerman Liquid Tankerman Liquid
Watch Rescue Boat Petroleum Chemicals Gas
Keeper Crewman Person in Charge Person in Charge Person in Charge

Engine Tankerman Liquid Tankerman Liquid

Advanced Fire Tankerman
Watch Chemicals Gas
Fighter Petroleum Assistant
Assistant Assistant
Keeper

4. National Health Certificate (all persons on board) Yes No If No, specify on page 8

8 SEAFARERS IDENTIFICATION AND RECORD BOOK

1. Do all seafarers hold valid Flag State (A & B) seafarer books? Yes No
2. Mark crew list accordingly and attach to this report.

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 DEPARTMENT OF MARINE SERVICES AND MERCHANT SHIPPING
ANTIGUA AND BARBUDA W.I.

9 CREW ACCOMMODATIONS
visual observation in accordance with MLC 2006

1. Interior finishing / ventilation / lighting

2. Access and emergency escape markings
3. Sanitary conditions (check toilets and wash spaces)
4. Potable water test / analysis (supply and arrangements) Last check:
5. Galley & Stores (cleanliness and housekeeping, incl. documentation thereof)
6. Crew spaces clear of ship stores and / or equipment
Are training/maintenance/crew familiarization manuals/fire safety operational booklets (SOLAS
7. Yes No
Ch. II Reg. 16/2) available and being used?
8. On board Complaint Procedure posted and is the crew aware of it? Yes No

9. MLC Inspection Report and evidence of financial security posted? (MLC, 2006, A5.1.4. and A2.5.2) Yes No

10 BRIDGE
1. NAVIGATIONAL AIDS / EMERGENCY EQUIPMENT / COMMUNICATION

Fitted Operational
Temporary Permissions in place?
Yes No Yes No

1. Radar No. 1

2. Radar No. 2

3. ARPA or Radar Plotting Facility

4. Magnetic Compass / Error Book Last adjustment: Last entry:

5. Gyro Compass (master / repeater)

6. Echo Sounding Device

7. Voyage Data Recorder All OOWs trained in use?

8. Rate of Turn Indicator

9. Speed and Distance Indicator

10. Steering Gear Test

11. Emergency Steering Drill Last drill: Change over procedure posted? Yes No

12. General Alarm/Public Address

13. Two-Way VHF Radio Telephone Apparatus Bridge Boat 1 Boat 2

14. Sealed Batteries for Portable VHF Expiry dates:

15. SART (SOLAS CH. III Part B Reg. 6.2.2)

16. GPS 1 (specify type and manufacturer)

17. GPS 2 (specify type and manufacturer)

18. AIS Last annual test:

19. LRIT

Bridge/ Engine/ Steering Gear

20.
Communication

21. Aldis Lamp (incl. spare bulb(s)) Spare bulb(s)? Yes No

22. Sound Signal

23. Navigational Lights (bridge panel indicator)

24. Bridge Navigational W atch Alarm System

25. Signal flags Yes No

26. EPIRB Battery valid? Yes No Coding valid? Yes No

Last annual test (SOLAS CH. IV Reg. 15.9)

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 DEPARTMENT OF MARINE SERVICES AND MERCHANT SHIPPING
ANTIGUA AND BARBUDA W.I.

10 BRIDGE (continued)
2. NAVIGATION / CHARTS / PUBLICATIONS / RECORDS
(please refer to A & B Circular SOLAS 2012-006 nautical charts and publications on www.abregistry.ag)
Specify Publisher

1. Chart List or Catalogue Year of issue:

2. Navigational Charts Last correction:
3. ECDIS Last correction:
4. Pilot Books / Sailing Directions Trade area:
5. Notices to Mariners Latest issues:
6. List of Lights / Radio Aids Last correction:
7. Tide Tables Year of issue:
8. Nautical Almanac Year of issue:
9. Required ITU publications (GMDSS station)
10. Voyage / passage planning as required? Yes No Berth to berth? Yes No
11. Does the master understand and perform his Safety Management System responsibilities? Yes No
12. SMS manuals on board? Yes No 13. Designated Person known? Yes No
14. Ship Security Plan on board? Yes No 15. Company Security Officer known? Yes No
16. ISPS records available? Yes No 17. SSAS test conducted/documented? Yes No
18. Company’s emergency contact number known? Yes No Tel. No.:

If more than 4 deficiencies, attach

19. Last PSC report, possible deficiencies rectified? Yes No
the PSC report for IID evaluation

11 LOG BOOKS
1. BRIDGE LOG BOOK / ENGINE LOG BOOK / LOGS / RECORDS
1. Has the working language been entered into the log book? Yes No Language:
2. Inspector’s comment on entries.
3. Date life- / rescue boat last lowered into the water?
4. Were boat- and fire drills and on board training held regularly? Yes No
5. Dates of last three drills:
2. Lookout – during periods of darkness – recorded in log book? Yes No A & B Directive 004 - 2012
3. Manoeuvring information posted? Yes No

12 SAFETY GENERAL
Satisfactory Unsatisfactory Comments
1. Boarding arrangements
2. Pilot accommodation ladder
3. Emergency lighting
4. Emergency engine stop (remote), check if reg. tested!
5. Forced ventilation stop (remote)
6. Paint locker ‘No Smoking’ warning posted
7. Fire dampers
8. Fire hoses and nozzles
9. International shore connection
10. Weather tight doors
11. Mooring Arrangements (winches, ropes and setup)
12. Muster list checked? Yes No

FO-I 04 Report_Safety_Inspection (Rev. 15 - 08 / 2017) Page 6 of 8

 DEPARTMENT OF MARINE SERVICES AND MERCHANT SHIPPING
ANTIGUA AND BARBUDA W.I.

12 SAFETY GENERAL (continued)

13. Check condition of lifesaving equipment
1. Life boat and equipment 2. Life boat launching arrangement
3. Life boat release mechanism 4. Rescue boat
Fall preventers installed?
5. 6. Pyrotechnics (expiry date)
(A&B Circular SOLAS 2012-007)

7. MOB lights 8. MOB smoke signals (expiry date)

9. Lifebuoys 10. Lifebuoys with line
11. Lifejackets 12. Line-throwing appliances
Inflatable liferaft hydrostatic
13. Inflatable liferafts in date? 14.
release in date?

15. EEBD (Emergency Escape Breathing Fitted? Yes No Expiry date:

Device)

16. Immersion suits Fitted? Yes No Last test:

Plans & setup for the recovery of
17. Available? Yes No Last Drill:
persons (A & B SOLAS Circ.2013-008)
18. Enclosed space drills/equipment SOLAS & A&B Inf. Notice 2015-005
14. Check condition of fire fighting equipment
1. Fire control plan posted? Yes No Language: Condition:
2. Portable extinguishers Last test:
3. Foam analysis Last test:
4. Fixed fire-extinguishing system (CO2 etc.) Last service:
5. Breathing apparatus Last service:
6. Fire pumps Operable? Yes No No.:
7. Emergency fire pump Operable? Yes No
8. Firemen outfit (2 > 500 GT) Location 1: Location 2:
15. Are the escape openings (hatches) unobstructed and marked? Escape trunks lit? Yes No
16. Smoke detection / sprinkler system Last test by crew:
17. Boat and fire drills carried out in presence of the inspector? Yes No
Was the performance of crew during the drills satisfactory? Yes No
Comments on need for further training with respect to boat and fire drills:

18. Common working language spoken and recorded? Yes No

19. Standing orders issued / followed? Yes No Check watch order book as well
20. Poster(s) against drug and alcohol abuse posted? Yes No

13 ENGINE ROOM
Engine room condition (bilges, leakages,
1. Yes No
cleanliness, floor plates well secured?)
2. Quick closing valves –Location known? Working? Yes No
Check emergency generator for operability
3. Yes No
(Alternative starting method?).
Is the oil filtering equipment (oily water separator,
4. Yes No
15ppm alarm etc.) operable?
5. Sounding pipes weighted cocks–closed/operational? Yes No
SECA Area fuel changeover procedure available
6. Yes No
and followed? See engine logbook.

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 DEPARTMENT OF MARINE SERVICES AND MERCHANT SHIPPING
ANTIGUA AND BARBUDA W.I.

14 REMARKS AND DEFICIENCIES

No. Description

IMPORTANT NOTICE
NEITHER THE INSPECTION NOR THE REPORT CONSTITUTES A CERTIFICATION, WARRANTY
OR OTHER REPRESENTATION AS TO THE SEAWORTHYNESS OF THE VESSEL DESCRIBED
HEREIN NOR DO THEY RELIEVE ANY PERSON OR ORGANISATION FROM THEIR RESPECTIVE
RESPONSIBILITIES AND OBLIGATIONS TO ENSURE THAT THE VESSEL IS MAINTAINED IN A
SEAWORTHY CONDITION.
THIS REPORT WILL NOT BE THE FINAL ONE. IT WILL BE REVIEWED BY THE ANTIGUA AND
BARBUDA W.I. DEPARTMENT OF MARINE SERVICES AND MERCHANT SHIPPING INSPECTION
AND INVESTIGATION DIVISION.
THE FINAL REPORT INCL. ALL DEFICIENCIES AND REMARKS WILL BE ISSUED AFTER THIS
REVIEW.
NOTICE TO MASTERS
MASTERS ARE REQUIRED TO REVIEW ALL ENTRIES IN THIS REPORT BEFORE SIGNING. IT IS
RECOMMENDED TO DISCUSS ANY FINDINGS WITH THE INSPECTOR WHICH MAY NOT MATCH
WITH THE ACTUAL CONDITION PREVAILING ON BOARD AT THE TIME OF INSPECTION.

Inspector’s Name (block letters) / ID: Master’s Name (block letters):

Inspector’s Signature: Master’s Signature:

Ship’s Stamp

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