TO: INTERTANKO

FAX: +47 22 12 26 41 (CONFIDENTIAL)

STANDARD INSPECTION FEEDBACK FORM (Revision 2/2001)

Parts 1 and 2

Complete Part 1 or 2 as appropiate)

PART 1 - COMMERCIAL VETTING INSPECTION

Scope & Purpose
The scope of this feedback form is to supply confidential information to INTERTANKO for statistical purposes which
will allow the Vetting Committee to continue to produce graphical data for improving Commercial Ship Vetting
Inspections.

DATE OF INSPECTION:_______________________PORT OF INSPECTION:_______________________

INSPECTION AUTHORITY:____________________NAME OF INSPECTOR:________________________
PHONE NUMBER:____________________________FAX NUMBER:_______________________________
TIME BOARDED VESSEL _____________________TIME DEPARTED ____________________________

1. Did the inspector observe all safety precautions during the inspection? YES NO

2. Did the inspector conduct the inspection according to the OCIMF/CDI

VPQ and VIQ form ? YES NO

3. Did the inspector use a different or additional questionnaire other than the VIQ? * YES NO

4. Did the inspector discuss any observations found before leaving the vessel? YES NO

5. Did the Inspector change his opinion due to discussion of the observations YES NO

6. Did the inspector leave a copy of his observations onboard? YES NO

7. Did the Inspector make any written or verbal positive observations? YES NO

8. Did the inspector act in an objective manner? YES NO

9. Did the observations that were left onboard match those contained in the YES NO N/A
SIRE or other final inspection report?

10.Was the safety/efficiency of the cargo handling operation effected by the manner
in which the inspection was conducted. YES NO

11. Did the observations reflect accurately the state of the vessel at the time? YES NO

12. Which part(s) of the ship was focussed upon : -

Deck q FFA q LSA q Engine q Accomodation q Certification q FFA/LSA
q ESP/Class Records q Stuctural q Cargo Gear q Bridge q SMS Record keeping q

* If yes to Q.3 What was the questionnaire………………………………………………………………………….

Any comments: ____________________________________________________________________________

_________________________________________________________________________________________

Master:__________________________________________Date:______________________
Sighted by Company:______________________________ Date:_____________________
To: INTERTANKO
FAX: 47 22 12 26 41 (CONFIDENTIAL)

STANDARD INSPECTION FEEDBACK FORM

PART 2 – PORT STATE CONTROL INSPECTION
Scope & Purpose
The scope of this feedback form is to supply confidential information to INTERTANKO for statistical purposes which
will allow the Vetting Committee to continue to produce graphical data for improving Port State Control
Inspections.

DATE OF INSPECTION:_______________________PORT OF INSPECTION:_______________________

INSPECTION AUTHORITY:____________________NAME OF INSPECTOR:________________________
PHONE NUMBER:____________________________FAX NUMBER:_______________________________
TIME BOARDED VESSEL _____________________TIME DEPARTED ____________________________

1. Did the inspector observe all safety precautions during the inspection? YES NO

2. Did the inspector discuss any deficiencies found before leaving the vessel? YES NO N/A *

3. Did the Inspector change his opinion due to discussion of the deficiencies YES NO N/A *

4. Did the inspector leave a copy of his inspection report onboard? YES NO

5. Did the Inspector make any written or verbal positive observations? YES NO

6. Did the inspector act in an objective manner? YES NO

7. If the vessel was detained was the Master advised of his right to appeal? YES NO N/A *

8. Did any observation reflect accurately the condition of the vessel at the time YES NO

9. Was the safety/efficiency of the cargo handling operation effected by the manner
in which the inspection was conducted. YES NO

10. Which part(s) of the ship was focussed upon:-

Deck q FFA q LSA q Engine q Accomodation q Certification q FFA/LSA q ESP/Class
Records q Stuctural q Cargo Gear q Bridge q SMS Record keeping q

* N/A should only be used if no deficiencies were noted Q.2&3 or Vessel not detained Q.7

Any comments:_____________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________

Master:__________________________________________Date:_____________________

Sighted by Company:______________________________ Date:_____________________