Data needed to be prepared for ASI

DOCUMENTS No. C
NAME OF VESSEL: DATE:
Name of Operator (ISM):

Operator’s Address:

Phone No.: Fax No:

Email Address: Authorization No. (for Inspector ref. only):

Name of DP-ISM: Name of CSO:

Cell-Phone No.: Cell-Phone No:

Fax no.: Fax No.:

Email Address: Email Address:

PANAMA ANNUAL TAX RECEIPT NO.:

Company ID Number (as in SMC):
Valid Until (day/month/year) :
Last Port State Control Inspection : Registration Number :
Country/Port/Date/Remark : Valid until (day/month/year):

Next port of Call: Agent or Legal Representative (as found in Ship’s registry Cert):

ETA:

Class Certificated by:

Ship's email address: Valid until (day/month/year):

Last Dry dock date:

Charterer Agent: Owner Agent:

Phone No.: Phone No.:

Email Address: Email Address:

STATUTORY CERTS
Issue Last
Description Issue Date Valid Till
Authority Endorsed

1 Bunker Convention Certificate

2 Safety Construction Certificate

3 Safety Equipment Certificate

4 Safety Radio Certificate

5 Certificate of Inspection of Crew Accommodation

6 Civil Liability for Oil Pollution Damage Certificate

7 Continuos Synopsis Record (CSR)

8 Document of Compliance (DoC/ ISM)

9 International Air Pollution Prevention (IAPP)

10 Int’l Antifouling System Certificate

11 Int’l Energy Efficiency Certificate

12 Int’l Engine Air Pollution Prevention Certificate

13 Int’l Load Line Certificate

14 Int’l Oil Pollution Prevention Certificate (IOPP)

15 Int’l Sewage Pollution Prevention Cert (ISPP)

16 Int’l Tonnage Certificate

17 Maritime Labour Certificate - MLC,2006 CERT

18 Minimum Safe Manning Document

19 Radio Station License

20 Ballast Water Management Certificate (BWMC)

21 COF for Carriage of D Chemicals in Bulk

22 COF for Carriage of Liquefied Gases in Bulk

Last
Description Issue Authority Issue Date Valid Till
Endorsed

23 Class Certificate

24 DOA for Carriage of Grain

25 DOC for ships carrying DG

26 DLMC (Part I and II)

27 Int/COF for the Carriage of D Chemicals in Bulk

28 IMSBC

Int’l Pollution Prevention Cert for the Carriage of

29
Noxious Liquid Substances in Bulk

30 International Ship Security Certificate (ISSC)

31 Passenger/MODU/Special Ship Safety Cert

32 Safety Management Certificate (SMC/ ISM)

33 Ship Energy Efficiency Management Plan

34 Ship Security Plan and associated records

 Additional Info for Bulk, Tankers, Gas-Carriers, or Passenger/Special Vessels:

Plans and Manuals to be ready for checking & verification: Available / Maintained

1 Muster List and Emergency Procedures have been updated & displayed

2 Damage Control Plan

3 Fire Control Plan

4 Fire Safety Equipment Instruction Booklets

Date of Approval:

5 SOPEP Approved by:

6 SMPEP Approved by:

7 Intact Stability Booklet Approved by:

Available / Maintained

8 Dangerous Goods Manifest / Stowage Plan (if applicable):

9 Garbage Management Plan

10 SOLAS Training Manual

11 Safety Management Documentation

12 a) Safety Manual

Cargo Handling
13 b)
Procedures :

14 c) Contingency Plan

15 d) Cargo Securing Manual Approved by: Date Approved:

Approved
16 e) Ballast Water Management Plan Date Approved:
by:

Record Books Y/N Date of Last Entry

17 Bridge Logbook

18 Bridge Bell Book

19 Engine Room Bell Book

20 Garbage Record Book (MARPOL)

21 Oil Record Book Part I (MARPOL)

22 Oil Record Book Part II (MARPOL)

23 Cargo Record Book (MARPOL ANNEX II)

24 File Bunker Delivery Notes

25 Ballast Water Management Record Book

Bridges Publications of following: Last Publication Date

26 Nautical Charts

27 IMDG Code

28 Pilot Charts

29 IMO MARPOL 73/78

30 Sailing Directions

31 IMO COLREG 72

32 List of Lights

33 IMO SOLAS 74-88

34 IMO Routing Scheme

35 LSA – FSS Codes

36 Tide Tables

37 ISPS Code

38 Navigation Tables

39 Radio Aids to Navigation

40 International Code of Signals

41 IAMSAR Manual III

42 Nautical Almanac

43 List of Coast Station (List No. IV)

44 Notice to Mariners

45 List of Ship Station (List No. V)

46 List of Radio Determination & Special Services Station (List No. VI)

47 List of Call Signs & Numerical Identities of Station Used by Maritime Mobile (No. VIIA)

48 IMO Port State Control Procedures

49 Merchant Marine Circulars of Panama

50 Manual for use by Maritime Mobile & Maritime Mobile - Satellite Services

Aids to Navigation and Communications

1 Vessel’s Equipped for GMDSS? (YES / NO)

Type of Contract GMDSS Maintenance

2 SHORE BASED Expiry Date :
Agreement:

Vessel’s MMSI Number : 354269000

3
Sea Areas which the ship is certified to operate A1 A2 A3 A4

Navigation and Communications Equipments Y/N

4 Magnetic Compass Last Adjustment Date:

5 MF or MF/HF Radio Installation capable of transmitting and receiving using

6 LSD / DSC

7 Gyro Compass Last Adjustment Date:

8 Radar (9 GHz)

9 Engine Room Telegraph

10 Automatic Radar Plotting Aid

11 NAVTEX Receiver

12 Echo Sounding Device

13 Two-way radio communications using the aeronautical frequencies

14 Rudder Angle Indicator and Rate-of-revolution of each propeller

15 INMARSAT SES Installation with: Type: A B C F M

16 a) Enhance Group Calling

17 b) Direct Printing Telegraphy

18 c) Radiotelephony

19 Device to indicate speed and distance

20 Rate-of-turn Indicator

21 Signal Flags and Day Shapes

22 Daylight Signaling Lamp

23 Ship-to-Shore Distress Alerts

24 a) Primary

25 b) Secondary

26 Ship Security Alert System (SSAS)

27 Global Position System (GPS)

28 On-board Communication and Alarm System

29 Automatic Identification System (AIS)

30 Voyage Data Recorder (VDR)

31 Conformance Test Certificate (LRIT) Approved by: Date Issued:

32 Portable Waterproof VHF Battery Expiration:

33 Radar Transponder Battery Expiration:

34 VHF Radio Installation capable of transmitting and receiving DSC and Radiotelephony

35 VHF Radio Installation of continuous DSC Watch on Channel 70

 Satellite EPIRB Hydrostatic Release Expiration Date:
36
Date of Annual Inspection: Battery Expiration:

DRILLS EVALUATION Last Drill Date

1 Fire Fighting

2 Oil Spill

3 Abandon Ship

4 Maritime Security / Anti-Piracy

5 Emergency Steering

6 Watertight Door/s Operations

7 Confined Spaces

Drills Observed by the inspector: (at least partial drills shall be performed) Y/N

8 Satisfactory Conduction Os The Drill

9 Boat Lowered To The Water’s Edge Effectively

10 Emergency Fire Pump Provided Appropriate Pressure

11 Crew Familiarized With Safety Procedures During Drills

FIRE FIGHTING EQUIPMENTS ( Operative = O / In Operative = I ) QUANTITY O/I

1 Fire Main Line

2 Nos. of Fireman’s Outfit

3 International Shore Connection

4 Nos. of Fire Pumps

5 Means of Escapes

6 Nos. of Fire Hoses

7 Dual Fire Nozzles with shutoff (spray / jet type):

8 Portable Fire Extinguishers Date of Issue of the Inspection Certificate:

9 Breathing Apparatus Date of Issue of the Inspection Certificate:

10 Emergency Escape (EEBD) Date of Issue of the Inspection Certificate:

11 Oxygen Analysis & Gas Detection Equipment On Board Date of Cert Issued:

Type of Fixed Fire-extinguishing system in machinery spaces:

12
Date of Issue of the Inspection Certificate:

Fire-extinguishing arrangements in cargo spaces:

13
Date of Issue of the Inspection Certificate:

LIFE SAVING EQUIPMENT AND ARRANGEMENTS

Total With Last date lowered to Visible
Life Boats Number/s
Capacity
Motor
Type
the water Condition

1 a) Port Y/N

2 b) Starboard Y/N

3 c) Freefall Y/N

4 d) Rescue Boats Y/N

Visible
Life Rafts With hydrostatic release Last date of service
Condition

5 a) Port Y/N

6 b) Starboard Y/N

7 c) Bow / Stern Y/N

8 Marine Evacuation Systems: Initial Deployment: Last Date of Service:

9 Operating instructions for survival craft visible Y/N

With
Total With With With smoke
Personal LSA Number/s
reflective
lights lifelines signals
Visible Conditions
tape

10 Lifebuoys

With
Visible Conditions
whistle

11 Lifejackets Y/N Y/N Y/N

12 Immersion Suits Y/N Y/N Y/N

13 Thermal protective aids Y/N Y/N Y/N

14 Optical Signals Y/N Y/N Y/N

Total
Number/s
Expiration Date

15 Rocket Parachute Flares

16 Hands Flares

17 Buoyant Smoke Signals

18 Line Throwing appliance

19 Total number of persons for which life-saving appliances are provided

GENERAL & STRUCTURAL CONDITIONS

ENGINE ROOM Visible Conditions

1 Visible Conditions of Engine Room

2 Lighting

3 Fire dampers

4 Jacketed Piping System

5 Visible Conditions of Generators and pumas

6 Visible Conditions of Emergency Generator

7 Escape Trunk

8 Oil Discharge Monitoring and Control System

9 Oily Water Filtering Equipment (15 PPM)

10 Steering gear room

11 Emergency instructions posted

12 Steering Gear System

13 Auxiliary steering gear

CARGO AREAS

1 Visible conditions of Cargo areas

2 Detect water ingress system/ audible and visible.

MOORING EQUIPEMENTS

1 Anchorage equipment

2 Mooring lines

HULL AND SUPERESTRUCTURE

1 Visible conditions of Hull and superstructure

2 Load line marks

3 Last Dry Dock Date:

OTHERS

1 Enhanced Survey Program of Inspection (ESP)

2 Pilot Ladder

3 Accommodation Ladder

4 Navigation Lights

5 Incinerator : Approved by:

 Y/N
MARITIME LABOR N/A - NIL

1 Seafarers Employment Agreements

2 Medical Certificate Of Seafarers

3 Training and Qualifications (Certification/ Endorsement)

4 Hours of Work and Hours of Rest

5 Minimum Age 18 Years

6 Minimun Safety Manning Certificate

7 Monthly Wages (Each 30 Days)

8 Seafares Repatriation-Financial Security

9 Seafers Accommodations in Appropriate Conditions

10 Crew Accommodation Certificate (ILO 92, if apply)

11 Food and Catering

12 Qualified Cook (Ships Carrying 10 or More Persons) Standard

13 Medical Chest

14 Medical Equipment

15 International Medical Guide On Board

16 Qualified Medical Doctor (Ships Carrying 100 or More Persons)

17 Seafarer On Board is in Charge of Medical Care (Ships Carrying Less 100 Persons)

18 Report an Occupational Accidents, Injuries and Diseases to Seafarers Reg. 4.3 MLC

19 Insurance Coverage of Accident, Illness or Diseases to Seafarers

20 Program Of Health and Safety Protection and Accident Prevention

21 Personal Protective Equipment

22 Ship’s Safety Committee (ships carrying 5 or more persons)

23 Medical Care On Board

24 Maritime Labour Certificate and Declaration of Maritime Labour Compliance (Ships of 500GT & above)

25 On Board Complaint Procedures

26 Maritime Labour Convention 2006 on Board

Signature by MASTER : Master’s/Ship Stamp:

Name in Print :

Please send the following documents:

➢ Fleet Distribution List – Superintendent Emergency Contact
➢ Arrival Crew List
➢ Certificate of Inspection of Crew Accommodations (CICA)

TANKER VESSELS Y/N

1. Conditions Of Cargo Pump Room (Solas Ch.11-2/63)

2. Conditions Of The Fixed Deck Foam System (Solas Ch.1i-2/6i)

3. Conditions Of The Inert Gas System (Solas Ch.Ii-2/62)

4. Are The Instruction Manuals For The Inert Gas System On Board (Solas Ch.U-2/62.21)?

5. Is Cargo Tank Venting And Purging And/Or Gas-Freeing (All Chemical Tankers Constructed After 01jan94.
Solas Ch.11/59.)

6. Is There Means To Gain Safe Access To The Bow (All Tankers Shall Be Ftted By The First Scheduled
Drydocking After 1 July 1998 But Not Later Than 1 July 2001, Solas 11-2/3-3.2)?

7. Is There An Emergency Towing Arrangement Fitted (Fitted At Both Ends Of Every Tanker Of Not Less Than
20,000 Tonnes Deadweight Ch. U-1/3-4)?

8. Is The Instrument For Measuring Of Oxygen And Flammable Vapour Concentrations In Double Hull And
Double Bottoms On Board (New Oil Tankers 01oct94, Solas Ch. 11-2/59.4)7

9. Is The Portable Instrument For Measuring Flammable Vapour Concentrations, Spares And Means Of
Calibration On Board (All Tankers Solas Ch.Il 1/59.5)?
10. Are There Dedicated Sea Water Ballast Tanks To Have An Efficient Corrosion Prevention System (New Oil
Tankers And Bulk Carriers 01jul98, Solas Ch.Ii-L/3-2)?

11. If There Is Any Permanent Access From A Pipe Tunnel To The Main Pump Room, Is It Fitted With A
Watertight Door (New T.Ankers 01jul98, Solas Ch.Ti-2/56.9)?

12. Is There A Secondary Means Of Full Flow Release Of Vapour From Cargo Tanks, Or Alternatively Pressure
Sensors With Monitoring (New Tankers 0ijul98, Solas Ch.11-2/59.1.2.3)?

13. Is There A Crude Oil Washing System Installed (New Crude Oil Tanker Of 20,000 Tons Deadweight And
Above, Marpol Annex 1/13)?
 14. Is There An Operations And Equipment Manual For Crude Oil Washing (Marpol Annex I/13b)?

15. If The Vessel Is A Chemical Tanker, Is The Ibc Code Onboard (Solas Ch.Vii, Part B)?

16. If The Vessel Is A Gas Carrier, Is The Igc Code On Board (Solas Ch Vii, Part C)?

17. If The Vessel Is A Chemical Tanker Or Gas Carrier Carrying Cargoes Emitting Toxic Vapours Or Gases, And
Does Not Carry Totally Enclosed Lifeboats, Does It Have Lifeboats With A Self Contained Air Support System
And Are The Boats Fire- Protected (Solas Ch. Iii/31.1.6, 31.1.7)?

18. Nox Technical Code On Board

19. Is The Vessel Provided With 2 Means Access To And Within Spaces In The Cargo Area?

20. Is The Vessel Fitted System For Continuous Monitoring Of The Concentration Of Hydrocarbon Gases?

21. If The Vessel Is Carrying Dangerous Chemicals In Bulk Is It Fitted With Secondary Tank Venting Systems?

22. Prohibits Of The Use Or Release Of Ozone Depleting Substances

Signature by MASTER : Master’s/Ship Stamp:

Name in Print :