Authorization No.:

International Safety Management (ISM-Code)

SMC-Checklist for:

Interim Certification

(For Ship)

(In accordance with Part B, Section 14-Interim Certification, Paragraph 14.2 of the ISM-Code)

Place: / Date
( Place of issue of Checklist) / ( Day, Month, Year)
Name of Ship:
Name of Company:
Address of Company:
IMO Unique Company Identification Number:
Distinctive Number or Letters:
Port of Registry:
Type of Ship: / Passenger shipPassenger high-speed craftCargo high-speed craftBulk carrierOil tankerChemical tankerGas carrierMobile offshore drilling unitOther cargo ship
Gross Tonnage:
IMO Number:

Comments in box: Yes (X), No (-), or Not Applicable (NA)

No. / Questions / Ship / Comments
Yes / No
1. / Interim Certification
2. / Verification for issuance of an Interim SMC is carried out where:
3. / New ships on delivery? (Section 14, Paragraph 14.2.1)
4. / A company takes on responsibility for the operation of a ship which is new to the company (Section 14, Paragraph 14.2.2)
5. / The ship changes flag? (Section 14, Paragraph 14.2.3)
6. / The DOC, or the Interim DOC, is relevant to the ship concerned?
7. / Does a document provided by the Company for the ship concerned cover key elements of the ISM Code?
8. / Has the Company developed plans to implement on SMS meeting the full requirements of the ISM Code within the period of validity of the Interim SMC?
9. / Do these plans include the following phases:
10. / ·  Intended date of receiving the SMC?
11. / ·  Date of internal audit of the SMS elements on board the ship?
12. / ·  Final date of full implementation of the SMS on board the ship?
13. / ·  Date of initial audit of the ship for issuing an SMC?
14. / Is there a documented SMS on board including the following:
15. / ·  Safety and environment protection policy?
16. / ·  Description of the organizational structure of the Company such as organizational charts or an equivalent?
17. / ·  Description of the responsibilities and authority of key personnel such as job descriptions or an equivalent?
18. / ·  Development of plans for shipboard operations (Section 7)?
Additional Comments:

Comments in box: Yes (X), No (-), or Not Applicable (NA)

No. / Questions / Ship / Comments
Yes / No
19. / ·  Emergency preparedness (Section 8)?
20. / Maintenance procedure (Section 10)
21. / Is there a list of potential emergency shipboard situations on board the ship?
22. / Are there documents on board the ship for responding to emergency situations?
23. / Do these documents refer to applicable rules, regulations, codes and guidelines?
24. / Are there documents on board the ship to determine the procedure of using internal communication lines in an emergency?
25. / Do these documents provide guidance to the Master on obtaining assistance from third parties?
26. / Do these documents give guidance to the master on means of maintaining communication throughout the emergency?
27. / Are the master and relevant senior officers familiar with the SMS and planned arrangements for its implementation?
28. / Are instructions identified as essential provided on board before the ships leaves port?
29. / Do these instructions include:
·  Lifeboat and liferaft station and launching responsibilities?
·  Fire station responsibilities?
30. / Are measures taken for the shipboard personnel involved in the SMS to comprehend the relevant norms, rules, codes and guidelines?
31. / Is the relevant information on the SMS given in a working language or languages understood by the ship’s personnel?
Additional comments:
General comments:

Final recommendation:

It is recommended that:

No Full Term SMC to be issued until Initial Verification will be carried out.……………………….
I have issued the Interim SMC No. / at
(Place of issue of Interim SMC)
the / of / of / .
(Day) / (Month) / (Year)
Valid until: / of / of / .
(Day) / (Month) / (Year)
Note: Interim SMC following Interim Certification should be issued for a period not exceeding six (6) months in accordance with Part B, Section 14, Paragraph 14.2 of the ISM Code. No Extension of Interim SMC to be issued without previous Authorization from the Administration (Part B, Section 14, paragraph 14.3 of the ISM Code)
Issued at : / the / of / of / .
(Place of issue of Checklist) / (Day) / (Month) / (Year)
Name and Signature of duly authorized ISM-Code Auditor
By: Intermaritime Certification Services (ICS)

ISM Code/SMC-Checklist for Interim Certification (2011/09) 4/4