GUARDIAN BUREU OF SHIPPING
Survey report for the issue of
Fishing Vessel Safety Certificate
Vessel 24 meters in length and above
This form must be kept on board and be available for inspection by nominated surveyor or recognized organization at all times.
Name of ship / Port of registry / Gross tonnage / Year keel laidCall letters / Patent number and date of expire
Details of persons requesting survey and to whom certificates are to be sent
Owner/MasterAgents/Operators
Vessel status regs...... New / Existing ship
Extent of survey:
Initial survey...... …..….
Periodical survey for renewal of certificate ...... …
Reason the survey has been carried out:
Completion of the new building ...... …......
Change of flag ......
Conversion of the ship ......
Expire of safety certificate......
Partial survey and reason for ......
Alterations, replacements or renewal affecting the Record of approved cargo ship Safety Equipment have
been checked, and the corrections made have been listed overleaf ......
Record of approved cargo, ship safety details on board ......
Any recommendation issued or deficiencies noted upon completion of the survey are also listed overleaf …
Documentation action:
Short term certificate has been issued: valid...... months until ...... …..
The existing certificate has been extended until ......
Interim certificate valid five months has been issued valid until ......
No certificate is issued due to the deficiencies found ......
This is to certify that the undersigned has examined the ship as reported herein, and has compared the
arrangements and equipment onboard with the Record of approved cargo ship......
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SAFETY ITEMS
DOCUMENTATION, NAVIGATION, ETC. 1 & 2
1DOCUMENTATION YES/NO
1Fire control ...... ….…...
2Muster Lists and Emergency Procedures posted ...... …...
3Damage Control Plans posted / booklets available ......
4Stability Data available ...... ….. .
1.2PRACTICE MUSTER AN DRILLS
a) Log book entries are being made by the Master……………………………………..…
b)Date when last full crew muster for boat and fire drills took place ...... … .
c)The boats’ equipment was examined at that time and found to be complete ...... …. .
d)The last occasion when the lifeboats were operated, indicate dates below :
LB Nos. Turned out Lowered to water Engines operated
1
2
1.3First aid / Medicine chest provided and accessible ......
2SAFETY OF NAVIGATION
2.1Shipborne navigational equipment according to Record, are in order
2.2Compasses adjusted (main and steering) ......
2.3Propeller speed and direction or pitch indication operational ......
2.4NAVIGATION LIGHTS (COLREG 1972)
a)Lights type approved or lights delivered with certificate (copy of certificate enclosed) ...
b)Lights are tested with power from mains and emergency source ......
c)If fitted. light failure indicator / alarm is tested ......
d)Sidelights are screened to prevent light from being seen across the centerline ......
e)Oil lights as listed in Record are in order ......
2.5SIGNALING APPARATUSES
a)Daylight signaling lamp is tested on mains and emergency source of power ......
b)Equipment, as listed in the Record, are onboard and in order ......
LIFE - SAVING APPLIANCES 3
3.1ROCKETS AND SIGNALS
a)Rockets and / or cartridges are valid (usual validity 3 years) ......
b)Distress signal are valid (usual validity 3 years) ......
c) Line Throwing Appliances……………………………………………………………….
3.2LIFEBOATS / RESCUE BOATS
No. 1 / No. 2a) Lifeboat now turned out and lowered to embarkation deck
b) Lifeboat now turned out and lowered to water
c) Hull inside and outside, and lifting hooks inspected
d) When lowered to water, disengagement gear readily released the
lifeboat
e) Portable or built-in air cases removed, found or placed in good
condition, replaced and secured
f) Air-cylinders in covered boats fully charged (if provided)
g) Lifeboats marked with dimensions, name, port of registry and
number of persons
h) Engines in motorboats operated
3.3LIFEBOAT EQUIPMENT
a)Food rations, tinned water and pyrotechnics are valid ......
(5 yrs)(3 yrs)(3 yrs)
b)Fire extinguisher in motorboat is serviced ......
c)Motor run ahead and reverse ......
d)Fuel tank with pipes are checked ......
e)Sufficient fuel for 4 hours’ operation provided ......
f)All equipment is in order and secured ......
3.4DAVITS AND WINCHES
a) All sheaves, blocks, falls and all moving parts are free and well lubricated ......
b)Hidden parts of wire falls have been inspected ......
c)Dates of reversal or renewal of falls ......
(Usually every 2nd/3rd and 4th/5th year)
LIFE - SAVING APPLIANCES 3 (CONT’ D)
3.5LAUNCHING AND EMBARKATION ARRANGEMENTS
a)All blocks, chains and shackles checked ......
b)Boat lashing and release arrangement in order ......
c)Lifelines fitted to davit spans checked ......
d)Embarkation ladders checked ......
e)Lighting at boat/raft stations and oversides tested on mains and emergency source of
power ......
f)Alarm system tested ......
g) Means of preventing water discharge into boats verified ……………………………..
3.6LIFERAFTS
Servicing of inflatable liferafts (due every 12 months) (Hydrostatic release to be serviced together with raft)
Date of / serviceNo. / Maker name and serial number / No. of persons / Raft / Hydrostatic release
3.7OTHER LIFESAVING APPLIANCES
1Lifejackets and found in order ......
2Lifejackets and readily accessible and their position plainly indicated ......
3Lifebuoys in good condition, and marked with name and port of registry ......
4Lights and lines in order, and smoke signal valid (3 yrs)......
5Quick release from bridge in order ......
6 Inmersion Suits and Thermal Protective aids………………………………………….
3.8PILOT LADDER
1Ladder, as required, is in good order with necessary spreaders(battens) and with interval
not more than 9 steps ......
2Adequate lighting and bulwark ladder provided ......
FIRE APPLIANCES 4
4.1FIRE APPLIANCES IN SPACES CONTAINING MAIN AND AUXILIARY MACHINES AND BOILERS
4.1.1Main fire pumps
State pressure in fire main with two jets of water when two fire pumps working
simultaneously ......
4.1.2Emergency fire pump
State pressure in fire main with two jets of water ......
4.2PORTABLE AND NON - PORTABLE FIRE - EXTINGUISHERS IN MACHINERY SPACES
a)Date of last checking ......
b)Spare charges provided for each fire - extinguisher ......
4.2.2CO2 Fire - extinguishers installations in machinery spaces
a) Date of biennial checking of CO2 system and control of CO2 bottles by recognized firm
...... …………......
b)Alarms tested and instructions verified ......
4.2.3Fixed foam fire - extinguishing system in machinery spaces
Low expansion foam installations:
a)Distribution system and control gear tested with fresh water, compressed air or
otherwise ......
b)Date of biennial control of foam samples by recognized firm ......
High expansion foam installations:
c)Foam generators have been tested by discharging foam outside the protected area ......
d)Date of biennial control of foam samples by recognized firm ......
4.2.4Fixed pressure water spraying fire - extinguishing system in machinery spaces
a)System tested by fresh water or compressed air ......
b)Automatic operation of the pump tested ......
c)All controls tested ......
4.2.5Special arrangements in machinery spaces
Following tested:
a)All remote stops ......
b)Remote closing of engine room skylights ......
c)Closing of ventilation and fire flaps ......
d)Closing of tunnel door ......
e)Closing of oil fuel shut downs ......
4.3OTHER FIRE APPLIANCES(outside machine spaces)
4.3.1Fireman’s outfit
a) Fireman’s outfit complete ......
4.3.2Self - containing breathing apparatus
a)Operation tested ......
b)Air cylinders are fully charged ......
4.3.3Smoke helmet or smoke mask
a)Functioning of smoke mask with air pump and hose tested ......
4.3.4Portable and non - portable fire - extinguishers outside machinery spaces
a)Date of annual checking ......
b)There are spare charges for each fire extinguisher ......
c)Date of last pressure testing ......
MACHINERY AND ELECTRICAL 5
5.1GENERAL
a)If arrangements are found which are materially different from those stated in the Record of Safety Details, an entry must be made at the end of this Report giving full particulars.
b)If the vessel is classed, indicate Class society and date of expire of valid machinery class Certificate ......
c) Test required under paragraphs 5.2, 5.3, 5.4, 5.5, 5.6 and 5.7 may be omitted if the vessel is classed by one of the Class societies which are authorized by the government to issue
technical certificates on its behalf.
5.2ELECTRICAL POWER
a)All main generators tested and operational ......
b)Emergency source of power tested and found operational under following simultaneous loads: emergency lighting(alleyways, stairways, propulsion machinery space, main
generator space, wheelhouse, chartroom, embarkation stations, steering gear room, as
applicable), navigation lights, alarm system …......
c)Emergency lighting adequate and in order ......
d)Visible condition of electric machinery and wiring found adequate to minimize the risk
of electric shock or short circuit ......
5.3ANCHOR AND MOORING EQUIPMENT
a)Windlass and stoppers (if provided) tested and found operational ......
b)Capstans and mooring winches (if provided) tested and found operational ......
5.4BILGE PUMPING EQUIPMENT
a)Bilge pumps tested and found operational ......
b)Pipes and valves found in adequate condition ......
c)Bilge wells and strainers found in order ......
d)Automatic remote bilge high level alarm, if provided, tested and found in order......
5.5STEERING GEAR
a)Rudder angel indicator operational ......
b)Steering gear tested and found in order ......
c)Emergency steering arrangements tested and found in order ......
d)Instructions for emergency steering arrangements available and adequate ......
5.6PROPULSION MACHINERY
a)Propulsion engines started three consecutive times ......
b)Propulsion engines run at idling speed for 30 minutes and found in order ......
c)Means of going astern tested and found in order ......
d)Speed controls and gauges found in order, remote RPM and direction or pitch indicators in the wheelhouse synchronized with engine ......
e)Propulsion auxiliaries (pumps, coolers, etc.) found in order ......
f)Piping systems found in order, without leaks, with valves operational and clean filters..
g)Inner sterntube seal examined and found in order ......
5.7BOILERS AND PRESSURE VESSELS
Applicable to boilers with power grater than 175 kW(T/h) or pressure vessels of capacity above 500 litters
(about130 gallons).
a)Boilers operated and found in order ......
b)Safety valves of boilers and major pressure vessels tested and found in order ......
c)Steam piping found in order, without leaks, valves operational, auxiliary tanks in order,
drains and strainers in order ......
d)Flammable or toxic gas containers located outside the accommodation of the main machinery spaces ......
HULL AND DECK EQUIPMENT 6
6.1GENERAL
a) If the vessel classed, indicate class Society and date of expire of valid hull class Certificate
......
b)Examinations under sections 6.2, 6.3, 6.4 and 6.5 may be omitted in vessels classed by one of the Class societies which are authorized by the Register to issue technical certificates on its behalf.
c)Indicate date of last dry-docking ......
6.2ANNUAL HULL SURVEY
This survey is to be carried out both for the issue and for the endorsement of the Certificate.
a)Overside over the waterline parts examined all around the vessel and found to be in overall good condition ......
b)The following items were especially examined and found in the following condition:
1.Degree of visible corrosion ......
2.Plates around chafing areas ......
3.Fenders, if fitted ......
4.No apparent dents at bulkhead locations or distortions in way of major internal structural members ......
c)Weather decks examined from above and found in good condition ......
d)Watertight bulkheads examined from both sides and found in good condition (if
accessible) ......
e)Visual condition of ladderways and railings ......
6.3DRY-DOCK SURVEY (See 6.1b)
This survey is to be carried out for the issue of the Certificate, or as required by the
Regulation.
a)Underwater parts of hull examined and found in the following condition ......
b)The following items were especially examined and found in the following condition .....
1.State degree of visible corrosion ......
2.Seachests (integrity, condition of grills, cleanliness) ......
3.Condition of shell around overboard discharges ......
c)Rudder examined and found in good condition, rudder pintles clearances corrected if found in excess of 10% of the pintle diameter or 10 mm, whichever is the lesser ......
d)Propeller examined and found in apparent good condition ......
e)Any cemented areas to be tested with hammer for proper adherence ......
f)The internal side of the boundaries of all holds and ballast, fuel - oil and cargo tanks examined and found in good condition. All oil tanks must be gas free and clean prior the examination ......
g)Insulation panels and/or wooden deck coverings, if provided, to be removed at locations near the peak bulk heads and near the center of the vessel and the underlying plates are found in
good condition. This operation need not be carried out in vessels less than eight years old.
The following locations were examined:
Double bottom ......
Upper side of decks ......
Insulated reefer cargo spaces ......
h)Main structural members were gauged. (these measurements shall only be carried out wherever heavy corrode wastage is apparent. Where the wastage is found to exceed 25% of the original thickness, the structure should be renewed.) The following locations were tested:
1...... Wastage...... %
2...... Wastage ...... %
Place and date of survey ______
Surveyor to GUARDIAN BUREU OF SHIPPING.
Name, Stamp and Signature
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