ประกาศกรมเจ้าท่า

ที่ ๓๕/๒๕๖๗
เรื่อง แก้ไขเพิ่มเติมแบบใบสำคัญรับรองและแบบบันทึกรายการอุปกรณ์เกี่ยวกับความปลอดภัยแห่งชีวิตในทะเลโดยเป็นไปตามอนุสัญญาระหว่างประเทศ
ว่าด้วยความปลอดภัยแห่งชีวิตในทะเล ค.ศ. ๑๙๗๔ (ฉบับที่ ๓)

ตามที่กรมเจ้าท่าได้ออกประกาศกรมเจ้าท่า ที่ ๑๒/๒๕๖๐ เรื่อง แบบใบสำคัญรับรองและแบบบันทึกรายการอุปกรณ์เกี่ยวกับความปลอดภัยแห่งชีวิตในทะเล และประกาศกรมเจ้าท่า ที่ ๑๙/๒๕๖๒ เรื่อง แบบใบสำคัญรับรองและแบบบันทึกรายการอุปกรณ์เกี่ยวกับความปลอดภัยแห่งชีวิตในทะเล โดยเป็นไปตามอนุสัญญาระหว่างประเทศว่าด้วยความปลอดภัยแห่งชีวิตในทะเล ค.ศ. ๑๙๗๔ (International Convention for the Safety of Life at Sea 1974 : SOLAS 1974) และประกาศกรมเจ้าท่า ที่ ๒๒/๒๕๖๖ เรื่อง แก้ไขเพิ่มเติมแบบใบสำคัญรับรองและแบบบันทึกรายการอุปกรณ์เกี่ยวกับความปลอดภัยแห่งชีวิตในทะเลโดยเป็นไปตามอนุสัญญาระหว่างประเทศว่าด้วยความปลอดภัยแห่งชีวิตในทะเล ค.ศ. ๑๙๗๔ (ฉบับที่ 2) ซึ่งต่อมาคณะกรรมการความปลอดภัยทางทะเลขององค์การทางทะเลระหว่างประเทศ (International Maritime Organization : IMO) ได้รับรองข้อมติดัง MSC.496(105) ในวันที่ 28 เมษายน พ.ศ.2565 เพื่อมีการแก้ไขเพิ่มเติมแบบใบสำคัญรับรองวิทยุและความปลอดภัยของเรือสินค้า (Cargo Ship Safety Radio Certificate) และระบบบันทึกรายการอุปกรณ์ (Record of Equipment : Form R) เพื่อให้มีการแก้ไขเพิ่มเติมรายละเอียดของเรือสินค้า ( Cargo Ship Safety Equipment Certificate ) และระบบบันทึกรายการอุปกรณ์ (Record of Equipment : Form E)

เพื่อให้แน่ใจในการออกใบสำคัญรับรองและระบบนี้ถูกต้องตามข้อกำหนดของอนุสัญญาระหว่างประเทศว่าด้วยความปลอดภัยแห่งชีวิตในทะเล ค.ศ. 1974 และที่แก้ไขเพิ่มเติมอาชีพนายนักการตรวจเรือ ก.พ.ศ.2559 และข้อ 6 จากประกาศกระทรวงคมนาคม เรื่อง การนำเข้าและออกกำลังกายของเครื่องจักรกลไฟฟ้า พ.ศ.2559 และข้อ 6 จากประกาศกระทรวงคมนาคม เรื่อง การนำเข้าและออกกำลังกายของเครื่องจักรกลไฟฟ้า พ.ศ.2560 สภาพการทำงานตรวจเรือให้ตรวจสอบและออกกำลังกายของการตรวจเรือจากกรมเจ้าท่า อธิบดีกรมเจ้าท่า
จึงประกาศกำหนดไว้ว่าดังต่อไปนี้

ข้อ 1 มาตรฐานนี้ใช้บังคับตั้งแต่วันประกาศในราชกิจจานุเบกษาเป็นต้นไป
ข้อ 2 หากเอกสารกรมเจ้าท่า มีการเปลี่ยนแปลงหรือยกเลิกประเภทของอุปกรณ์ใดๆภายในระยะเวลาของคำประกันจะทำให้เสียหาย

ข้อ ๓ แบบใบสำคัญรับรองและแบบบันทึกรายการอุปกรณ์ ซึ่งออกตามกฎข้อบังคับสำหรับ
การตรวจเรือ กำหนดหลักเกณฑ์ วิธีการและเงื่อนไขในการออกใบสำคัญรับรองเกี่ยวกับความปลอดภัย
แห่งชีวิตในทะเล พ.ศ. ๒๕๕๙ ดังต่อไปนี้ ให้เป็นไปตามรายละเอียดที่ปรากฏตามภาคผนวกแนบท้าย
ประกาศ

๓.๑ แบบใบสำคัญรับรองอุปกรณ์เพื่อความปลอดภัยของเรือสินค้า (Cargo Ship
Safety Equipment Certificate) และแบบบันทึกรายการอุปกรณ์ (Record of Equipment : Form E)

๓.๒ แบบใบสำคัญรับรองวิทยุเพื่อความปลอดภัยของเรือสินค้า (Cargo Ship
Safety Radio Certificate) และแบบบันทึกรายการอุปกรณ์ (Record of Equipment : Form R)

ข้อ ๔ ในกรณีที่ใบสำคัญรับรองออกโดยสถาบันการตรวจเรือ (Recognized Organization : RO)
ให้ใบสำคัญรับรองนั้นมีรายละเอียดสอดคล้องกับมาตรา MSC.496(105) AMENDMENTS TO THE
INTERNATIONAL CONVENTION FOR THE SAFETY OF LIFE AT SEA, 1974

ประกาศ ณ วันที่ ๑๔ กุมภาพันธ์ พ.ศ. ๒๕๖๗
กริชเพชร ชัยช่วย
อธิบดีกรมเจ้าท่า

# CARGO SHIP SAFETY EQUIPMENT CERTIFICATE

This certificate shall be supplemented by a Record of Equipment of Cargo Ship Safety (Form E)

Issued under the provisions of the
INTERNATIONAL CONVENTION FOR THE SAFETY OF LIFE AT SEA, 1974, AS AMENDED
under the authority of the Government of THE KINGDOM OF THAILAND
by the MARINE DEPARTMENT

Particulars of ship\(^1\)

| Name of Ship | Distinctive Number or Letters |
|---------------|--------------------------------|
| Port of Registry | Gross Tonnage                |
|               | Deadweight of ship (metric tons)\(^2\) |
|               | Length of ship (regulation III/3.12) |
|               | IMO Number\(^3\)             |

Type of Ship\(^4\)

Bulk Carrier
Oil tanker
Chemical tanker
Gas carrier
Cargo ship other than any of the above

Date on which keel was laid or ship was at a similar stage of construction or, where applicable date on which work for a conversion or an alteration or modification of a major character was commenced.

THIS IS TO CERTIFY :

1. That the ship has been surveyed in accordance with the requirement of Regulation I/8 of the Convention.
2. That the survey showed that:
   2.1 the ship complied with the requirements of the Convention as regards fire safety systems and appliances and fire control plans;

\(^1\) Alternatively, the particulars of the ship may be placed horizontally in boxes.

\(^2\) For oil tankers, chemical tankers and gas carriers only.

\(^3\) In accordance with the IMO Ship Identification Number Scheme, adopted by the Organization by resolution A.117(30).

\(^4\) Delete as appropriate.

the life-saving appliances and the equipment of lifeboats, liferafts and rescue boats were provided in accordance with the requirements of the Convention;

2.3 the ship was provided with a line-throwing appliance in accordance with the requirements of the Convention;

2.4 the ship complied with the requirements of the Conventions as regards shipborne navigational equipment, means of embarkation for pilots and nautical publications;

2.5 the ship was provided with lights, shapes, means of making sound signals and distress signals in accordance with the requirements of the Convention and the International Regulations for Preventing Collisions at Sea in force;

2.6 in all other respects the ship complied with the relevant requirements of the Convention;

2.7 the ship was/was not\(^4\) subjected to an alternative design and arrangements in pursuance of regulation(s) II-2/17 / III/38\(^4\) of the Convention;

2.8 a Document of approval of alternative design and arrangements for fire protection/life-saving appliances and arrangements\(^4\) is/is not\(^4\) appended to this Certificate.

3. That the ship operates in accordance with regulation III/26.1.1\(^5\) within the limits of the trade area

4. That an Exemption Certificate has/has not been issued.

This certificate is valid until subject to the annual and periodical surveys in accordance with Regulation l/8 of the Convention

Completion date of the survey on which this certificate is based (dd/mm/yyyy)
Issued at

(date of issue)

Government Ship Surveyor

Endorsement for annual and periodical surveys

---

\(^4\) Delete as appropriate

5 Refer to the 1983 amendments to SOLAS (MSC.4(48)), applicable to ships constructed on or after 1 July 1986, but before 1 July 1998 in the case of self-righting partially enclosed lifeboat(s) on board.

THIS IS TO CERTIFY that, at a survey required by Regulation I/8 of the Convention, the ship was found to comply with the relevant requirements of the Convention.

Annual Survey :
Signed : .................................................................(
)
Place : .............................................................................
Date : ................................................................................

Annual/Periodical Survey :
Signed : ..............................................................(
)
Place :...............................................................................
Date :..................................................................................

Annual/Periodical Survey :
Signed : ...............................................................(
)
Place :.............................................................................
Date :..................................................................................

This ship complies with the relevant requirements of the Convention, and this certificate shall, in accordance with Regulation I/14(d) of the Convention, be accepted as valid until

Signed:
(
)

Place:

Date:

Endorsement to extend the validity of the certificate until reaching the port of survey or for a period of grace where Regulation I/14(e) or I/14(f) applies

This certificate shall, in accordance with Regulation I/14(e) /I/14(f) of the Convention, be accepted as valid until

Signed:
(
)

Place:

Date:

Endorsement for advancement of anniversary date where Regulation I/14(h) applies
In accordance with Regulation I/14(h) of the Convention, the new anniversary date is

Signed:
(
)

Place:

Date:

In accordance with Regulation I/14(h) of the Convention, the new anniversary date

# RECORD OF EQUIPMENT FOR CARGO SHIP SAFETY (FORM E)

RECORD OF EQUIPMENT FOR COMPLIANCE WITH
THE INTERNATIONAL CONVENTION FOR THE SAFETY
OF LIFE AT SEA, 1974, AS AMENDED
## 1 Particulars of ship

Name of ship

Distinctive number or letters
## 2 Details of life-saving appliances
<table>
<tr>
<td colspan="2">1 Total number of persons for which life-saving appliances are provided</td>
<td></td>
</tr>
<tr>
<td rowspan="2">2</td>
<td>Total number of davit launched lifeboats</td>
<td>Port</td>
<td>Starboard</td>
</tr>
<tr>
<td></td>
<td></td>
<td></td>
</tr>
<tr>
<td rowspan="2">2.1</td>
<td>Total number of persons accommodated by them</td>
<td></td>
<td></td>
</tr>
<tr>
<td></td>
<td></td>
<td></td>
</tr>
<tr>
<td rowspan="2">2.2</td>
<td>Number of self-righting partially enclosed lifeboats (regulation III/43<sup>5</sup>)</td>
<td></td>
<td></td>
</tr>
<tr>
<td></td>
<td></td>
<td></td>
</tr><tr><td rowspan="2">2.3</td>
<td>Number of totally enclosed lifeboats (regulation III/31 and LSA Code, section 4.6)</td>
<td></td>
<td></td>
</tr><tr><th></th><th></th><th></th><th></th><th></th><th></th><th>(International Convention on the Safety of Life at Sea 1974 : SOLAS 1974)</th><th colspan="2"></th><th colspan="3"></th><th colspan="3"></th><th colspan="3"></th><th colspan="3"></th><th colspan="3"></th><th colspan="3"></th><th colspan="3"></th><hline>105) MSCE.GS(105)</hline> <div style="text-align:center">GRIPEHURONTITULARES DE LA MARINE FRANCAISE ET DU GOUVERNEMENT FEDERAL ALLEMANDE EN MATIERE D'ARMEMENTS MARINS.</div> <table border="0">
The table below shows details about your vessel's life-saving equipment. Please complete all relevant fields.
The total number of people for whom life-saving appliances are provided is also shown above.
The data should reflect the current state as of July 1, 1998.
The information here will help to ensure the safety of seamen and passengers on board.
The table continues on page two.
The first line asks how many free-fall lifeboats there are.
The second line asks how many motor lifeboats are included in the total lifeboat count.
The third line asks how many boats have searchlights.
The fourth line asks how many rescue boats there are.
The fifth line provides a breakdown by location (port and starboard).
The sixth line gives the total number of launchable davit-launched lifeboats.</table>

# 2 Details of life-saving appliances (continued)

|    | Liferafts                        |
|----|-----------------------------------|
| 6   | Those for which approved launching appliances are required |
| 6.1 | Number of liferafts              |
| 6.1.1 | Number of liferafts                  |
| 6.1.2 | Number of persons accommodated by them       |
| 6.2 | Those for which approved launching appliances are not required |
| 6.2.1 | Number of liferafts              |
| 6.2.2 | Number of persons accommodated by them       |
| 6.3 | Number of liferafts required by regulation III/31.1.4     |
| 7   | Number of lifebuoys                |
| 8   | Number of lifejackets               |
| 9   | Immersion suits                   |
| 9.1 | Total number                      |
| 9.2 | Number of suits complying with the requirements for lifejackets      |
| 10  | Number of anti-exposure suits        |

## 3 Details of navigational systems and equipment
<table>
<thead>
<tr>
<th></th>
<th>Item</th>
<th>Actual provision</th>
</tr>
</thead>
<tbody>
<tr>
<td>1.1</td>
<td>Standard magnetic compass<sup>6</sup></td>
<td></td>
</tr>
<tr>
<td>1.2</td>
<td>Spare magnetic compass<sup>6</sup></td>
<td></td>
</tr><tr>
<td>1.3</td>
<td>Gyro-compass<sup>6</sup></td>
<td></td>
</tr><tr>
<td>1.4</td>
<td>Gyro-compass heading repeater<sup>6</sup></td>
<td></td>
</tr><tr>
<td>1.5</td>
<td>Gyro-compass bearing repeater<sup>6</sup></td>
<td></td>
</tr><tr><td>1.6</td>
<td>Heading or track control system<sup>6</sup></td>
<td></td>
</tr><tr><td>1.7</td>
<td>Pelorus or compass bearing device<sup>6</sup></td>
<td></td>
</tr><tr><td>1.8</td>
<td>Means of correcting heading and bearings                       </td>
<td rowspan="2"></td>
The above essential functions shall be assigned to positions in the ship's organizational structure that are appropriate to the knowledge, skills and abilities required for the job, consistent with the Rank or Seniority of the person concerned.
The distribution of duties may vary according to departmental needs, taking into account the knowledge, skills and experience of individual officers, so far as it can be judged from their records.</tr><tr><td>1.9</td><td>The above essential functions shall be assigned to positions in the ship's organizational structure that are appropriate to the knowledge, skills and abilities required for the job, consistent with the Rank or Seniority of the person concerned.</td></tr><tr><td colspan="2">2.Nautical charts / Electronic chart display and information system (ECDIS)<sup>-4)</sup>(ECDIS) <br>(Back-up arrangements for ECDIS) <br>(Nautical publications) <br>(Back-up arrangements for electronic nautical publications)</td><td rowspan="2"></td></tbody></table>

| Item                                                                 | Actual provision |
|-----------------------------------------------------------------------|-------------------|
| 3.3 Second radar (3 GHz/9 GHZ)⁵                                        |                   |
| 3.4 Automatic radar plotting aid (ARPA)⁶                            |                   |
| 3.5 Automatic tracking aid⁶                                           |                   |
| 3.6 Second automatic tracking aid⁶                                |                   |
| 3.7 Electronic plotting aid⁶                                         |                   |
| 4.1 Automatic identification system (AIS)                              |                   |
| 4.2 Long-range identification and tracking system                    |                   |
| 5.1 Voyage data recorder (VDR)⁴                                       |                   |
| 5.2 Simplified voyage data recorder (S-VDR)⁴                      |                   |
| 6.1 Speed and distance measuring device (through the water)⁶       |                   |
| 6.2 Speed and distance measuring device (over the ground in the forward and athwartships direction)⁶ |               |
| 7 Echo-sounding device⁶                                             |                   |
| 8.1 Rudder, propeller, thrust, pitch and operational mode indicator⁴⁶    |                       |
| 8.2 Rate-of-turn indicator⁶                                          |                   |
| 9 Sound reception system⁶                                            |                   |
| 10 Telephone to emergency steering position⁶                        |                   |
| 11 Daylight signaling lamp⁶                                          |                   |
| 12 Radar reflector⁶                                                 |                   |
| 13 International Code of Signals                                     |                   |
| 14 IAMSAR Manual, Volume III                                         |                   |
| 15 Bridge navigational watch alarm system (BNWAS)                 |                   |

THIS IS TO CERTIFY that this Record is correct in all respects.

Issued at

(date of issue)

Government Ship Surveyor

Footnotes:
④ Delete as appropriate
⑤ Alternative means of meeting this requirement are permitted under regulation V/19. In case of other means, they shall be specified.

# CARGO SHIP SAFETY RADIO CERTIFICATE

This certificate shall be supplemented by a Record for Cargo Ship Safety Radio (Form R)

Issued under the provisions of the
INTERNATIONAL CONVENTION FOR THE SAFETY OF LIFE AT SEA, 1974, AS AMENDED

under the authority of the Government of THE KINGDOM OF THAILAND
by the MARINE DEPARTMENT

Particulars of ship\(^1\)

| Name of Ship | Distinctive Number or Letters |
|---------------|--------------------------------|
| Port of Registry | Gross Tonnage                |
|               | Sea areas in which ships is certified to operate (regulation IV/2)\(^2\) |
|               | Date on which keel was laid or ship was at a similar stage of construction or, where applicable, date on which work for a conversion or an alteration or modification of a major character was commenced |

IMO Number\(^3\)

Date on which keel was laid or ship was at a similar stage of construction or, where applicable, date on which work for a conversion or an alteration or modification of a major character was commenced.

THIS IS TO CERTIFY :

1. That the ship has been surveyed in accordance with the requirement of Regulation I/9 of the Convention.
2. That the survey showed that:
   2.1 the ship complied with the requirements of the Convention as regards radio installations;
   2.2 the functioning of the radio installations used in life-saving appliances complied with the requirements of the Convention;
3. That an Exemption Certificate has / has not\(^4\) been issued.

---

\(^1\) Alternatively, the particulars of the ship may be placed horizontally in boxes.

\(^2\) For a ship certified to operate in sea area A3, indicate the recognized mobile satellite service in brackets.

\(^3\) In accordance with the IMO Ship Identification Number Scheme, adopted by the Organization by resolution A.1117(30).

\(^4\) Delete as appropriate.

This certificate is valid until ________________ subject to the periodical surveys
in accordance with Regulation 1/9 of the Convention.

Completion date of the survey on which this certificate is based _______ (dd/mm/yyyy)
Issued at _______________________

(date of issue)

# Endorsement for periodical surveys

THIS IS TO CERTIFY that, at a survey required by Regulation I/9 of the Convention, the ship was found to comply with the relevant requirements of the Convention.

## Periodical survey
| Signed | ( ) |
| --- | --- |
| Place |  |
| Date |  |

## Periodical survey
| Signed | ( ) |
| --- | --- |
| Place |  |
| Date |  |

## Periodical survey
| Signed | ( ) |
| --- | --- |
| Place |  |
| Date |  |

## Periodical survey
| Signed | ( ) |
| --- | --- |
| Place |  |
| Date |  |

Endorsement where the renewal survey has been completed and Regulation l/14(d) applies
The ship complies with the relevant requirements of the Convention, and this certificate shall, in accordance with Regulation l/14(d) of the Convention, be accepted as valid until

Signed:
(
)
Place:
Date:

Endorsement to extend the validity of the certificate until reaching the port of survey or for a period of grace where Regulation l/14(e) or l/14(f) applies
This certificate shall, in accordance with Regulation l/14(e)/l/14(f) of the Convention, be accepted as valid until

Signed:
(
)
Place:
Date:

Endorsement for advancement of anniversary date where Regulation l/14(h) applies
In accordance with Regulation l/14(h) of the Convention, the new anniversary date is

Signed:
(
)
Place:
Date:

In accordance with Regulation l/14(h) of the Convention, the new anniversary date is

# RECORD OF EQUIPMENT FOR THE CARGO SHIP SAFETY RADIO (Form R)

RECORD OF EQUIPMENT FOR COMPLIANCE
WITH THE INTERNATIONAL CONVENTION FOR THE SAFETY
OF LIFE AT SEA, 1974, AS AMENDED

## 1. Particulars of ship
- Name of Ship
- Distinctive Number or Letters
- Minimum number of persons with required qualifications to operate the radio installations

## 2. Details of radio facilities
| Item | Actual provision |
| --- | --- |
| Primary systems | 1. |
| VHF radio installation | 1.1 |
| DSC encoder | 1.1.1 |
| DSC watch receiver | 1.1.2 |
| Radiotelephony | 1.1.3 |
| MF radio installation | 1.2 |
| DSC encoder | 1.2.1 |
| DSC watch receiver | 1.2.2 |
| Radiotelephony | 1.2.3 |
| MF/HF radio installation | 1.3 |
| DSC encoder | 1.3.1 |
| DSC watch receiver | 1.3.2 |
| Radiotelephony | 1.3.3 |
| Recognized mobile satellite service ship earth station | 1.4 |
| Secondary means of initiating the transmission of ship-to-shore distress alerts | 2 |
| Facilities for reception of maritime safety information and search and rescue related information | 3 |
| EPIRB | 4 |
| Two-way VHF radiotelephone apparatus | 5 |
| Portable two-way VHF radiotelephone apparatus | 5.1 |
| Two-way VHF radiotelephone apparatus fitted in survival craft | 5.2 |
| Search and rescue locating devices | 6 |
| Radar search and rescue transponders (radar SART) stowed for rapid placement in survival craft | 6.1 |
| Radar search and rescue transponders (radar SART) stowed in survival craft | 6.2 |
| AIS search and rescue transmitters (AIS-SART) stowed for rapid placement in survival craft | 6.3 |
| AIS search and rescue transmitters (AIS-SART) stowed in survival craft | 6.4 |

3. Methods used to ensure availability of radio facilities (regulation IV/15.6 and 15.7)

3.1 Duplication of equipment

3.2 Shore-based maintenance

3.3 At-sea maintenance capability

THIS IS TO CERTIFY that this record is correct in all respects.

Issued at:

(date of issue)

Government Ship Surveyor