Spreadsheet: 858024d1706817496-list-of-data-to-be-populated-into-a-predefined-report-template-without-vba-sample_1-mxdxbuae3404-
Sheet: Report

Vessel |  |  |  |  |  |  |  |  | Kuala Lumpur Express |  |  |  |  |  |  |  |  |  |  | Year |  |  |  |  |  |  |  |  | 2023
Safety Report PART A-1: General [NAME] and Training  The consecutively updated 'Safety Report' may be used to compensate respective SOLAS-related entries in the front pages of the deck log book. Therefore the report has to be signed, stamped and fixed as attachment to the deck log book.
Corrected Muster List displayed (date)
Note: According to ISM, a plan for all safety and emergency drills has to be made well in advance! If full muster, drill or training session is not held at the appointed time, this has to be documented, stating circumstances and extent of muster, drill or training session held (SOLAS III R 19.5 'Records')
[NAME] acc. [NAME] (monthly)
January |  |  |  |  |  |  | February |  |  |  |  |  | March |  |  |  |  | April |  |  |  |  |  | May |  |  |  |  | June |  |  |  |  | July |  |  |  |  | August |  |  |  |  | September |  |  |  |  | October |  |  |  |  | November |  |  |  |  |  | December
Date
January |  |  |  |  |  | February |  |  |  |  |  |  | March |  |  |  |  | April |  |  |  |  |  | May |  |  |  |  | June |  |  |  |  | July |  |  |  |  | August |  |  |  |  | September |  |  |  |  | October |  |  |  |  | November |  |  |  |  |  | December
Number of boat (as applicable)
Lifeboat lowered  (SOLAS  [NAME]. 19.3)
Lifeboat: launched Freefall Lifeboat: free-fall-launched or lowered into the water (SOLAS  [NAME]. 19.3) (at least every 3 months)
Freefall-Lifeboat free-fall-launched (SOLAS  [NAME]. 19.3) (at least every 6 months)
Manoeuvring Exercises (at least every 3 months)
Training in the use of Davit-Launched Life rafts acc. SOLAS III R 19.4.3 (once every 4 months)
January |  |  |  |  |  | February |  |  |  |  |  |  | March |  |  |  |  | April |  |  |  |  |  | May |  |  |  |  | June |  |  |  |  | July |  |  |  |  | August |  |  |  |  | September |  |  |  |  | October |  |  |  |  | November |  |  |  |  |  | December
Date
Rescue Boat Drill (launched & manoeuvred in water) acc. SOLAS R 19.3.4.6 (shall be carried out monthly, but at least once every 3 months
January |  |  |  |  |  | February |  |  |  |  |  |  | March |  |  |  |  | April |  |  |  |  |  | May |  |  |  |  | June |  |  |  |  | July |  |  |  |  | August |  |  |  |  | September |  |  |  |  | October |  |  |  |  | November |  |  |  |  |  | December
Date
Recovery of Persons from the Water acc. to procedures laid down in the ISM Emergency Plans (once every 3 months)
January |  |  |  |  |  | February |  |  |  |  |  |  | March |  |  |  |  | April |  |  |  |  |  | May |  |  |  |  | June |  |  |  |  | July |  |  |  |  | August |  |  |  |  | September |  |  |  |  | October |  |  |  |  | November |  |  |  |  |  | December
Date
[NAME] acc. SOLAS II-2 R 15.2.2 and SOLAS III R 19 (monthly)
January |  |  |  |  |  | February |  |  |  |  |  |  | March |  |  |  |  | April |  |  |  |  |  | May |  |  |  |  | June |  |  |  |  | July |  |  |  |  | August |  |  |  |  | September |  |  |  |  | October |  |  |  |  | November |  |  |  |  |  | December
Date
Operational functions of equip. and arrangements in the drill area have been checked acc. [NAME]. 19.3
Appliances used (see abbreviations)
Abbreviations |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 1)  Personal equipment Fire-fighter's outfit (FSS III 2) 2)  Breathing apparatus 3)   Lifeline 4)  EEBD 5)  Heat Protective Suit 6)  Gas/Acid protective Suit 7)  [NAME] 8)  Foam appl. Unit |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 9)    Hoses/Nozzles 10)  Sprinkler 11)  Emergency fire pump 12)  MFAG-Equipment 13)  [NAME] 14)    Fog Nail 15)    Hydropen 16)    Portable Water Monitors 17)    CO2 System |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Others (to be defined by vessel): 18) 19) 20)
Emergency Steering Drill acc. SOLAS V R 26.4 (once every 3 months)
January |  |  |  |  |  | February |  |  |  |  |  |  | March |  |  |  |  | April |  |  |  |  |  | May |  |  |  |  | June |  |  |  |  | July |  |  |  |  | August |  |  |  |  | September |  |  |  |  | October |  |  |  | November |  |  |  |  |  | December
Date
Emergency [NAME] acc. HL standard (once every 6 month)
January |  |  |  |  |  | February |  |  |  |  |  |  | March |  |  |  |  | April |  |  |  |  |  | May |  |  |  |  | June |  |  |  |  | July |  |  |  |  | August |  |  |  |  | September |  |  |  |  | October |  |  |  | November |  |  |  |  |  | December
Date
Failure of Main Engines (at least quarterly acc. SMM chapter 10)
January |  |  |  |  |  | February |  |  |  |  |  |  | March |  |  |  |  | April |  |  |  |  |  | May |  |  |  |  | June |  |  |  |  | July |  |  |  |  | August |  |  |  |  | September |  |  |  |  | October |  |  |  | November |  |  |  |  |  | December
Date
Black Out (monthly acc. SMM chapter 10 and chapter 7.6.09)
January |  |  |  |  |  | February |  |  |  |  |  |  | March |  |  |  |  | April |  |  |  |  |  | May |  |  |  |  | June |  |  |  |  | July |  |  |  |  | August |  |  |  |  | September |  |  |  |  | October |  |  |  | November |  |  |  |  |  | December
Date
Enclosed Space Entry and Rescue Drill acc. SOLAS III R 19 (once every 2 months)
January |  |  |  |  |  | February |  |  |  |  |  |  | March |  |  |  |  | April |  |  |  |  |  | May |  |  |  |  | June |  |  |  |  | July |  |  |  |  | August |  |  |  |  | September |  |  |  |  | October |  |  |  | November |  |  |  |  |  | December
Date
Occupational Health & Safety Drill acc. SMM chapter 7.4.01 (once every 2 months)
January |  |  |  |  |  | February |  |  |  |  |  |  | March |  |  |  |  | April |  |  |  |  |  | May |  |  |  |  | June |  |  |  |  | July |  |  |  |  | August |  |  |  |  | September |  |  |  |  | October |  |  |  | November |  |  |  |  |  | December
Date
Topic (see abbreviations)
Abbreviations |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Interval: Items to be integrated at least twice a year Participants: Department Heads & Officers* |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Interval: Items to be integrated at least once a year Participants: Officers & Crew |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Others (to be defined by vessel): 14) 15) 16) 17) 18) Remark: As far as applicable, the Handbook for Safe Working Practice issued by the BG-Verkehr shall be used for the Occupational Health & Safety Drills
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 1)  HL Risk Assessment Procedure 2)  On-Scene Risk Assessment 3)  Risk Assessment for external Persons 4)  Working with hazardous Substances & Materials 5)  Hygiene and Health Care 6)  Supervision of Hazardous Works (acc. SMM 7.4.05) 7)  Performance of Hazardous Work (acc. SMM 7.4.05) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 8)  Permit to Work System 9)  Work in Enclosed Spaces 10)   Use of PPE (Glove Plan, Skin Care Plan, Dreager X-plore Filter masks, donning & use of the Safety Harness etc.) 11)   Working with high pressure water blaster 12)   First Aid (incl. Defibrillator training)
Cyber Security Drill (at least yearly acc. SMM chapter 14)
January |  |  |  |  |  | February |  |  |  |  |  |  | March |  |  |  |  | April |  |  |  |  |  | May |  |  |  |  | June |  |  |  |  | July |  |  |  |  | August |  |  |  |  | September |  |  |  |  | October |  |  |  | November |  |  |  |  |  | December
Date
Cyber Security Drill scenarios are laid down in SMM chapter 14 Attachment 03
Mooring Training (after significant crew changes, but at least quarterly acc. 138th OHSC Minutes)
January |  |  |  |  |  | February |  |  |  |  |  |  | March |  |  |  |  | April |  |  |  |  |  | May |  |  |  |  | June |  |  |  |  | July |  |  |  |  | August |  |  |  |  | September |  |  |  |  | October |  |  |  | November |  |  |  |  |  | December
Date
Theoretical & practical training of deck crew & responsible officers based on 138th OHSC Minutes & SMM chapter 7.4.05, [NAME]. 01
Emergency Drills according ISM Emergency Plans (yearly)
Emergency Case |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Date |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Number and page of logbook |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Remark
Fire on board |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | May be included in SOLAS "Fire Drill" if conducted in terms of [NAME] Emergency Plan
Damages caused by [NAME] and Heavy Seas/ Ingress of Water
Collision
Grounding / Stranding
[NAME] |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | May be included in SOLAS "Abandon Ship Drill" if conducted in terms of [NAME] Emergency Plan
Search and Rescue
Man over Board |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | May be included in SOLAS "Rescue Boat Drill" if conducted in terms of [NAME] Emergency Plan
Recovery of Persons from the Water |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | May be included in SOLAS "Rescue Boat Drill" if conducted in terms of [NAME] Emergency Plan
Oil Spill (drill may be combined with an exercise acc. PC-SOPEP, NTVR-Plan etc.)
Failure of Main Engines |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | In accordance with chapter 10 and FC SM 01-2010 to be done quarterly
Failure of Steering Gear |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | May be included in SOLAS "Emergency Steering Drill" if conducted in terms of [NAME] Emergency Plan
Blackout |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | In accordance with chapter 10 and chapter 7.6.09
Missing Person
Recovery of Injured and Sick Persons
Rowdyism
Cargo: Spillage/Contamination/Shifting
Emergency Response Service
Safety Report PART A-2: Trade related Drills and Training
Oil Spill Drill - Quarterly
January |  |  |  |  |  | February |  |  |  |  |  |  | March |  |  |  |  | April |  |  |  |  |  | May |  |  |  |  | June |  |  |  |  | July |  |  |  |  | August |  |  |  |  | September |  |  |  |  | October |  |  |  | November |  |  |  |  |  | December
Date
Panama Waters
US Waters – QI Notification Drill
US Waters – Onboard Emergency Procedures Exercises & Discussed Content
Abbreviations for US Waters – Onboard Emergency Procedures
1.Transfer System Leak 2.Tank Overflows 3.Suspected Fuel Tank or [NAME] 4.Stranding |  |  |  |  |  |  |  |  |  |  |  |  |  | 5.Grounding 6.Collision 7.Fire and Explosion 8. Hull Failure |  |  |  |  | 9.Excessive List 10. Equipment Failure: Steering Gear 11. Equipment Failure: Main Engine 12. Use of Anchors |  |  |  |  |  |  |  |  |  |  |  | 13. Internal Ship-to-Ship Transfer of fuel 14. Emergency Towning
Safety Report PART B: Inspection and Maintenance (Send one Copy to HL Fleet Management at the end of the Year)
WEEKLY INSPECTIONS acc. SOLAS III R 20.6 & MSC/Circ. 1432     Visual inspection Survival crafts, Rescue boats & launching appliances     Engine-run-test of Lifeboats & Rescue boats (for a period of not less than 3 minutes)     Test of General Alarm and Public Address System     Davit launched life boats to be moved out of the storage position without persons on board     Breathing apparatus & EEBD cylinders do not present leakages & are in the correct pressure range     Fire door control panel indicators are functional     Fixed gas fire fighting system control panels are functional and control/section valves are in the correct position     Verify that all control panel indicator and alarms of water mist, water spray and sprinkler systems are functional, visual inspection of respective pumps/fitting and valves (unit valve positions)     The emergency lighting for muster and abandon ship must be tested during each abandon ship drill All Inspections have to be documented in the ship's log book and shipboard controlled documents
>> LIFE SAVING APPLIANCES << On board maintenance & inspection according to. SOLAS III R 20 (monthly)
January |  |  |  |  | February |  |  |  |  |  |  | March |  |  |  |  | April |  |  |  |  | May |  |  |  |  | June |  |  |  |  | July |  |  | August |  |  |  |  |  | September |  |  |  |  | October |  |  |  | November |  |  |  |  | December |  |  |  |  |  | [NAME]
Lifeboat and respective  equipment (LSA IV 4.4.8); Davit launched Lifeboat turned out from stowage position without persons on board |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | M1
Life saving equipment - life jackets (& lights) -  inflatable life jackets |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | M2
Life saving equipment - lifebuoys (incl. self igniting lights) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | M3
Life saving equipment - immersion suits |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | M4
Liferafts (visual inspection) & Liferaft-davit (inspection) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | M5
January |  |  |  |  | February |  |  |  |  |  |  | March |  |  |  |  | April |  |  |  |  | May |  |  |  |  | June |  |  |  |  | July |  |  | August |  |  |  |  |  | September |  |  |  |  | October |  |  |  | November |  |  |  |  | December |  |  |  |  |  | [NAME]
Hydrostatic release units (visual insp. on board) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | M5
Rescue boat & respective equipment (LSA V 5.1.2) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | M6
Embarkation device |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | M7
Emergency Lighting for mustering & abandonment (SOLAS III R 19.3 ‘Drills’) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | M7
Alarm signal devices |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | M7
Battery of EPIRB (SOLAS IV R 7.6) Exp. Date:                               Hydrostatic release unit, Exp. Date: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | M8
Portable Two-way VHF radiotelephone (GMDSS) (SOLAS III R 6.2.1) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | M8
Search And Rescue Transponder, SART (SOLAS III R 6.2.2) No1. Exp. Date:                                  , Storage Location: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | M8
Search And Rescue Transponder, SART (SOLAS III R 6.2.2) No2. Exp. Date:                  , Storage Location: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | M8
'Man over board'- lifebuoys (self igniting/activating light/smoke signal) Valid until, acc. Imprint: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | M8
Pyrotechnic Distress Signal 'SHIP' acc. SOLAS III R 6 (12 Rocket parachute flares) Valid until, acc. Imprint: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | M8
Pyrotechnic Distress Signals 'LIFEBOAT' acc. LSA IV 4.4.8 (4 Rocket parachute flares) Valid until, acc. Imprint: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | M8
Pyrotechnic Distress Signals 'LIFEBOAT' acc. LSA IV 4.4.8 (2 Buoyant smoke signals) Valid until, acc. Imprint: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | M8
January |  |  |  |  | February |  |  |  |  |  |  | March |  |  |  |  | April |  |  |  |  | May |  |  |  |  | June |  |  |  |  | July |  |  | August |  |  |  |  |  | September |  |  |  |  | October |  |  |  | November |  |  |  |  | December |  |  |  |  |  | [NAME]
Pyrotechnic Distress Signals 'LIFEBOAT' acc. LSA IV 4.4.8 (6 Hand flares) Valid until, acc. Imprint: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | M8
Ammunition for Line-Throwing Appliances acc. SOLAS III R 18 (4 Rockets) Valid until, acc. Imprint: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | M8
Ammunition for Line-Throwing Appliances acc. SOLAS III R 18 (4 Lines, launchers) Valid until, acc. Imprint: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | M8
[NAME] acc. SOLAS III R 20.4 (acc. 2006 amendments) and Means of Embarkation& Disembarkation (Falls used in launching shall be inspected periodically with special regard for areas passing through sheaves, and renewed when necessary due to deterioration of the falls or at intervals of not more than 5 years, whichever is the earlier.)
Last Renewal |  |  |  |  |  |  |  |  |  |  |  |  |  | Quarterly visual inspection / date of check – FIRST QUARTER |  |  |  |  |  |  |  |  |  |  |  | Quarterly visual inspection / date of check – SECOND QUARTER |  |  |  |  |  |  |  |  |  |  | Quarterly visual inspection / date of check – THIRD QUARTER |  |  |  |  |  |  |  |  |  |  |  | Quarterly visual inspection / date of check – FOURTH QUARTER |  |  |  |  |  |  |  |  |  |  |  | [NAME]
Falls Lifeboats  –  Last exchange:                           Next exchange: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Q1
Falls Rescue Boats  –  Last exchange:                           Next exchange: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Q1
Falls lifting devices Liferaft-davits  –  Last exchange:                           Next exchange: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Q1
Means of embarkation & disembarkation (gangway / accommodation ladder); acc. [NAME]. [NAME]), effective 01.01.2010 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Q2
Monitoring of Expiration Dates
Description |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Exchange/Service Interval |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Manufacturing/ Activation Date |  |  |  |  |  |  |  |  |  |  |  |  |  | Valid until |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | [NAME]
Food Rations of lifeboat equipment |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | M1
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | (acc. [NAME])
First Aid Kit of lifeboat/rescue boat |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | M1
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | (annual)
Annual testing and inspection
Visual check of Rescue Sling (proper condition, no visual damages)
Date:
>> LIFE SAVING APPLIANCES << Shore-based Approved Servicing & Inspection
Service Interval |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Last inspection (acc. imprint or document/certificate) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Valid until (acc. Imprint or document/certificate)
EPIRB (SOLAS IV/15.9.1) (together with annual safety radio certificate survey)
yearly
EPIRB (SOLAS IV/15.9.2)
5 years
Radio Battery Capacity (SOLAS IV/13.6.2) For Ships equipped with solid batteries (wartungsfreie [NAME]) shore service has to be arranged before annual safety radio certificate survey. Ships with other batteries conduct acid check.
yearly
Voyage Data Recorder (VDR) (SOLAS V/18.8)
yearly
Voyage Data Recorder (VDR) battery
acc. to annual survey report
Inflatable life rafts (acc SOLAS III R. 20)
yearly
Inflatable lifejackets (twin chamber system) (acc SOLAS III R. 20)
yearly
Inflatable safety vests (single chamber system) (acc SOLAS III R. 20)
2 years (voluntary, acc. manufacturer)
Hydrostatic release units (non-disposable) (acc SOLAS III R. 20)
yearly
Disposable Hydrostatic release units (acc SOLAS III R. 20)
2 years
Service Interval |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Last inspection (acc. imprint or document/certificate) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Valid until (acc. Imprint or document/certificate)
Launching appliances shall be maintained in accordance with instructions for on-board maintenance and subjected to an annual thorough examination, incl. dynamic Winch Brake Test (WBT) at maximum lowering speed. At intervals not exceeding five years, the WBT shall be carried out in conj. with respective load test (SOLAS III/ 20.11.1)
Yearly (thorough examination incl. WBT)
5 years (incl. WBT with load test)
Lifeboat or rescue boat on-load release gear, incl. free-fall lifeboat release systems, shall be maintained in accordance with instructions for on-board maintenance and subjected to an annual thorough examination and operational test by properly trained personnel. At least once every 5 years the release gear shall be over-hauled and load tested.  (SOLAS III/ 20.11.2)
Yearly (thorough examination and operational test)
5 years (incl. overhauling and load test)
Davit-launched liferaft automatic release hooks shall be maintained in accordance with instructions for on-board maintenance and be subject to a thorough examination and operational test by properly trained personnel. At least once every 5 years the release hooks shall be over-hauled and load tested. (SOLAS III/ 20.11.3)
Yearly (thorough examination and operational test)
5 years (overhauling and load test)
Immersion Suits (According MSC/Circ. 114 (Guideline))
3 years
Breathing apparatus air recharging systems checked for air quality (if applicable) (According MSC/Circ. 1114 (Guideline) / MSC/Circ. 1432)
1 year
>> FIRE PROTECTION – AND FIGHTING EQUIPMENT << On Board Maintenance, Testing & Inspection acc. SOLAS II-2 R 14.2.2 in conjunction with IMO-MSC/Circ. 1432 and [NAME]/Circ.1318
Monthly checks: all installations in place, properly arranged & in good condition
January |  |  |  |  | February |  |  |  |  |  |  | March |  |  |  |  | April |  |  |  |  | May |  |  |  |  | June |  |  |  |  | July |  |  | August |  |  |  |  |  | September |  |  |  |  | October |  |  |  | November |  |  |  |  | December |  |  |  |  |  | [NAME]
Safety lockers with fire-fighting equipment contain proper inventory and equipment is in proper condition |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | M9
Portable & wheeled Fire extinguishers incl. spares charges |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | M10.1
Portable foam applicators |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | M10.2
Fire mains, hydrants, hoses & nozzles in place, adequate arranged & in serviceable condition |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | M11
All fixed fire-fighting system stop valves in proper open or closed position |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | M11
Fire detection and alarm system: test a selected sample of detectors and manual call points so that all devices have been tested within 5 years (for vessels with a fire detection plant with self- monitoring and addressable sensors and call points). – as applicable |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | M12
Fire detection and alarm system: test a selected sample of detectors and manual call points so that all devices have been tested within1  year (for vessels with fire detection plants with conventional loops without addressable sensors and call points) – as applicable |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | M12
Water mist, water spray & sprinkler systems |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | [NAME]
   verify all pump units & section vales are in proper position    test automatic starting arrangement & correct tank levels    verify standby pressure gauges are in proper range   test a selected sample of system section valves for flow and initiation of alarms (all valves shall be tested within a one year period)
All fire doors & dampers tested for local operation |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | M14
All fire pumps operated |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | M15
January |  |  |  |  | February |  |  |  |  |  |  | March |  |  |  |  | April |  |  |  |  | May |  |  |  |  | June |  |  |  |  | July |  |  | August |  |  |  |  |  | September |  |  |  |  | October |  |  |  | November |  |  |  |  | December |  |  |  |  |  | [NAME]
Fixed CO2-extinguishing installation |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | M16
   free from leakage    general visual inspection |  |  |  |  |  |  |  |  |  |  |  |   verify all stop valves in closed position   verify release controls in proper position |  |  |  |  |  |  |  |  |  |  |  |  |  |  verify all discharge piping and pneumatic tubing intact  verify all high pressure cylinders are in place & properly secured |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |    verify alarm devices are in place and not damaged
Quarterly Testing & inspections (acc. MSC/Circ. 1432 / HL standard)
FIRST QUARTER (January - March) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | SECOND QUARTER (April – June) |  |  |  |  |  |  |  |  |  |  |  |  |  |  | THIRD QUARTER (July – September) |  |  |  |  |  |  |  |  |  |  |  |  |  | FOURTH QUARTER (October – December) |  |  |  |  |  |  |  |  |  |  |  |  |  |  | [NAME]
International shore connection in proper condition |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Q3
All fire doors & dampers tested for remote operation (acc. to HL standard) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Q4
All breathing apparatus compressed air cylinders checked for validity of hydrostatic testing ( 5 years ) (acc. to HL standard) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Q5
Sprinkler systems: assess system water quality against manufacturer’s quality guideline (acc. MSC/Circ. 1516 (amendment to MSC/Circ. 1432)) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Q6
Annual testing and inspection (acc. MSC/Circ. 1432) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | [NAME]
All accessible components of fixed fire fighting systems visually inspected for proper condition |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Y1
Date:
All fire pumps are flow tested for proper pressures and flows |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | M15
Date:
All hydrants tested for operation |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | M11
Date:
All fire hoses hydrostatically tested |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | M11
Date:
All nozzles checked for correct size/type, maintained and working |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | M11
Date:
Verify that all fire pump relief valves (if provided) are properly set & filters/strainers are free of debris |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | M15
Date:
Test all fire doors & dampers for remote operation; (as applicable) verify that galley exhaust duct and filters are free of grease built up & test all ventilation control interconnected with fire protection system for proper operation |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Q4
Date:
All portable foam-water units are in proper condition and that all portable containers with foam concentrate are sealed and valid |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | M10
Date:
All accessible components of fixed gas fire fighting system checked for proper condition incl. the following detailed inspections: -   external examination of all high pressure cylinder for corrosion -   check of the hydrostatic test date of all storage containers -   function check of all fixed audible/visual alarm systems -   verify correct position of all control/section valves -   check connections of pilot release piping and tubing for tightness -   examine all flexible hoses acc. to manufacturer -   test all fuel shut-off controls to fire-protection system for proper operation -   visually inspection of protected space boundaries for modifications (e.g. damages) -   if cylinders are installed inside a protected space, verify the integrity of the double release line & check low pressure or circuit integrity monitors on release cabinet (as applicable) -   Air blown through the piping of CO2-extinguishing system |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Y2
Date:
All fire extinguishers checked for proper location (Fire-fighting & Safety-plan), charging pressure & condition. Inspection has to be marked on fire extinguisher with name, date and signature.  (Every 2nd year this inspection has to be carried out by Approved Shore Company (see shore based approved servicing table), acc. to HL standard |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | M10
Date:
All accessible components of wheeled fire extinguishers check for proper condition; check of the hydrostatic test date of each cylinder; invert extinguisher to ensure powder is agitated |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | M10
Date:
Fire detection and fire alarm systems: all accessible detectors visually inspected for evidence of  tampering obstructions, etc, so that all detectors are inspected within one year.; test emergency power supply switchover |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | M12
Date:
Visual Inspection of Breathing apparatuses incl. face mask (Every 2nd year this inspection has to be carried out by Approved Shore Company (see shore based approved servicing table)) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Y3
Date:
5 year expiration acc. class rules
Exchange/Service Interval |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Manufacturing/ Activation Date |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Valid until (acc. Imprint or document/certificate)
Foam liquid for mobile foam applicator
5 years
>> FIRE PROTECTION – AND FIGHTING EQUIPMENT << Shore-based Approved Servicing & Inspection
Breathing apparatus (Interval acc. to manufacturers regulations & MSC Circular 1432)
Breathing apparatus No 1 |  |  |  |  |  |  |  |  |  | Breathing apparatus No 2 |  |  |  |  |  |  |  |  |  | Breathing apparatus No 3 |  |  |  |  |  |  |  |  |  | Breathing apparatus No 4 |  |  |  |  |  |  |  | Breathing apparatus No 5 |  |  |  |  |  |  |  |  |  | Breathing apparatus No 6 |  |  |  |  |  |  |  | Breathing apparatus No 7
Shore-based servicing incl. face mask ( 2 years ) – valid until:
Compressed Air Cylinders, hydrostatic testing ( 5 years ) – valid until:
see checklist Q5 for due dates of all cylinders |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | next due date:
Fire extinguisher
General inspection: 2 years (acc. to HL standard)
Valid:
Hydrostatic pressure test: 10 years (acc. to IMO MSC/Circ. 1432)
Valid:
CO2  extinguishing systems
Annual charge inspection (acc. HL standard)
Valid:
General inspection: 2 years ([NAME]. to MSC/Circ.1318)
Valid:
CO2  hose assemblies made of synthetic rubber replaced: 10 years (class rule)
Valid:
CO2  gas cylinders hydro test, internal inspection: 10 yearly at least 10% of cylinders (acc. to IMO MSC/Circ. 1318)
Valid:
Testing of fixed Fire Fighting Systems
Last Test |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Next Test
Water mist (High Fog), water spray and sprinkler systems (Inspection and maintenance according to manufacturers manual & MSC. Circular 1432: yearly)
Local fire fighting application for deep fat fryer in galley (Vessels build after 2005) (Inspection and maintenance according to manufacturer’s manual: yearly)
Local fire fighting application for deep fat fryer in galley (Vessels build after 2005) (Inspection acc. to DNVGL class rules incl. hydrostatic test: 10 yearly)
Sprinkler & CO2  extinguishing system (Internal inspection of all control valves by shore based service company (acc. to IMO MSC Circ. 1432): 5 years
EEBD
No. 1 |  | No. 2 |  |  |  |  |  | No. 3 |  |  | No. 4 |  |  |  | No. 5 |  |  | No. 6 |  |  | No. 7 |  |  |  | No. 8 |  |  | No. 9 |  |  | No. 10 |  |  | No. 11 |  | No. 12 |  |  |  | No. 13 |  |  | No. 14 |  |  | No. 15 |  |  | No. 16 |  | No. 17 |  |  |  | No. 18 |  |  | No. 19 |  |  |  | No. 20
Last Annual inspection/function check
Next hydrostatic cylinder test: 5 years
Basic overhaul: 10 years
>> ADDITIONAL CHECKS & INSPECTIONS << On Board Maintenance, Testing & Inspection
Equipment of medicine and remedies: at least every 3 months
Quarterly visual inspection / date of check – FIRST QUARTER |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Quarterly visual inspection / date of check – SECOND QUARTER |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Quarterly visual inspection / date of check – THIRD QUARTER |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Quarterly visual inspection / date of check – FOURTH QUARTER
Inventory of medicine & remedies, check of proper condition equipment and arrangements (incl. first-aid outfit lifeboat & rescue boat)
Validity ‘Order on a druggist’ (yearly)
MFAG-Emergency equipment, check of condition (every 6 months)
Half yearly visual inspection / date of check |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Half yearly visual inspection / date of check
Medicine
Oxygen respirator
Test tubes (Dräger) every 6 month
Valid until (acc. Imprint) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Half yearly visual inspection / date of check |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Half yearly visual inspection / date of check
8 x Oxygen 5% / b (Dräger Order 6728081)
10 x Hydrogen Cyanide 0,5 / a (Dräger Order No. 8103601)
10 x Carbon Dioxide 0,5% / a (Dräger Order No. CH 31401)
10 x Carbon Monoxide 5/ c (Dräger Order No. CH 25601)
10 x Hydrogen Sulphide 1/ c (Dräger Order No. 6719001)
10 x [NAME] (Dräger Order No. CH 28401)
10 x Nitrous Gases 0,2/ a (Dräger Order No. 8103661)
10 x Methyl Bromide 0,1 / a (Dräger Order No. 3706307)
10 x Phosphine 0,01/a  (Dräger Order No. 8101611)
5 x Sulfuryl Fluorid 1/a (Dräger Order No. 8103471)
Gas, Poison and Acid Protective Equipment (every 6 months)
Half yearly visual inspection / date of check |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Half yearly visual inspection / date of check |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | [NAME]
Check of gas and poison detection & protective devices - Dräger Electronic Multigas Measuring Device X-am 5000 / X-am 2500 (X-am 5600 – LNG fuel vessel only) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | H1
Chemical protective suits |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | H2
Monitoring of Expiration Dates
Description |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Exchange/Service Interval |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Manufacturing/ Activation Date |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Valid until
Safety Helmets (see “Minimum Checklist for Occupational Health & Safety Equipment” for additional checks)
Safety helmets |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 4 years |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | oldest date: |  |  |  |  |  |  |  |  |  |  |  |  |  |  | next due date:
Equipment Ladders (quarterly)
Quarterly visual inspection / date of check – FIRST QUARTER |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Quarterly visual inspection / date of check – SECOND QUARTER |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Quarterly visual inspection / date of check – THIRD QUARTER |  |  |  |  |  |  |  |  |  |  |  |  |  | Quarterly visual inspection / date of check – FOURTH QUARTER |  |  |  |  |  |  |  |  |  |  |  |  |  |  | [NAME]
Inspection of all portable ladders, incl. Pilot ladders, for proper condition & operation; documented in shipboard controlled documents |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | [NAME]
Inspection of fixed ladder-installations, in particular emergency escapes; documented in shipboard controlled documents. |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Q7.2
Electrical Equipment (annual)
All portable electrical tools / equipment checked for proper and safe operation; documented in shipboard controlled checklists by a competent person (Electrician) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | [NAME]
Date: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Y4
>> ADDITIONAL CHECKS & INSPECTIONS << Shore-based Approved Servicing & Inspection
Gas, Poison and Acid Protective Equipment
Last Test |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Next Test
Chemical Protective Suits (2 years, respectively 5 years acc. to FC NFM 16-2013)
Dräger Electronic Multigas Measuring Device X-am 5000 / X-am 2500 (annually shore based service)
Dräger X-plore 3500 Filter Cartridge Respirator  (to be replaced  latest after 4 years)
Fall Protection (yearly shore based servicing)
Falling Protection Set-Number |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Next Test
Safety Harnesses / Shock Absorber / Positioning Rope
Last Test |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Next Test
Fall Arrestor IKAR41
Safety Report PART C: Inspections
Inspections
Date |  |  |  |  |  |  |  | Port/MOU |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Deficiencies(s) / Code(s) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Action required (yes/no) |  |  |  |  |  |  |  |  | Done (date)
Port State Control
Other Inspections
Date |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Signature Master |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Signature Chief Officer