Section 2 - Standard Forms Table of contents

SECTION 2 STANDARD FORMS Table of contents

Section 2-1 Section 2-2 Section 2-3 Section 2-4 Section 2-5 Inspection Report Forms A & B Form for Report of Deficiencies Not Fully Rectified or Provisionally Repaired Form for Report of Action Taken to the Notifying Authority Sample Form for Notification of Detention of Ship Sample Form for Notification of Release of Ship

Inspection Report Forms A & B Section 2-1

FORM A REPORT OF INSPECTION IN ACCORDANCE WITH THE MEMORANDUM OF UNDERSTANDING ON PORT STATE CONTROL IN THE ASIA-PACIFIC REGION1)
(reporting authority) (address) (telephone) (telefax) (e-mail address) copy to: master head office PSCO if ship is detained, copy to: flag State IMO recognized organization, if applicable

1 3 6 9 12 14a

name of reporting authority flag of ship IMO number year keel laid classification society IMO company number

4 7 10 13

2 name of ship type of ship 5 call sign gross tonnage 8 deadweight (where applicable) date of inspection 11 place of inspection 2 date of release from detention ) 14b particulars of company

15 name and signature of master to certify that the information under 14b is correct: name signature 16 details of ship certificates a title
1 2 3 4 5 6 7 8 9 10 11 12

issuing authority

date of issue and expiry

information on last intermediate or annual survey date surveying authority

place

1 2 3 4 5 6 7 8 9 10 11 12

17 deficiencies 18 ship detained 19 supporting documentation issuing office telephone telefax

no no no

yes (see attached FORM B) yes 3) yes (see annex)

name (duly authorized PSCO of reporting authority) signature

This report must be retained on board for period of two years and must be available for consultation by Port State Control Officers at all times.

1)

2) 3)

This inspection report has been issued solely for the purpose of informing the master and other port State that an inspection by the port State, mentioned in the heading, has taken place. This inspection report cannot be construed as a seaworthiness certificate in excess of the certificates the ship is required to carry. To be completed in the event of a detention. Masters and companies are advised that detailed information on a detention may be subject to future publication.

Page S2-1-1
Revision 2/2006

Inspection Report Forms A & B Section 2-1

FORM B REPORT OF INSPECTION IN ACCORDANCE WITH THE MEMORANDUM OF UNDERSTANDING ON PORT STATE CONTROL IN THE ASIA-PACIFIC REGION
(reporting authority) (address) (telephone) (telefax) (e-mail address) copy to: master head office PSCO if ship is detained, copy to: flag State IMO recognized organization, if applicable

2 10

name of ship date of inspection 21 code nature of deficiency 4)

6 IMO number 11 place of inspection convention 5) reference 22 action taken 6) 23 responsible RO 5)

20 number

name (duly authorized PSCO of reporting authority) signature

4)

5) 6)

This inspection was not a full survey and deficiencies listed may not be exhaustive. In the event of a detention, it is recommended that full survey is carried out and all deficiencies are rectified before an application for re-inspection is made. To be completed in the event of a detention. Applicable Deficiency Action Codes (see reverse side of copy) to be entered.

Page S2-1-2
Revision 2/2006

Inspection Report Forms A & B Section 2-1

(reverse side of Form B)

codes for action taken

code

Deficiency action code

10 15 16 17 18 30 99

deficiency rectified rectify deficiency at next port rectify deficiency within 14 days rectify deficiency before departure rectify deficiency within 3 months detainable deficiency other (specify in clear text)

PSC inspection action code (tick as applicable)

26 27 40 45 50 55 70 85

competent security authority informed ship expelled on security grounds next port informed rectify detainable deficiencies at next port flag State/consul informed flag State consulted recognized organization informed investigation of contravention of discharge provisions (MARPOL)

Page S2-1-3
Revision 2/2006

Report of Deficiencies Not Fully Rectified Section 2-2

REPORT OF DEFICIENCIES NOT FULLY RECTIFIED OR ONLY PROVISIONALLY REPAIRED In accordance with the provision of paragraph 3.8 of the Memorandum of Understanding on Port State Control in the Asia-Pacific Region
(Copy to maritime Authority of next port of call, flag administration, or other certifying authority as appropriate) (See Section 3-3 of this Manual for maritime Authority addresses)

1. 3. 5. 7. 8.

From (country/region) : To (country/region) : Name of ship : Estimated place and time of arrival : IMO number :

2. 4. 6. 9.

Port : Port : Date departed : Flag of ship & POR :

10. Type of ship : 12. Gross tonnage : 14. Issuing authority of relevant certificate(s) : 15. Nature of deficiencies to be rectified :

11. Call sign : 13. Year of build : 16. Suggested action (including action at next port of call) :

17. Action taken :

Reporting Authority: ................................................ Name: .......................................................................

duly authorized PSC officer of (reporting authority)

Office: ............................................... Facsimile: ......................................... E-mail: Date: ...............................................

Signature: ................................................................

Page S2-2-1

Report of action taken to the notifying Authority Section 2-3

REPORT OF ACTION TAKEN TO THE NOTIFYING AUTHORITY In accordance with the provision of paragraph 3.8 of the Memorandum of Understanding on Port State Control in the Asia-Pacific Region (by Facsimile and/or Mail) 1. To : (Name) (Position) (Authority) Telephone: Date: 2. From : (Name) (Position) (Authority) Telephone: 3. 4. 6. 7. 8. Name of ship: Call sign: Port of inspection: Date of inspection: Action taken: (a) Deficiencies (b) Action taken 5. IMO number: Telefax: E-mail: Telefax: E-mail:

9.

Next port: No

(Date) Yes (See attached)

10. Supporting documentation

Signature ............................................

Page S2-3-1

Sample form for notification of detention of ship Section 2-4

SAMPLE FOR NOTIFICATION OF DETENTION OF SHIP

Flag State/consulate Classification Society Fax no. E-mail

Number of pages, incl. this

Dear Sirs (Insert ships name), flag, IMO No. Detention of ship The . Maritime Authority have on (insert date) carried out an inspection of the above ship at (insert port, country). The ship is detained at (time of detention) hours due to the following detainable deficiencies: 1. 2. 3. 4. Enclosed please find a copy of Report of Inspection and Notice of Detention of Ship*. For further enquiries, please contact: (insert name and contact details)

Yours faithfully

To be used when national legislation provides for such document to be issued.

Page S2-4-1

Sample form for notification of release of ship Section 2-5

SAMPLE FORM FOR NOTIFICATION OF RELEASE OF SHIP

Flag State/consulate Classification Society Fax no. E-mail

Number of pages, incl. this

Dear Sirs (Insert ships name), flag, IMO No. Release of ship The . Maritime Authority have on (insert date) carried out a re-inspection of the above ship at (insert port, country). The ship was released at (insert time of release) hours. (Insertion of free text, if any) Enclosed please find a copy of the Report of Inspection.

Yours faithfully

Page S2-5-1