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FORM CSSL-062
Things: 1/3
CHECK LIST AUDIT SHIPS
Name
Ship
Port
Helmsman
N
o.
:.....................
Date : . . . . . . . . . . . . . . . . . .
:.....................
:.....................
Voyage : . . . . . . . . . . . . . . . . . .
KKM : . . . . . . . . . . . . . . . . . .
Question
General/Administrative
NC
Description
available?
10
11
12
13
Terms: 2/3
No
Question
NC
Description
Operation
10
Incident/Accident (Accident/Incident)
Terms:
3/3
N
o.
Question
Navigation
Exercise
(Drill)
NC
Descriptio
n
confined space?
I.S. M
FORM CSSL-063
NOTICE OF IMPLEMENTATION OF INTERNAL SAFETY AUDIT
To The Designation. : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
From : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
The Audit will be carried out according to plan on the part of the brothers to the
schedule as follows:
No.
TIME
..................
To The Designation : . . . . . . . . . . . . . . . . . . . . . . .
From : . . . . . . . . . . . . . . . . . . . . . . .
I agree with the above schedule;
I propose the following itinerary;
Jakarta, . . . . . . . . . . . . . .
Today:
Place:
Date:
Page:
N
O.
The OFFICE
of the
SIGNATURE
CSSL FORM-065
DISCREPANCIES AND DEMAND CORRECTIVE ACTION
REPORT
REPORT DISCREPANCIES (NC)
AND CORRECTIVE ACTION REQUEST (CAR)
The Scope Of The Audit
CATEGORIZED AS Number:
Date:
DETAILS OF DISCREPANCIES
Type mismatch: MAJOR MINOR
OBSERVATION
Signature auditor:
CORRECTIVE ACTIONS
Date:
Corrective actions/implemented
With good
Signature Auditor:
Audit Signature:
Date:
Date:
FORM
CSSL-066
Auditor's Name:
Date Of Audit
Page
1/
Conclusion:
Auditees
FORM
CSSL-067
THE REPEATED AUDIT RECOMMENDATIONS
Audit Name
Section
Implementation of personnel
Auditor
Date of audit
The following audit results delivered over the safety management system are
conducted at random/random, so that still allow the existence of a discrepancy in
the other.
LARGE DISCREPANCIES
SMALL DISCREPANCIES
OBSERVATION
Jakarta, . . . . . . . . . . . . . . . . . . . .
FORM
CSSL-068
MINUTES OF MANAGEMENT MEETINGS
Meeting Date:
List Of Participants:
Agenda:
1. Actions of the
meeting of
previously
2. The arrangement of the
Organization
3. The Status of the
implementation of the
Policy Manual:
1. Other safety
Action
Date of completion
.....................
CSSL
FORM-069
Things: 1/4
THE REPORT NOTES THE INSPECTION & MAINTENANCE
RADIO AND NAVIGATION EQUIPMENT
KM
......
CRUISE NO
......
No.
1.
a.
:..............................
: ... ... ... ... ... ... ... ... ....
NO
DATE REPORT
Type Of Inspection
MAIN & EMERGENCY TRANSCEIVER
Check whether the battery in good condition?
:.........
:.........
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
CSSL FORM-069
Terms:
2/4
No.
3.
Type Of Inspection
VHF TRANSCEIVER
Yes/No
a.
Yes/No
b.
Yes/No
c.
Yes/No
d.
Yes/No
e.
Yes/No
4.
E.P.I.R. B
a.
Yes/No
b.
Yes/No
c.
Yes/No
d.
Yes/No
e.
Yes/No
5.
GYRO COMPASS
a.
Yes/No
tolerance?
b.
Yes/No
c.
Yes/No
d.
Yes/No
e.
Yes/No
f.
Yes/No
g.
Yes/No
6.
AUTO PILOT
a.
Yes/No
b.
Yes/No
c.
Yes/No
d.
Yes/No
No
.
a.
b.
c.
d.
e.
f.
g.
h.
I.
Type Of Inspection
7.
MAGNETIC COMPASS
Does a magnetic compass work well?
If calibration certification still valid?
What is the appropriate place on each map deviasinya is
still within the limits of tolerance and has been recorded in
the log book?
Whether supporting liquid still enough?
What is Tin penimbal still complete and appropriate
position?
If the lamp lighting the Roses guidelines work well?
If the Roses guidelines can still be read easily?
Is it still good reflector so that the designation of the Roses
guidelines can be read from the sterring stand?
Note the observation or measurement for abnormalities on
the sbb?
CSSL
FORM-069
Terms:
3/4
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
CSSL
FORM-069
It:
4/4
No
.
a.
b.
c.
11
.
a.
b.
Type Of Inspection
10.
S.A.R. T
What is the lifetime of battery is still above 6 months?
Whether automatic emit respondance signal (12 sweeps)
can be read by a 9 Ghz radar (at the time of the final RDF
calibration or Boat Drill)?
Note the abnormality in measurement tools as well as sbb
observation?
TWO WAY RADIO COMUNICATION
What is the condition of the battery still good (final radiating
light, indicator not Dim)?
Whether the transmitter and receiver on every channel can
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
c.
d.
12
.
a.
b.
c.
d.
e.
f.
g.
13
.
a.
b.
c.
be functioning properly?
Whether all the charger works fine?
Note the observation or measurement for abnormalities on
the sbb?
BATTERY (ACCUMULATOER)
Does the device a backup device on a regular basis every
day on the test?
If after the completion of the use of the device the device
backup, accu is filled (charger) back to the brim so that the
voltage of each cell is around 2.6-2.7 volts or elecrolitnya
type weight 1.24 1.26?
What is the level of the water should be in accordance with
the accu (about 1 cm above the cell)?
Does the cover cover every cell examined and cleaned so
that the ventilation holes are not clogged gas dust/dirt?
Whether the ventilation room accu function with normal, not
closed other objects?
What is the position of the accu is good so it doesn't shake
when a ship hit by waves?
Notes on measurements or observational abnormalities?
ANTENNA SYSTEM (TRANSMITTER, RECEIVER)
What is the condition of the antenna wire is still good (there
hasn't been a break up or porous)?
Whether all the safety link still good?
What is the driving force of the rope (hosting wire) is still
good and coated vinyl?
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
CSSL
FORM-069
No
.
Type Of Inspection
d.
It: 4/4
Yes/No
Yes/No
Yes/No
Yes/No
What is the ampere meter and volt meter to the charging and
discharging is still working?
What is the charging and discharging switch function
normally?
If charging the battery with a trickle charge function properly?
Notes on measurements or observational abnormalities:
CHRONOMETER
Yes/No
Yes/No
Yes/No
FIND OUT
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
HELMSMAN
FORM CSSL029
Desc
ripti
on
Care
7
H
3
B
6
B
T
H
T
H
5
T
H
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Shaft bearings
Cargo shaft
propeller
Pad tube on
the tube
Tabng shaft
lubricant cargo
propeller
Rubber seal
Replacement/maintenance
Holder M/I
* Machine
window Crank
case
The curvature
of the
crankshaft
Measurement
Close cylinder
CARDIOTHORA
CIC SURGERY
Governor
Treatment by maker
Turbo charger
Pump
Go to the complete
Sump Tanks
1
0
Air
conditioners
1
1
Sieve
Cleanup
1
2
Alternator
rotor/stater
charcoal
Performance
Test run
V. EMERGENCY PUMP
1
Performance
Test run
ACB
Ground lights
Test run
Measuring
meter
VII. ALARM
Alarm
temperature M/I
Alarm pressure
M/I
Emergency
termination of
Test function
M/I
M/I primary
circuit board
Fire alaram
Bilge alarm
High surface
Test function
Fresh water
pump
Feed pump
Fuel pump
Fuel transfer
pump
Lubricating oil
pump
IX. TANK
For the
purposes of the
daily M/I setting
tanks
For the
purposes of the
auxiliary motor
daily (setting
tank) location:
Other tanks:
Other tanks:
Oil cooling of
public relations
Sea water
cooling
Auxiliary
condenser
Fuel heaters
CARDIOTHORAC
IC SURGERY
Go to the complete
Suction and
pressure valves
Crank case
Cooling
Go To The Complete
Cardiothoracic
surgery
Go to the complete
Suction and
pressure valves
Crank case
cooling
Go To The Complete
Hydraulic valve
Go to the complete
Sieve
X
X
Hydraulic valve
u/msn
anchor/Tow
Hydraulic motor
u/msn anchor
Anchor machine
X
X
X
Standby pump
Test run
Emergency
generator
Test run
X
X
Emergency fire
pump
Test run
Emergency
steering
machine
Test run
Lifeboat engine
Test run
Auto pilot
brand:
Auto pilot
brand:
Komas
magnetism
brand:
The Radar
Brand:
GPS brand:
Wall clock
brand:
Echo sounder
brand:
Fair leader
a. it opened complete
b. given a fat
Peranginan
It opened complete
Tool cover
Watertight
doors
X
X
X
Hydrants, fire
hose
firefighting
danozle
Examination
Fireman tubes
Tube CO2
Foam fluid
Replacement by the
manufacturer of the
Lifeboat
Steel arrives
CSSL FORM070
K-SET
N
o.
Editio
n
Document Name
SOLAS
Consolidated
Text
1997
Responsib
ility
Responsib
ility
Propagator II
The location
of the
The Viewing
Room
1997
Propagato
r II
The Viewing
Room
STCW 1995
1996
Propagato
r II
The Viewing
Room
1996
Propagato
r II
The Viewing
Room
1994
Propagato
r II
The Viewing
Room
Propagato
r II
The Viewing
Room
Propagato
r II
The Viewing
Room
Nautical Almanac
Propagato
r II
The Viewing
Room
Map-map
Propagato
r II
The Viewing
Room
1
0
Propagato
r II
The Viewing
Room
1
1
Propagato
r II
The Viewing
Room
1
2
Indonesia's Diary
Propagato
r II
The Viewing
Room
1
3
Diary Of Decks
Propagato
rI
The Viewing
Room
1
4
Markonis
The Viewing
Room
1
5
Propagato
r II
The Viewing
Room
1
6
Diary Machines
KKM
Space KKM
1
7
KKM
Space KKM
1
8
Propagato
r II
The Viewing
Room
1
9
Propagato
r II
The Viewing
Room
2
0
Propagato
r II
The Viewing
Room
FORM CSSL-071
P-SETS
INTERNAL AUDIT RECORDS
N
o.
No Auditing.
Work
Unit
Auditor
The date
of the
Audit
Results
The
status of
the
FORM CSSL-072
PK-SET
LIST OF PICTURES OF THE SHIP
Ship Name:
No.
ID
Image Name