The following information should bg completed by the ship and checked by theinspectar.

DRILL or item Date lasf canied out or approval

Last Fire Fiohtinq drill:Last Abandon Ship drill:Last Port / Starboard UB in Water:Last Rescue boat in Water:Last yearly UB and Urafts serviceLast 5 vears UB serviceLast Steerinq Gear Drill:Last SOPEP D'rill:

Last ISPS drillLast drills of : Collision / Flooding / Vapourtoxic release / Propulsion failure / EnergyfailureLast vearlv liftino qear inspectionLast 5 years lifting gear inspection and testLast SSAS testLast Caroo Lines test & Pressure.:Last COW Lines test & Pressure:Last Foam analysis:Last CO2 / Powder fixed svstems serviceLast safe$ equipment annual service byexpert (Chemical and Gas)Last PSC date and port:

SOPEP and / or VRP Approval:Qualified lndividualLast Operator lnternal ISM audit:Last Safutv Committee Mto:'GMDSS / EPIRB service date:Last two Operator's Representative visit:D&A Test date and frequencvLast Alcohol test date I ftequency i limitLast ODME test:Last ODME use:Presentlv Products handledTvpe of tanks (Gas / Chemical)Carqo Hose tests dates:Winch tests dates:Last Service / lnspection of following:Deck Seal:lG check valve:PA/ Breaker:Mast Riser:PA/ Valves:

SIR E Insnecfion Prenarafion

Ihe Master can expect that the inspection will take about E to l0 hours and be pertbrmed in the fbllowingorder, unless the order of inspection should be altered to fit the vessel's schedule:

l. Openrng Meetrng, wrth Master, ChtelEngrneer and Chief Mate (iiavailable)2. Complete review of documentation3. 'l he exterior of the Wheelhouse, Accommodations to the Poop4. Up the Main Deck to the Forecastle and Forecastle spaces

5. tsack down the Marn Deck and checkrng a ballast tank (as agreed rn Openurg Meetrng)6. The Pump room to the Cargo Control Room7. Wheelhouse and navigation8. Communications (radio room or GMDSS station)9. Discussion with Chiet'Engineer and into the Engine room including review ot PMS.10. Back through the internal areas of the accommodationsI l. l''inally a penod tbr the inspector to summanze his thoughts and12. a final meeting with the Master and Departrnent heads. .

Any variation necessary to avoid disruption of the ship's normal operation will be considered. Iheorder of inspection can be varied as necessary.