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Rev  1/2011     IOPAI  Condition  Survey  Report  Form   Page  1  of  25  

Condition Survey

Instructions & Report Form

 

Rev  1/2011     IOPAI  Condition  Survey  Report  Form   Page  2  of  25  

INSTRUCTIONS FOR SURVEYORS

Please complete the enclosed form with the information available on site, but remember always

this is only a guide to assist with reporting. Typing is optional, however highly appreciated. Please note that only ONE copy of the report is required, which should be forwarded as soon as possible in electronic format along with a signed copy of the recommendation sheet .

We would expect a survey to be completed within maximum one day, however, if it is required that a surveyor should attend longer then the Club‘s Managers should be contacted immediately.

When reporting on the various items a tick in the respective boxes is often sufficient. Details of e.g. any machinery or manufacturer‘s serial number etc. are usually not required.

If an item is not on board, or an operation is not carried out this should be noted in the report, it does not mean that it is necessarily a defect. The surveyor should use his knowledge and experience to determine if a real “defect” exists and consequently if a recommendation is required.

Hose test of hatch covers and pressure test of double bottom tanks: these are essential at all surveys. If such tests are considered necessary, but could not possibly be carried out, surveyors should report this and detailed circumstances in the usual way

The surveyor should test items wherever appropriate whilst conducting the survey, such tests of course only being carried out with the prior knowledge and co-operation of the ship’s staff. If particular areas appear to be well maintained and operational then it will be beneficial, due to possible time constraints, to limit testing to the more important items or those, whose condition gives cause for concern.

The last page includes a “summary” section. This should be a brief summary of the vessel’s condition after the survey. The last page of the form should clearly state any deficiencies found, including anything related to crew or management and items that could not be tested. It is important that the nature and extent of the defect is clearly stated so that it is apparent to the owner and the Club.

The last page(s) of the form, with the list of defects and recommendations, must be signed for receipt by the Master or any other manager’s or owner’s representative and the original returned to the Club’s Managers. If a signature is refused or is unobtainable this should be stated with the reason. A copy of the signed page(s) should be left with the person signing with the request that it is passed to the ship’s managers or operators. The surveyor should explain that the recommendations made would be forwarded to the Club who will subsequently inform the Assured as appropriate.

The Club usually requires a few photographs to indicate the type and layout, and condition of the vessel, and then photographs of defects but only where these usefully supplement the report. A large number of photographs showing satisfactory items are not required for reporting but should be retained on file. Photocopies of plans or diagrams to supplement the report, preferably A4 size, are helpful, especially a general arrangement plan. If information is required by the surveyor in writing from the vessel or owners / managers once the surveyor has departed the vessel, then the vessel’s owner / manager should be requested to forward these directly to the Club.

The rating section on the last page is used to assist the Club to make an assessment for insurance purposes. Considerable objectivity is required from the surveyor. To ensure a common basis in completing this section, the following brief guide should be followed (only whole numbers should be used!).

If the surveyor has any other information he feels might be relevant to the Club, an additional

confidential page can be attached to the report.

For all sections please use the following numbering:

5 Excellent 4 Good 3 Satisfactory 2 Poor

Rev  1/2011     IOPAI  Condition  Survey  Report  Form   Page  3  of  25  

1 Dangerous In using the above number code the following factors should be among those taken into account for each section: Management / Administration Cargoworthiness Communications Condition of holds Administration Condition of hatch coaming Records of maintenance Condition and sealing arrangements of hatch

covers Management afloat and ashore Bilges Motivation of Officers Ventilation arrangements Procedures and Company Instructions Maintenance Certification to ISM Code, ISPS Code, ISO, EN or other approved standards Cleanliness

Previous cargo damage claims Damage Non Cargo Tanks Crew Safety Crew inspections Accidents in the past Class inspections Safety awareness and attitude Maintenance Safety posters and books Coating / anodes Safety policy Corrosion Protective clothing worn Water tightness Protective clothing supplied Corrosion LSA & FFA Navigation Crew ability to use equipment Language Condition of equipment Passage planning Maintenance records Bridge equipment Regular inspection and servicing Publications and charts Emergency Prepareness Procedure and logbooks Operating and maintenance instructions Master / Pilot information exchange Manning level Manning / Competence Machinery Language used Spare gear and tools Attitude of crew Maintenance Competence Cleanliness and tidiness Safe manning Leaks Work being carried out Lighting Certificates of competency Hull Pollution Prevention Equipment Crew attitude/training Paint coatings Procedures Corrosion Bunkering Accommodation space Oil and garbage disposal Tidiness Shipboard Oil Pollution Emergency Plan Maintenance Damage

Rev  1/2011     IOPAI  Condition  Survey  Report  Form   Page  4  of  25  

Contents: • Cover Page • A – Documentation and Certificates • B – Manning and Qualifications • C –Management • D –Safety Equipment • E – Bridge, Navigation and Communication Equipment • F – Accommodation • G – Machinery Installation • H – Condition of Ship’s Hull, Structure and Fittings • I – Cargoworthiness Items • Summary

Rev  1/2011     IOPAI  Condition  Survey  Report  Form   Page  5  of  25  

CONDITION SURVEY REPORT FORM Vessel Name:

Operators / Owners:

Vessel Type:

Year and Country of Construction:

Gross Tonnage:

Classification:

Flag:

Call Sign:

IMO Number:

Last Dry-docked:

Next Dry-dock Due:

Main Engine Type/Power:

Major Conversion details:

Date and Place of Survey:

Survey Company:

Surveyor’s Name:

Rev  1/2011     IOPAI  Condition  Survey  Report  Form   Page  6  of  25  

A DOCUMENTATION AND CERTIFICATES

Yes No Remarks

1. Certificate of Registry

2. Safety Construction Certificate

3. Safety Equipment Certificate

4. Safety Radio Certificate

5. International Load Line Certificate

6. I.O.P.P.C.

7. Firefighting Appliance Certificate

8. Life Raft Certificate

9. ISM Document of Compliance

10. Safety Management System Certificate

11. Hull Special Survey / Continuous Survey

12. Hull Annual Survey

13. Machinery Special Survey / Continuous Survey

14. Machinery Annual Survey

15. CLC Details Bunkers/Cargo

16. International Security certificate

17. Dry-Dock Survey

18. Cargo Gear Thorough Annual Survey

19. De-Ratting Exemption Certificate

20. Flag or Port State Control Inspection or U.S. Coast Guard Inspection

State any Conditions of Class and overdue surveys (Attach copy if required)

Comments:

Rev  1/2011     IOPAI  Condition  Survey  Report  Form   Page  7  of  25  

B MANNING AND QUALIFICATIONS

1. What are the Safe Manning Certificate Requirements?

STCW CoC Code Flag COE Tanker

endors. Medical

-- Master Yes / No / NA * Yes/No * Yes/No *

-- Chief Officer Yes / No / NA * Yes/No * Yes/No *

-- 2nd Officer Yes / No / NA * Yes/No * Yes/No *

-- 3rd Officer Yes / No / NA * Yes/No * Yes/No *

-- Chief Engineer Yes / No / NA * Yes/No * Yes/No *

-- 2nd Engineer Yes / No / NA * Yes/No * Yes/No *

-- 3rd Engineer Yes / No / NA * Yes/No * Yes/No *

AB’S Yes / No / NA * Yes/No * Yes/No *

Motormen Yes / No / NA * Yes/No * Yes/No *

Other Yes / No / NA * Yes/No * Yes/No *

2. Total Number of Officers and Crew

3. Are the crew employed by manning agent or owners/managers?

• Delete as necessary Note: STCW code refers to grade of licence, eg Master II/2 or II/3 which should be stated on the Safe Manning Certificate. PLEASE ATTACH THE LATEST CREW LIST TO THE REPORT

Rev  1/2011     IOPAI  Condition  Survey  Report  Form   Page  8  of  25  

C MANAGEMENT

1. How often does the Master communicate with the Owners / Charterers?

2. Are the following publications available on board?

-- Company Orders? -- Training Manual? -- Safety Manual?

-- Fire Safety Operational Booklet (FSOB)?

3. Is the oil record book properly maintained?

4. Is a soundings book maintained?

5. Are written instructions provided for: -- tank entry procedures? -- bunker loading procedures?

6. Is a written contingency plan provided for dealing with major incidents such as

-- fire? -- collision? -- grounding? -- pollution? SOPEP?

7. Are materials carried on board to deal with minor oil spills?

-- Sawdust?

-- Detergent?

SOPEP locker/kit?

8. Can the officers and crew converse in a common language? What language is it?

9. How frequently are the crew exercised at emergency stations?

10. State the dates of the last -- boat drill. -- fire drill.

11. Does the crew wear appropriate PPE PpPPEprotective equipment?

--

12.

Does Maintenance Plan for fire fighting appliances and Life saving Appliances exist and is properly maintained by the Safety Officer ?

13. Is existing Fire Control Plan revised to comply with ISM Code or new Fire Control Booklet prepared?

Comments:

Rev  1/2011     IOPAI  Condition  Survey  Report  Form   Page  9  of  25  

D SAFETY EQUIPMENT

LIFESAVING APPLIANCES

1. Lifeboats

No. Fitted:

No. Persons:

Material:

Engine : Type:

2. Life rafts Type/No. of /No of Persons

3. Are lifeboat hulls free from damage or corrosion?

4. Is lifeboat equipment in satisfactory condition?

5. Are davits and wire falls in satisfactory condition and certified?

6. Are lifeboat embarkation ladders and attachments sound?

7. Are lifeboats in place complete with efficient self-igniting lights, smoke signals, lifelines, etc.?

8. Are E.P.I.R.B’s, line throwing apparatus and pyrotechnic devices all valid and properly stowed?

9.

Are Emergency Escape Breathing Devices (E.E.B.D.) well maintained, charged and crewmembers know how to use them?

FIREFIGHTING INSTALLATION

1. Is the fire main on deck free from corrosion?

2. Are fire hydrants well maintained?

3. Are fire hose boxes on deck in good condition and all contents complete?

4. Is the international shore connection readily stowed?

5. Are portable fire extinguishers in place and properly serviced?

6. Is the emergency fire pump regularly tested?

7.

Is there a properly kept emergency centre where firemen’s outfits, breathing apparatus, BA compressor etc. are stored and properly maintained?

8.

Is the engine room/deck fire fighting equipment properly maintained, (incl. gas flooding installation, alarms and remote stops)?

Comments:

Rev  1/2011     IOPAI  Condition  Survey  Report  Form   Page  10  of  25  

E BRIDGE, NAVIGATION AND COMMUNICATION EQUIPMENT

1. Can the Master confirm that all equipment and controls are working efficiently?

2. Is all the equipment of the main radio station and VHF radio reported working efficiently?

3. State date of the latest Notice to Mariners or Navigational Warnings on board?

4. Are all charts corrected up-to-date?

5. Are the following publications on board up-to-date?

-- Radio Signals? -- Light Lists? -- Pilot Books?

6. Is compass deviation card posted? State date of last adjustment:

7. Are muster lists and fire safety plans posted?

8. Are muster lists and fire safety plans displayed in a language understood by the crew?

9. Is an approved trim and stability booklet on board?

State issuing authority and date:

10. Are calculations made on a regular basis and recorded?

11.

Are all instruction manuals, plans and stability information in a language understood by the officers and crew as applicable?

Comments:

F ACCOMMODATION

1. Are the accommodation spaces generally clean, tidy and free from obvious fire / safety hazards?

2. Are galleys, pantries and storerooms clean and free from obvious hazards?

3. Are “locked-in” alarms working efficiently and freezer room doors fitted with means of opening from inside?

Comments:

Rev  1/2011     IOPAI  Condition  Survey  Report  Form   Page  11  of  25  

G MACHINERY INSTALLATION

It is not possible for a Surveyor to assess fully the condition of the main and auxiliary machinery within the time scale allowed therefore Surveyors should make a general examination of the

engine room, workshops and steering compartment.

1. Are machinery spaces: -- well illuminated? -- well ventilated? -- well painted?

2. Is there evidence of exhaust gas leakage by soot deposits on lagging of uptakes?

3. Are ladders, gratings, floor plates and machinery guards adequate and securely fitted?

4. Is there evidence of significant leakage at:

-- stern glands? -- pump glands? -- pipe flanges / valves?

5. Is there excessive leakage of fuel oil / lube oil at or around:

-- diesel engines? -- boilers? -- purifiers / transfer

pumps?

6. Are machinery bilges clean and dry?

7. Does bilge alarm work?

8. Are oil / water separator and alarm in full working order?

9. Emergency shut downs/QCV tests?

10.

Are there adequate machinery maintenance handbooks on board in a language understood by the engineers?

11. Are comprehensive maintenance records kept?

12. Bowthruster

13. Steering gear operation/emergency instructions

14. Fuel system protection as per SOLAS requirements?

Comments:

Rev  1/2011     IOPAI  Condition  Survey  Report  Form   Page  12  of  25  

H CONDITION OF SHIP’S HULL, STRUCTURE AND FITTINGS

1. Is external shell plating -- well painted? -- free from heavy corrosion? -- free from heavy indentation?

2. Are weatherdecks -- well painted? -- free from heavy corrosion?

3. Are the following well maintained: -- superstructures? -- mast houses? -- bulwarks?

4. Are external doors, hatches, ports etc. well maintained regarding seals and fastenings?

5. Are the following in safe condition:

-- ladders / stairways? -- accommodation ladders? -- pilot ladders? -- handrails?

6. Are ventilation openings, air pipes and their closing appliances in good condition?

7. Are the following in safe and efficient condition:

-- windlasses and winches? -- cranes and derricks? -- wire ropes and chains? -- safety guards of deck

machinery?

8.

Are the filling connections and air pipes of fuel oil / diesel oil tanks structurally sound and fitted with oil tight coamings?

9. Are light fittings on deck and in the forecastle safe and efficient?

10. Is there any evidence of temporary repairs of

-- cement boxes to pipelines? -- small doubler plate to hull?

-- deck? -- hatch covers?

Comments:

Rev  1/2011     IOPAI  Condition  Survey  Report  Form   Page  13  of  25  

I CARGOWORTHINESS ITEMS

Please sketch general arrangement of the deck layout showing cargo holds and/or tanks including permanent ballast tanks. Indicate cargo manifolds/discharge points

Ballast tanks

Cargo Tanks/holds

Rev  1/2011     IOPAI  Condition  Survey  Report  Form   Page  14  of  25  

BULK CARRIERS AND GENERAL CARGO VESSELS

Surveyors should inspect all accessible cargo holds and hatchways!

1. Are the following items in satisfactory condition (please take photos):

--

hatch cover panels?

--

rubber packing?

--

rubber packing channels? --

cross joints and wedges?

--

quick acting cleats? --

compression bars?

--

coaming tops, drains and non-return valves?

2. Is there any distortion of heavy corrosion of hatch coamings and brackets?

3. Are tarpaulins or sealing tape in use?

4. Is there any evidence of previous leakage by rust stains inside hatch coamings?

5. Are access hatches, seals and fastenings in a satisfactory condition?

6. Are hold ventilation arrangements efficient?

7. Are ventilation watertight closures efficient?

8. Are hold ladders, safety rails etc. efficient?

9. Are air pipes / sounding pipes etc. in satisfactory condition?

10. Are air pipes / sounding pipes / watertight closures efficient?

11. Are bilge wells clean and dry?

12. Does bilge alarm work?

13. Is there any oil / water residue on tanktops?

14. Are longitudinal / transverse bulkheads structurally intact?

15. Is corrosion evident at side: -- shell? -- frames? -- brackets?

16. Is plating of upper / lower hopper tanks intact?

17. Are brackets to tanktop wasted or damaged?

18. State last cargo carried and being presently loaded.

19. Is a loading computer or stress finder fitted?

20. Are calculations made on a regular basis and recorded?

21. Describe type of hatch covers and operating mechanism.

Rev  1/2011     IOPAI  Condition  Survey  Report  Form   Page  15  of  25  

TANKERS (INCLUDING GAS AND CHEMICAL CARRIERS)

1. Is there evidence on deck of cargo leakage from hatches, pipework or valves?

2. Is there any loose oil in manifold spill tanks?

3. Is pipework on deck free from heavy corrosion (incl. cargo, I.G., C.O.W., steam, hydraulic lines, etc.)?

4. Are the gangway gratings, platforms, stairs, ladders and handrails in safe condition?

5. Are tank access hatches, ullage ports, washing hatches, and their covers and fastenings well maintained?

6. Is the inert gas system fully operational?

7. Is the crude oil washing system fully operational?

8. If a cargo control room is fitted, is all control and monitoring equipment fully operational?

PUMP ROOM

1. Is there any evidence of cargo leakage from pumps, piping, valves, etc.?

2. Are bilges clear of loose oil?

3. Does bilge alarm work?

4. Is lighting adequate and working efficiently?

5. Are vent fans, trunking and fire dampers in satisfactory condition?

6. Are ladders, gratings and handrails in safe condition?

7. Is the oil discharge monitoring and alarm system fully operational?

8. State last cargo carried and being presently loaded.

Comments:

Rev  1/2011     IOPAI  Condition  Survey  Report  Form   Page  16  of  25  

TANKERS (INCLUDING GAS AND CHEMICAL CARRIERS) / CONTINUED

CARGOWORTHINESS

Describe or attach plan of cargo tank layout

Describe or attach plan of pipeline system

Describe type and condition of tank coatings (as applicable) and advise if any restrictions on grade of cargo that can be carried Describe tank venting system

Describe condition of pump room (including cleanliness, ventilation, access and communication arrangements) Describe tank deck fire-fighting arrangements

Rev  1/2011     IOPAI  Condition  Survey  Report  Form   Page  17  of  25  

TANKERS (INCLUDING GAS AND CHEMICAL CARRIERS) / CONTINUED

CARGOWORTHINESS (OIL SUPPLEMENT)

Yes No N/A NI

Do the senior officers have petroleum cargo endorsements?

Does vessel carry ICS Tanker Safety Guide? Is vessel fitted with continuous deck edge coaming around tank deck? State approx height.

Is vessel fully equipped with scupper plugs for main deck (including spares)? How many different grades of cargo can the vessel carry simultaneously whilst maintaining two valve separation throughout the operation?

Can sea suction / discharge lines be blanked / isolated from cargo system?

Are drain cocks fitted between sea valves?

Are tank lid securing arrangements in good condition?

Is tank lid packing in good condition?

Is ullage port packing in good condition?

Is Butterworth cover packing in good condition? Is condition of manifold installation (including valves, blanks, drip trays and sea valves) satisfactory?

Is condition of valve stem packing and extended spindles satisfactory?

Are manifolds, valves, ports and tank lids properly labelled?

Does a visual examination of the pipelines give rise for concern?

Date PV valves and Pipe line safety valves last tested.

Date of last cargo system pipeline pressure test?

If fitted, was a test of the heating coils satisfactory? If not tested date of last test.

If fitted, are automatic cargo measuring devices operational? (state type)

If fitted, are high level alarms fully operational?

Were these tested? If not, date of last test.

Are cargo pump emergency stops operational?

Are cargo hoses in apparent good condition?

Are cargo hoses regularly -- megger tested?

-- pressure tested?

Date of last pressure test?

Does the vessel carry an operational explosimeter?

Does the vessel carry an operational oxygen analyser?

Does the vessel carry an oil / water interface detector?

Rev  1/2011     IOPAI  Condition  Survey  Report  Form   Page  18  of  25  

TANKERS (INCLUDING GAS AND CHEMICAL CARRIERS) / CONTINUED

CARGOWORTHINESS (OIL SUPPLEMENT)

Yes No N/A NI

Is all electrical equipment in designated hazardous areas (e.g. forecastle, cargo deck and pump room) intrinsically safe?

Can the designed cargo pumping rate be achieved?

Are loading / discharging plans prepared?

Are pre-loading / discharging checks made (safety, operational & ship/shore liaison?)

If fitted, is the Inert Gas System fully operational?

Comments:

Rev  1/2011     IOPAI  Condition  Survey  Report  Form   Page  19  of  25  

TANKERS (INCLUDING GAS AND CHEMICAL CARRIERS) / CONTINUED

CARGOWORTHINESS (GAS SUPPLEMENT)

Yes No N/A NI

Does the vessel have valid Certificate of Fitness?

Do the senior officers have gas cargo endorsements?

Does vessel carry ICS Tanker Safety Guide Liquefied Gas?

Is the vessel equipped with a comprehensive procedures and arrangements manual (including emergency shutdown procedures)?

Does the vessel carry safety data sheets for all cargoes she is likely to carry?

Are cargo tank pressure release valves operable over the entire range of settings applicable to the cargoes the vessel is fit to carry?

Does the vessel carry valid test certificates for cargo tank pressure safety valves? State test date.

Are all cargo compartments fitted with fully operational level, pressure and temperature indicators (including function of pitot tubes)? State last calibration dates.

Are high level alarms operational? (State last test date).

Are all liquid line, vapour line and condensate line valves fully operational?

Does a visual examination of the pipelines give rise for concern?

Date cargo pipelines last pressure tested.

Are manifolds, pipelines, valves, ports and lids clearly marked?

Is manifold installation (including drip trays and sea valves) satisfactory?

Is the vessel fitted with operational inert gas system?

Are cargo tank hatches gastight?

Are cargo containment internals in satisfactory condition?

Are the cargo tanks free of any significant build up of scale?

Are the vent risers free of any significant build up of scale? Are Deck Pressure vessels in good condition (i.e. show no signs of heavy pitting etc.?)

Are cargo tank deck seals watertight?

Are all void spaces fitted with operational bilge alarms?

Date bilge alarms last tested.

Are void space fixed gas detection systems operational? Is cargo liquefaction machinery fully operational (e.g. automation and expansion valves)?

Is the vessel supplied with sufficient decontamination showers and eye washes?

Rev  1/2011     IOPAI  Condition  Survey  Report  Form   Page  20  of  25  

TANKERS (INCLUDING GAS AND CHEMICAL CARRIERS) / CONTINUED

CARGOWORTHINESS (GAS SUPPLEMENT)

Yes No N/A NI

Is the vessel supplied with sufficient emergency escape BA sets?

Is the vessel equipped with oxygen resuscitation equipment?

Is the vessel equipped with CABA compressor?

Is the deck waterspray system operational?

Are gas detection tubes (Draeger or similar) provided for range of cargoes carried?

Are gas freeing arrangements and procedures satisfactory?

Comments:

Rev  1/2011     IOPAI  Condition  Survey  Report  Form   Page  21  of  25  

TANKERS (INCLUDING GAS AND CHEMICAL CARRIERS) / CONTINUED

CARGOWORTHINESS (CHEMICAL SUPPLEMENT)

Yes No N/A NI

Does the vessel have a valid Certificate of Fitness?

Do senior officers have valid chemical cargo endorsements?

Does vessel carry chemical data sheets for all cargoes she is likely to carry?

Does vessel carry a copy of the BHC / IBC Code?

Does vessel carry a tank cleaning manual e.g. Verways?

Does vessel carry chemicals / equipment for testing tank cleanliness? Are vapour detection tubes (Draeger or similar) provided for range of cargoes carried?

Does vessel carry ICS Tanker Safety Guide – Chemicals?

Is vessel equipped with UTI (ullage / temperature / interface) sets?

Is vessel equipped with return vent lines for closed loading?

Is vessel equipped with an emergency cargo pump?

Does a visual examination of the pipelines give rise for concern?

Date cargo pipelines last pressure tested.

Are manifolds, pipelines, valves, ports and lids clearly marked?

Is vessel equipped with a cargo sample locker conforming to the requirements of the IBC Code?

Are cargo tank high level alarms fully operational?

Is vessel equipped with sufficient chemical protection suits?

Is vessel equipped with sufficient emergency escape BA sets?

Is vessel equipped with CABA compressor?

Is vessel equipped with oxygen resuscitation equipment?

Is vessel equipped with chemical antidotes?

Is vessel equipped with adequate decontamination showers / eye baths?

Is vessel equipped with toxic vapour detection equipment?

Does vessel carry safety equipment inspection log?

Does vessel have comprehensive contingency plans for spills?

Date of last spill exercise.

Comments:

Rev  1/2011     IOPAI  Condition  Survey  Report  Form   Page  22  of  25  

CONTAINER VESSELS (ADDITIONAL ITEMS)

1. Are tank tops clean and dry in container holds?

2. Are container cell guides well maintained?

3. Does bilge alarm work?

4. Are container lashings and attachments sufficient and well maintained?

5. Are gratings, platforms and handrails around hatch covers in satisfactory condition?

REEFER VESSELS (ADDITIONAL ITEMS)

1. Are cargo spaces, insulation and thermal seals of hatch covers in satisfactory condition?

2. Are fans, ducting, coolings and air distribution arrangements in satisfactory condition?

3. Is temperature monitoring equipment in full working order?1

4. Does the vessel carry a dedicated refrigeration engineer? How many years of experience does the engineer have?

1  A  sample  copy  of  temperature  log  printout  from  the  last  cargo  voyage  should  be  provided,  if  possible.  

Rev  1/2011     IOPAI  Condition  Survey  Report  Form   Page  23  of  25  

SUMMARY Condition Rating Scale: 5 = Excellent to 1 = Dangerous Management / Administration Navigation Cargoworthiness Manning / Competence Non Cargo Tanks Machinery Crew Safety Pollution Prevention LSA & FFA Hull ADDITIONAL COMMENTS Name of the Master: Owners’ Representative:

Rev  1/2011     IOPAI  Condition  Survey  Report  Form   Page  24  of  25  

LIST OF DEFICIENCIES Total deficiencies : Total pages : Page :

Rec. no. Description

Non accomplished inspections (if any). Start numbering with an ‘X’ (x.1, x.2 etc). x.

x.

x.

x.

x.

ISSUED BY: ADRESS : TELEPHONE : FAX: EMAIL : For receipt on behalf of the vessel

SURVEYORS NAME : NAME :

SIGNATURE : SIGNATURE :

DATE : POSITION / RANK : This entire report, together with its summary of defects and / or recommendations for action (if any), has been prepared conditional upon the clear understanding that in no circumstances whatsoever shall the Insurer be held responsible and/or liable for any inaccuracy in the report, or for any act, omission or negligence of its staff or its appointed surveyor howsoever arising and that it is provided for the sole reference of the Insurer and without warranty as to the accuracy of any information or advice supplied therein.

Rev  1/2011     IOPAI  Condition  Survey  Report  Form   Page  25  of  25