SHIP/SHORE SAFETY CHECK LIST

Ship's Name: __________________________________________________

Berth: __________________________

Port: _____________________

Date of Arrival: ___________________

A.

General

Ship

Terminal

Code

Remarks

1.

Is the ship securely moored?

Yes / No / NA*

Yes / No / NA*

R

Wind Velocity                    Stop cargo at:_____ kts              Disconnect at:_____ kts     Unberth at: _______ kts

2.

Are emergency towing wires correctly positioned?

Yes / No / NA*

Yes / No / NA*

R

3.

Is there safe access between ship and shore?

Yes / No / NA*

Yes / No / NA*

R

4.

Is the ship ready to move under its own power?

Yes / No / NA*

Yes / No / NA*

PR

5.

Is there an effective deck watch in attendance on board and adequate supervision on the terminal and on the ship?

Yes / No / NA*

Yes / No / NA*

R

6.

Is the agreed ship/shore communication system operative?

Yes / No / NA*

Yes / No / NA*

AR

7.

Has the emergency signal to be used by the ship and shore been explained and understood?

Yes / No / NA*

Yes / No / NA*

A

8.

Have the procedures for cargo, bunker and ballast handling been agreed?

Yes / No / NA*

Yes / No / NA*

AR

9.

Have the hazards associated with toxic substances in the cargo being handled been identified and understood?

Yes / No / NA*

Yes / No / NA*

10.

Has the emergency shutdown procedure been agreed?

Yes / No / NA*

Yes / No / NA*

A

11.

Are fire hoses and fire-fighting equipment on board and

ashore positioned and ready for immediate use?

Yes / No / NA*

Yes / No / NA*

R

12.

Are cargo and bunker hoses/arms in good condition, properly rigged and appropriate for the service intended?

Yes / No / NA*

Yes / No / NA*

13.

Are scuppers effectively plugged and drip trays in position, both on board and ashore?

Yes / No / NA*

Yes / No / NA*

R

14.

Are unused cargo and bunker connections properly secured with blank flanges fully bolted?

Yes / No / NA*

Yes / No / NA*

15.

Are sea and overboard discharge valves, when not in use, closed and visibly secured?

Yes / No / NA*

Yes / No / NA*

16.

Are all cargo and bunker tank lids closed?

Yes / No / NA*

Yes / No / NA*

17.

Is the agreed tank venting system being used?

Yes / No / NA*

Yes / No / NA*

AR

18.

Has the operation of the P/V valves and/or high velocity vents been verified using the checklift facility, where fitted?

Yes / No / NA*

Yes / No / NA*

19.

Are hand torches of an approved type?

Yes / No / NA*

Yes / No / NA*

20.

Are portable VHF/UHF transceivers of an approved type?

Yes / No / NA*

Yes / No / NA*

A.

General

Ship

Terminal

Code

Remarks

21.

Are the ship's main radio transmitter aerials earthed and radars switched off?

Yes / No / NA*

Yes / No / NA*

22.

Are electric cables to portable electrical equipment

disconnected from power?

Yes / No / NA*

Yes / No / NA*

23.

Are all external doors and ports in the accommodation

closed?

Yes / No / NA*

Yes / No / NA*

R

24.

Are window-type air conditioning units disconnected?

Yes / No / NA*

Yes / No / NA*

25.

Are air conditioning intakes which may permit the entry of

cargo vapours closed?

Yes / No / NA*

Yes / No / NA*

26.

Are the requirements for use of galley equipment and other cooking appliances being observed? 

Yes / No / NA*

Yes / No / NA*

R

27.

Are smoking regulations being observed?

Yes / No / NA*

Yes / No / NA*

R

28.

Are naked light regulations being observed?

Yes / No / NA*

Yes / No / NA*

R

29.

Is there provision for an emergency escape?

Yes / No / NA*

Yes / No / NA*

30.

Are sufficient personnel on board and ashore to deal with an emergency?

Yes / No / NA*

Yes / No / NA*

R

31.

Are adequate insulating means in place in the ship/shore

connection?

Yes / No / NA*

Yes / No / NA*

32.

Have measures been taken to ensure sufficient pumproom ventilation?

Yes / No / NA*

Yes / No / NA*

R

33.

If the ship is capable of closed loading, have the

requirements for closed operations been agreed?

Yes / No / NA*

Yes / No / NA*

R

34.

Has a vapour return line been connected?

Yes / No / NA*

Yes / No / NA*

35.

If a vapour return line is connected, have operating

parameters been agreed?

Yes / No / NA*

Yes / No / NA*

36.

Are ship emergency fire control plans located externally?

Yes / No / NA*

Yes / No / NA*

Inert Gas System

Ship

Terminal

Code

Remarks

1.

Is the Inert Gas System fully operational and in good working order?

Yes / No / NA*

Yes / No / NA*

P

2.

Are deck seals in good working order?

Yes / No / NA*

Yes / No / NA*

R

3.

Are liquid levels in P/V breakers correct?

Yes / No / NA*

Yes / No / NA*

R

4.

Have the fixed and portable oxygen analysers been calibrated and are they working properly?

Yes / No / NA*

Yes / No / NA*

R

5.

Are fixed IG pressure and oxygen content recorders working?

Yes / No / NA*

Yes / No / NA*

R

6.

Are all cargo tank atmospheres at positive pressure with an oxygen content of 8% or less by volume?

Yes / No / NA*

Yes / No / NA*

PR

7.

Are all the individual tank IG valves (if fitted) correctly set and locked?

Yes / No / NA*

Yes / No / NA*

R

8.

Are all the persons in charge of cargo operations aware that in the case of failure of the Inert Gas Plant, discharge operations should cease and the terminal be advised?

Yes / No / NA*

Crude Oil Washing

Ship

Terminal

Code

Remarks

1.

Is the Pre-Arrival Crude Oil Washing Check List, as contained in the approved Crude Oil Washing Manual, satisfactorily completed?

Yes / No / NA*

Yes / No / NA*

2.

Is the Crude Oil Washing Check List for use before, during and after Crude Oil Washing, as contained in the approved Crude Oil Washing Manual, available and being used?

Yes / No / NA*

Yes / No / NA*

R

Tank Cleaning

Ship

Shore

Remarks

1.

Are tank cleaning operations planned during the ship's stay alongside the shore installation?

Yes / No*

2.

If so, have the Port Authority and terminal authority been informed?

Yes / No*

Yes / No*

Bulk Liquid Chemicals

Ship

Terminal

Code

Remarks

1.

Is information available giving the necessary data for the safe handling of the cargo, and where applicable a manufacturer's inhibition certificate?

Yes / No / NA*

Yes / No / NA*

2.

Is sufficient and suitable protective equipment (including self-contained breathing apparatus) and protective clothing ready for immediate use?

Yes / No / NA*

Yes / No / NA*

3.

Have counter measures against accidental personal contact with the cargo been agreed?

Yes / No / NA*

Yes / No / NA*

4.

Is the cargo handling rate compatible with the automatic shutdown system, if in use?

Yes / No / NA*

Yes / No / NA*

A

5.

Are cargo systems gauges and alarms correctly set and in good order?

Yes / No / NA*

Yes / No / NA*

6.

Are portable vapour detection instruments readily available for the products to be handled?

Yes / No / NA*

Yes / No / NA*

7.

Has information on fire-fighting media and procedures been exchanged?

Yes / No / NA*

Yes / No / NA*

8.

Are transfer hoses of suitable material, resistant to the chemical action of the cargoes?

Yes / No / NA*

Yes / No / NA*

9.

Is cargo handling being performed with portable pipelines?

Yes / No / NA*

Yes / No / NA*

P

Bulk Liquefied Gases

Ship

Terminal

Code

Remarks

1.

Is Information available giving the necessary data for the safe handling of the cargo including, as applicable, a manufacturer’s inhibition certificate?

Yes / No / NA*

Yes / No / NA*

2.

Is the water spray system ready for use?

Yes / No / NA*

Yes / No / NA*

3.

Is sufficient suitable protective equipment (including self-contained breathing apparatus) and protective clothing ready for immediate use?

Yes / No / NA*

Yes / No / NA*

4.

Are hold and inter-barrier spaces properly inerted or filled with dry air as required?

Yes / No / NA*

Yes / No / NA*

5.

Are all remote control valves in working order?

Yes / No / NA*

Yes / No / NA*

6.

 Are the required cargo pumps and compressors in good order, and have maximum working pressures been agreed between ship and shore?

Yes / No / NA*

Yes / No / NA*

A

7.

Is reliquefaction or boil off control equipment in good order?

Yes / No / NA*

Yes / No / NA*

8.

Is the gas detection equipment properly set for the cargo, calibrated and in good order?

Yes / No / NA*

Yes / No / NA*

9.

Are cargo system gauges and alarms correctly set and in good order?

Yes / No / NA*

Yes / No / NA*

10.

Are emergency shutdown systems working properly?

Yes / No / NA*

Yes / No / NA*

11.

Does the shore know the closing rate of ship’s automatic valves; does the ship have similar details of shore system?

Yes / No / NA*

Yes / No / NA*

A

Ship: …………..

Shore: ………... 

12.

Has information been exchanged between ship and shore on the maximum/minimum temperatures/pressures of the cargo to be handled?

Yes / No / NA*

Yes / No / NA*

A

13.

Are cargo tanks protected against inadvertent overfilling at all times while any cargo operations are in progress?

Yes / No / NA*

Yes / No / NA*

14.

Is the compressor room properly ventilated, the electrical motor room properly pressurised and the alarm system working?

Yes / No / NA*

Yes / No / NA*

15.

Are cargo tank relief valves set correctly and actual relief valve settings clearly and visibly displayed?

Tank No. 1   ………………..

Tank No. 2   ………………..

Tank No. 3   ………………..

Tank No. 4   ………………..

Tank No. 5   ………………..

Tank No. 6   ………………..

Tank No. 7   ………………..

Tank No. 8   ………………..

Tank No. 9   ………………..

Tank No. 10 .……………….

Yes / No / NA*

*Delete Yes, No or NA as appropriate

Code:

The presence of the letters A, P or R in the column ‘Code’ indicates the following:

A   -  any procedures and agreements should be in writing in the remarks column of this Check List or other mutually acceptable form. In either case, the signature of both parties should be required.

P   -  in the case of a negative answer, the operation should not be carried out without the permission of the Port Authority

R   -  indicates items to be re-checked at intervals not exceeding that agreed in the declaration below

Declaration

We the undersigned have checked, where appropriate jointly, the items on this check list and have satisfied ourselves that the entries we have made are correct to the best of our knowledge.

We have also made arrangements to carry out repetitive checks as necessary and agreed that those items with the letter ‘R’ in the column ‘Code’ should be re-checked at intervals not exceeding _______ hours.

For Ship

For Shore

Name:

Name:

Rank:

Rank:

Signature:

Signature:

Date / Time:

Items Marked "R"  checked and found in compliance

Applicable Item Numbers : 

General: 1, 2, 3, 4, 5, 6, 8, 11, 13, 17, 23, 26, 27, 28, 30, 32, 33

Inert Gas System: 2, 3, 4, 5, 6, 7

Crude Oil Washing: 2          

Date

Time

Ship Rep. Sign

Shore Rep. Sign

Items Marked "R"  checked and found in compliance

Applicable Item Numbers : 

General: 1, 2, 3, 4, 5, 6, 8, 11, 13, 17, 23, 26, 27, 28, 30, 32, 33

Inert Gas System: 2, 3, 4, 5, 6, 7

Crude Oil Washing: 2          

Date

Time

Ship Rep. Sign

Shore Rep. Sign

Items Marked "R"  checked and found in compliance

Applicable Item Numbers : 

General: 1, 2, 3, 4, 5, 6, 8, 11, 13, 17, 23, 26, 27, 28, 30, 32, 33

Inert Gas System: 2, 3, 4, 5, 6, 7

Crude Oil Washing: 2          

Date

Time

Ship Rep. Sign

Shore Rep. Sign