INTERNATIONAL NAVAL SURVEYS BUREAU

REPORT OF SURVEY OF PREVENTION OF POLLUTION BY OIL

To meet Regulations of ANNEX I of the International Convention for the
Prevention of Pollution from Ships, 1973 and Its 1978 Protocol, as amended.
Initial Survey Renewal Survey Intermediate Survey Annual Survey

Name of Ship : Distinctive Letters : Port of Registry:

Gross Tonnage: Dead Weight (metric tons): Year of Build:

Managers (or agents) :

Place of survey: in dry-dock on slipway afloat Survey Commenced :

At: Survey Completed :

Note: i. Fields should be filled with YES, NO or N/A as required.

ii. All negative entries (NO) should be clarified under "Surveyor's Notes" with reference by item number.
I. GENERAL SURVEY
1. Type of Ship
1.1 Crude oil carrier 1.2 Product carrier 1.3 Crude oil / product carrier
1.4 Cargo ships with cargo oil tanks > 200 m³ [MARPOL ANNEX I: Reg. 2 (2)]
1.5 Cargo ship other than the above
II. MANDATORY ANNUAL SURVEY
Oil Filtering Equipment :
- Maker / model of Oil Filtering
Equipment (Oily water Separator)
- Maker / model of Oil Content Meter

2. Oil filtering equipment 15 ppm, was externally examined, tested and found satisfactory
3. 15 ppm bilge alarm and automatic stopping device were tested and found in good order
4. Operational instructions for the oil filtering equipment and piping diagram are displayed
5. Sufficient storage of filtering and / or coalescing is provided
Others:
6. Overboard discharge valve was externally examined and found satisfactory.
7. Fuel system and ballast system are separated from each other except as provided in Regulation 16 (2).
8. Installation for ballast discharge to reception facilities is in good condition, if applicable.
9. Testing of homogenizers, sludge incinerators or other recognised means for the control of sludge, where fitted.
10. Holding tank for oily bilge water is in good condition, where fitted
11. Dedicated Sludge tank and a designated pump installation (separate by bilge system) verified and are in good condition.
12. Installation for oil residues discharge to shore reception facilities is in good condition.
12.1 There is no discharge connections of the sludge tank to the bilge system, oily bilge water holding tank(s), tank top or oily
water separators except that: the sludge tank discharge piping and bilge-water piping is connected to a common piping
leading to the standard discharge connection, which does not allow for the transfer of sludge to the bilge system.
13. Standard discharge connection is in good order.
14. Vessel is provided with a revised oil record book Part I in accordance with regulation 17 and Part II in accordance with reg.36
and entries were made duly.
15. Vessel is provided with a S.O.P.E.P. in accordance with regulation 37 (Tankers >5000dwt which shall have prompt access to
computerized, shore-based damage stability and residual strength calculation programs as required by reg.37.4)

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 Additional requirements for oil tankers :
16. Records of Oil Discharge Monitoring and Control System were sighted
17. The following approved manuals are kept on board
17.1 Operational Manual of Discharge of Ballast water in connection with Monitoring and
Control System Reg.31.4
17.2 Operations and Equipment Manual of Crude Oil Washing System (COW)
17.3 Dedicated Clean Ballast Tank Operation Manual
18. Last survey of inert gas system was carried out on the occasion of :
18.1 Class Periodical Special Survey
18.2 Class annual Survey
18.3 Intermediate Survey of Safety Equipment
19. Pressure test of flexible hoses in COW system of combination carrier on board was carried out
Date of last test :
Note : Pressure test of flexible hoses shall be at intervals of not more than 2 1/2 years
20. Vessel is provided with segregated ballast tanks in accordance with Reg.18
21. Non-existence of connections between segregated ballast and cargo system was confirmed
22. Vessel operates with dedicated ballast tanks in accordance with Reg.18
23. Dedicated Clean Ballast System including pumps, piping and fittings were checked and found in accordance with the manual and
in satisfactory condition
24. Segregated and / or dedicated ballast tanks were visually inspected from deck and found free from oil contamination
25. In case vessel is engaged in specific trades or has special ballast arrangements, the operational procedures are being complied with
26. Vessel complies with requirements of Reg.19
If not state date that vessel has to comply with Reg.19 :
27. Piping and discharge manifold for the dirty ballast water or oil contaminated water were examined and found in good order
28. Means of discharge were examined and found in good order (new oil tankers)
29. Discharge of dirty ballast water or oil contaminated water can be stopped:
29.1 Indirectly by means of communication system
29.2 Directly at observation position
30. Means of draining and stripping of cargo pumps and lines for pumping to the slop or cargo tanks or ashore were examined and
found in good order (new oil tankers and existing crude oil tankers provided with SBT or COW)
31. Test of part flow system, where fitted
32. Slop tanks' arrangements and associated piping were externally examined and found satisfactory
33. Non existence of permanent pipe connection from engine room to slop tanks was confirmed
34. Oil Discharge and Monitoring System and Oil/Water interface detector (Reg.31 and 32):
34.1 External examination was made and found satisfactory
34.2 Manual / Automatic stop was tested and found satisfactory
34.3 Function of indicators and recorder was checked and found satisfactory
34.4 Consumables for recorders on board are sufficient
34.5 Operation of audible / visual alarm was tested and found satisfactory
34.6 The starting interlock was checked and found satisfactory
34.7 Calibration as per manufacturer's Operational Manual carried out
34.8 Operation test of oil / water interface detector was checked and found satisfactory

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35. The size and arrangements of cargo tanks, wing cargo oil tanks comply with the requirements of Reg.26
36. Approved information and data relative to loading and damage stability (Reg. 28 )
36.1 Confirming that the information relative to loading and distribution of cargo is kept on board
36.2 Confirming that the data on the ability of the ship to comply with damage stability criteria is kept on board (New Tanker)
37. COW system
37.1 COW system are arranged as outlined in the manual
37.2 Piping, pumps, valves and deck mounted washing machines were examined and found free from leakages
37.3 Anchor devices of COW piping were examined and found in satisfactory condition
37.4 Repairs made on COW system were carried out properly (no welded doublers are allowed)
37.5 Heater fitted in the COW system is isolated by:
.5.1 double shut-off valves
.5.2 clearly identifiable blanks
37.6 Sufficient number of portable drive units are provided on board as per manual
37.7 Operation tests of portable drive units are provided on board as per manual
37.8 Operation test of portable drive units was made and found satisfactory
37.9 A sufficient number of covers for deck openings and blanks for supply pipes are kept on board
37.10 Function test of the following safety devices for COW pumps was made and found satisfactory
.10.1 Relief valve
.10.2 Temperature sensing device to stop the pump (centrifugal type) in the case of overheating
37.11 Effectiveness of stripping system was tested and found satisfactory
37.12 Communication system between the watch keeper on deck and the cargo position was tested and found operational
37.13 Flexible hoses for COW system on a combination carrier are protectively stored
38. Vessel is provided with an approved Ship To Ship (STS) operations plan
39. Vessel is provided with an approved Stability Instrument.

III. INTERMEDIATE SURVEY OR RENEWAL SURVEY

40. Oil filtering equipment was internally examined and found satisfactory.
41. Pumps of filtering equipment with bilge piping and pipes to sludge tank were examined and found in good condition
42. All oil, water, steam and drain valves of oil filtering equipment were opened, examined and found satisfactory
43. Coalescer and / or filter cartridge were renewed
44. The oil contents meter for the 15 ppm alarm was tested and calibrated according to manufacturer's instruction
45. 15 ppm bilge alarm was tested according to manufacturer's instruction
46. Cargo pump room boom protection of height of not less than B/15 or 2 meters (whichever is lesser, with a minimum value of 1
meter) has been verified. (Applies to Oil tankers >5000DWT and built >1/1/2007)
47. Vessel with Fuel oil tanks of total capacity above 600cbm meets one of the following requirements.
(Applies to all ships built >1/8/2010)
i) Fuel oil tanks located at a minimum distance inboard of shell plating as per reg. 12A
ii) Meets the accidental oil fuel outflow performance standards as per reg.23

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 Additional requirements for oil tankers :
48. Internal arrangement of slop tank (s) was examined and found in satisfactory condition
49. Cargo tanks (at least 2 cargo tanks) of :
Tank No. Location Tank No. Location

were inspected internally and the effectiveness of COW and stripping system were verified
50. The operation test of all tank valves was carried out and found in satisfactory condition
51. COW piping was pressure tested up to kg / cm²
(working pressure kg / cm²) and found in satisfactory condition
Note : Pressure tested shall be 1.5 times working pressure of COW piping

52. Double shut-off valves / blind flanges for heater fitted in the COW system were removed, inspected and found in satisfactory
condition
53. Confirming that the closing devices installed in the cargo transfer system and interconnections mentioned on Reg. 26 as
appropriate

IV. SURVEYOR'S NOTES

54. Describe in detail system and equipment or parts which have been altered or modified (Additional pages to be attached if
necessary)

55. The alterations or modifications together with manuals or operational procedures have been approved.

56. Verification of the type approval certificate of the following newly installed equipment carried out.

57. Describe in detail parts which remain to be examined, and deficiencies, if any (Additional pages to be attached if necessary)

V. CERTIFICATE
58. The I.O.P.P. Certificate with No. was endorsed on

59. A Short Term I.O.P.P. Certificate with No. was issued on

60. It is recommended that:

A full term I.O.P.P.Certificate valid until to be issued by the Head Office of the Society, or
No Full Term I.O.P.P.Certificate is to be issued before the survey is completed.

Date:
Surveyor to International Naval Surveys Bureau - I.N.S.B.

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