Instructions to Maritime Cook Islands Inspector

1. Section A, 1-3: The vessels Master should complete Section A 1-3 prior to the inspection and have it available, in soft copy, for the inspector
to audit and include in the final form. This will shorten the inspection process considerably.

2. Deficiency List: A copy of any deficiencies that are issued shall be listed on the Deficiency List (survey from 85) and given to the Master upon
completion of the inspection.

3. Photographic Record: A Photographic Record shall be submitted with the completed Inspection form of images relevant to the inspection –
including inter alia general view of the hull and accommodation.

4. Submitting Inspection and Photographic Record: The completed Inspection Form (84A) Deficiency List (85) and Photographic Record
shall be submitted in PDF format to the Maritime Cook Islands Technical Office df@maritimecookislands.com, with the vessel’s Maritime Cook Islands
Fleet Manager and info@maritimecookislands.com in copy.

PART A : GENERAL INFORMATION

(To be completed by Master)

Name of Ship       Type of      

IMO No.       Year of Registration in CI      
Year Built       Ship’s Classification      
Gross Tonnage       Net Tonnage       Official Number      
DPA Contact details ( as listed and available on board)
Name       Phone      
Address       Email      
Name of Company Representative on       Phone      
Email      
Name of Inspector       CIFSS number      
Date / Place inspection            
Deficiencies by PSC closed
5. Policy Of Unsafe Vessels: If at any time, in your professional opinion, a vessel flying the Cook Islands Flag is considered to be unseaworthy
or a risk to the marine environment, you must issue notice to the vessel owners that the registration and other certification is suspended until such
time as the deficiencies have been rectified.
Such suspension shall be immediate and the ‘Letter of Suspension’ can initially be issued electronically with subsequent forwarding of the original
notice in due course. Copies must be sent to the Technical Director df@maritimecookislands.com.
Where the certification has been suspended the vessel must undergo an inspection by a Cook Islands Approved Surveyor prior to re-instatement on
the register and the appropriate certification reissued.

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 In such a case you will be required to keep the following records:
1. Advice from Surveyor / RO / Flag State of the vessel’s condition and/or potential threat to the environment
2. Notice by the Registrar
3. Subsequent inspection/survey reports
4. Re-instatement documents (if applicable)

1. SHIP DOCUMENTS

(To be completed by Master) EXPIRY ISSUED Type of cert (F=Full;

YES NO N/A
DATE BY I=Interim; S=Short term)
Original Certificates on-board? Required annual, intermediate or
periodic surveys completed

International Tonnage Certificate                  

Passenger Safety Ship Certificate                  

Cargo Ship Safety Contruction Certificate                  

Cargo Ship Safety Equipment Certificate                  

Cargo Ship Safety Radio Certificate                  

International Loadline Certificate                  

International Oil Pollution Prevention Certificate                  

International Sewage Pollution Prevention Certificate                  

International Air Pollution Prevention Certificate                  

Engine International Air Pollution Prevention

                 
Certificate
International Pollution Prevention Certificate for the
                 
Carriges of Noxious Liquid Substances in Bulk
Certificate of Fitnes for the Carrigage of Dangerous
                 
Chemicals in Bulk
Certificate of Fitness for the Carriage of Liquiefied
                 
Gases in Bulk
Safety Management Certificate                  

Document of Compliance                  

International Ship Security Certificate                  

Continuous Synopsis Record                  

Civil Liability Convention                  

Civil Liability Bunker Convention                  

Page 2 of 11
 International Anti-Fouling Systems Certificate                  

Radio Station Licence                  

Conformance Test Report LRIT                  

Certificate of Registry                  

AIS Compliacne Report                  

Safe Manning                  

International Energy Efficiency Certificate                  

SSAS test Report                  

Wreck Removal                  

MLC                  

                       

                       

2. MANUALS AND RECORD BOOKS

(To be completed by Master) YES NO N/A REMARKS:

Are the following on-board?

1. Oil Record Book – Machinery      

2. Oil Record Book – Cargo      

3. Garbage Management Plan      

4. Garbage Record Book      

5. Cargo Securing Manual      

6. Cargo Gear Record Book      

7. Ballast Management Plan      

8. Intact Stability Book      

9. Trim and stablity book      

10. Damage Control Booklets      

11. Bulk Carrier Booklet / Grain Loading Manual      

Shipboard Oil Pollution Emergency Plan or

12.      
Shipboard Marine Pollution Emergency Plan
Manual for onboard maintenace of life saving
13.      
appliances
14. Evacuation plan      

15. Fire fighting plan      

Page 3 of 11
 REMARKS: Enter latest edition on board where
3. PUBLICATIONS YES NO N/A
applicable
(To be completed by Master)

1. SOLAS (Latest Edition)      

2. MARPOL      

3. STCW (Latest Edition)      

4. IMDG Code      

5. IMSBC Code      

Code o Safe Practices for Timber Deck Cargos (Latest

6.      
Edition)

7. International Code of Signals (Latest Edition)      

8. IAMSAR Manual (Latest Edition)      

9. ICS Tanker Safety Guide (Chemicals) (Latest Edition)      

10. ICS Tanker Safety Guide (Liquified Gas) (Latest Edition)      

11. Medical Publications      

12. Maritime Labour Convention      

13. IBC Code hemical Tankers (built after July 1986)      

14. BCH Code Chemical Tankers (built before July 1986)      

15. Compilation of Maritime Cook Islands Circulars      

PART B: SAFETY MANAGEMENT SYSTEMS (SMS) YES NO N/A REMARKS

Is the SMS written in a language understood by the crew?      

Is there a computerized PMS on board?      

Is there a schedule for drills and training?      

Procedures for Internal Audit & Management Review?      

Procedures in place for contacting the company in an emergency?      

Are the crew wearing the appropriate PPE      

Are there records of crew familiarization?      

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Ship reports nonconformities as required by SMS?      

Company takes corrective action when appropriate?      

Risk Assessment recorded?      

PART C: SECURITY YES NO N/A REMARKS

1. Was there a gangway watch?      

2. Was identification requested upon boarding?      

3. Are visitors escorted to the senior officer on duty?      

4. Are crew aware of the current security level?      

5. Are Restricted Areas marked?      

6. Are security drills conducted and recorded?      

Was the Ship Security Officer familiar with terminal

7.      
security procedures and local contact information?

PART D: DRILLS AND RECORDS YES NO N/A REMARKS

1. Are weekly, monthly, quarterly and annual

     
inspections held and recorded?
2. Are weekly emergency, response and training drills
     
conducted and recorded?
3. Are Fire Drills carried out and recorded?      

4. Radio Log Book properly maintained?      

5. Required daily, weekly and monthly tests of the

     
GMDSS including reserve power testing
6. Emergency generator tested and recorded?      

7. Fire and Abandon Ship drills carried out      

PART E: MARITIME LABOUR CONVENTION 2006 – STCW YES NO N/A REMARKS

1. Original of Maritime Labour Certificate or
     
Declaration on board?
2. Original of Declaration of Maritime Labour
     
Compliance (DMLC Part I, II)

Page 5 of 11
 3. Ship Manned according to the approved safe      
manning document.
4. Records of seafarers’ work and rest hours?      

5. No seafarer under the age of 18 has been

employed or engaged, or has been working, as      
the ship’s cook
6. Documentary evidence of the ship cook being
instructed on board in matters of environmental      
protection and catering health and safety

7. Copy of license or certificate for the operation of

a private seafarer recruitment and placement      
service
8. Copies of seafarers’ employment agreements –
     
Payments in accordance MLC 2006.
9. Are the crew familiar with the on board
     
complaints procedure.
10. Bridge Log books / Machinery log books / Other
     
log books

PART F: OPERATIONAL TESTS SATISFACTORY YES NO N/A REMARKS

1. Watertight / weather tight tests?      

2. Bilge Alarms?      

3. Steering Gear Alarms and operation?      

4. Emergency Lighting?      

5. General alarm and engineers alarm for unmanned

     
machinery
6. Emergency generator has been tested?      

7. Oily Water Separation (OWS) alarms?      

8. Firefighting Equipment?      

9. Fixed Fire Installations      

PART G: BRIDGE AND NAVIGATIONAL EQUIPMENT YES NO N/A REMARKS

1. Echo sounding device      

2. Course recorder      

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 3. Rater of Turn Indicator (≥ 50,000GT)      

4. Maneuvering Characteristics      

5. Speed and distance through the water log      

Voyage Data Recorder or simplified Voyaged Data

6.      
Recorder

7. Automatic Identification System      

8. SART      

9. EPIRB      

Distress & Emergency Equipment stowed on or

10.      
near the bridge?
11. VHF sets (fixed & hand held)      

12. NAVTEX      

13. GMDSS      

Navigation lights including duplication and failure

14.      
alarm?

15. Charts & Publications      

If equipped, ECDIS up to date and crew familiar

16.      
with use?
17. Berth passage plan available including UKC?      

18. VDR / S-VDR Test Certificate      

19. EPRIB Test Certificate      

20. MOB quick release      

PART H: CREW ACCOMODATION & GENERAL SAFETY YES NO N/A REMARKS

1. Is accommodation clean & tidy      

Is the hospital equipped and maintained ready for

2.      
use immediately?

Are Emergency Escapes accessible, free of

3.      
obstructions, properly lit and well marked?

Are IMO symbols used for marking escape ways

4.      
and locations of emergencies equipment?

Are Pilot ladders and related boarding

5.      
arrangements clean, and in good condition?

Page 7 of 11
PART I : LIFESAVING APPLIANCES YES NO N/A REMARKS

Life buoys with reflective tape, markings, lights

1. and smoke signals on board I required numbers /      
locations?
Required numbers of lifejackets with whistles,
2.      
retro-reflective material and lights available?
Required number of immersion suits and thermal
3. protective aids available, proper size for crew, and      
serviced per manufacturers specs (≤3 yrs.)?

Muster list and emergency instructions provided

4. to crew members and posted on the bridge, in the      
engine room and accommodations?
5. Life Rafts      

Embarkation ladders in good condition including

6.      
forward ladder?

PART J: FIREFIGHTING EQUIPMENT YES NO N/A REMARKS

Weekly, monthly and quarterly maintenance,

1.      
testing and inspections.

2. Portable fire extinguishers      

3. Paint locker fire extinguishing system installed?      

4. Fire hydrants operational      

5. Fire hoses serviceable      

6. Fire suits ready for use and in good condition.      

PART K: HULL YES NO N/A REMARKS

Plimsoll mark properly marked and painted,

1.      
corresponding to the load line certificate?
Draft marks properly marked and painted on bow
2.      
and stern?
3. Condition of shell plating satisfactory?      

4. Opening in hull satisfactory?      

5. Condition of deck plating satisfactory?      

Page 8 of 11
 6. Condition of hatch covers satisfactory?      

7. Condition of rails satisfactory?      

Deck scupper pipes free of obstructions and in

8.      
good condition?
Air pipes / closing appliances in acceptable
9.      
condition & operable?
Anchors. Windless and mooring arrangements
10.      
satisfactory?
Maintenance of masts, cranes, and rigging
11.      
satisfactory?
ALL TANKER VESSELS:

Fore and aft walkways and gangways in acceptable

12.      
condition?

Cargo and ballast deck lines in good condition and

13.      
free of leakages?

PV valves free of leakages, working and in

14.      
acceptable condition?

15. Flame screen installed in PV Breaker?      

16. Pump room clean and in satisfactory condition?      

17. ODME Operable and tested.      

PART L: MACHINERY AND ELECTRICAL YES NO N/A REMARKS

1. Engine Control room

2. Emergency lights marked      

3. Main engine free of oil and water leakages?      

Auxiliary engines /generators in good operating

4.      
condition?
Boilers and steam system appear satisfactory and
5.      
free of excessive leakages?
Exhaust manifold and exhaust lines in satisfactory
6.      
condition?
Engine room vent and ducting system in good
7.      
condition?

Page 9 of 11
 Bilge and ballast pumps in good operable
8.      
condition?
Feed and cooling pumps and valves in good
9.      
condition?
10. Shipboard waste incinerator satisfactory?      

11. Purifiers and purifier space satisfactory?      

12. Fresh water coolers free of leakages      

Air compressors and piping, valves in good

13.      
condition?

Engine room firefighting equipment is

14.      
satisfactory?

Engine room bilges and other machinery areas

15.      
free of oil, debris and other fire hazards?

PART M: STEERING YES NO REMARKS

Full movement of rudder verified (35 port to 35

1.      
starboard)?

Steering linkage in satisfactory condition and

2.      
operating properly?

3. System free of excessive leaks?      

Means of communication between the navigation

4.      
bridge and the steering compartment satisfactory?
5. Change over procedure diagrams posted?      

6. Emergency steering systems operating properly?      

Heading information displayed visually at

7. emergency steering position (required on board      
vessels built after 1992)?

PART N: GENERAL COMMENTS

General remarks regarding the overall condition of the vessel and the competence of the officers and crew. In addition, place
observations and / or recommendations in this block. Deficiencies should be listed in Survey Form 84C.

CURRENT OPERATION & VOYAGE CIRCUMSTANCES:

     

Page 10 of 11
DOCUMENTATION & RECORDS:
     

HULL, DECKS & FITNESS:

     

MACHINERY & ELECTRICAL:

     

ACCOMODATION (Internal / External):

     

SAFETY & FIREFIGHTING:

     

CREW PERFORMANCE/COOPERATION:
     

OBSERVATIONS & RECOMMENDATIONS DISCUSSED WITH MASTER & CHIEF ENGINEER

(summarize below)

     

Date:                  

(dd/mm/yy) Name of Master or Representative (print) Signature

Date:                  

(dd/mm/yy) Name of Inspector (print) Signature

Page 11 of 11