Appendix 13 - Report of Inspection in Accordance with Procedures for Port State Control footnote
Clasification Society 2024 - Version 9.40
Statutory Documents - IMO Publications and Documents - Resolutions - Assembly - IMO Resolution A.1155(32) – Procedures for Port State Control, 2021 – (Adopted on 15 December 2021) - Annex – Procedures for Port State Control, 2021 - Appendix 13 - Report of Inspection in Accordance with Procedures for Port State Control 1

Appendix 13 - Report of Inspection in Accordance with Procedures for Port State Control footnote

FORM A
(Reporting authority)   Copy to: Master
(Address)     Head office
(Telephone)     PSCO
(Telefax)      
(Email)      
    If ship is detained, copy to:
      Flag State
      IMO
      Recognized organization, if applicable
1 Name of reporting authority ...................... 2 Name of ship ...........................................
3 Flag of ship .............................................. 4 Type of ship .............................................
5 Call sign ................................................... 6 IMO number ............................................
7 Gross tonnage ......................................... 8 Deadweight (where applicable) ................
9 Year of build ............................................. 10 Date of inspection ....................................
11 Place of inspection ................................... 12 Classification society ...............................
13 Date of release from detentionfootnote ...............
14 Particulars of ISM company (details or IMO Company Number)footnote ...........................................
15 Relevant certificate(s)footnote
  a) Title b) Issuing authority c) Dates of issue and expiry
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d) Information on last intermediate or annual surveyfootnote
  Date Surveying authority Place
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16 Deficiencies No Yes (see attached FORM B)
17 Penalty imposed No Yes Amount:
18 Ship detained No Yes footnote  
19 Supporting documentation No Yes (see annex)  
Issuing office .............................................. Name ......................................................
  (duly authorized PSCO of reporting authority)
Telephone ..................................................
Telefax ...................................................... Signature ................................................
This report must be retained on board for a period of two years and must be available for consultation by port State control officers at all times.
 
REPORT OF INSPECTION IN ACCORDANCE WITH
PROCEDURES FOR PORT STATE CONTROL
FORM B
(Reporting authority)   Copy to: Master
(Address)     Head office
(Telephone)     PSCO
(Telefax)      
(Email)      
    If ship is detained, copy to:
      Flag State
      IMO
      Recognized organization, if applicable
2 Name of ship ............................................ 6 IMO number ............................................
10 Date of inspection .................................... 11 Place of inspection ..................................
20 Nature of deficiencyfootnote Conventionfootnote 21 Action takenfootnote 22 ISM-related
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  Name ......................................................
  (duly authorized PSCO of reporting authority)
  Signature ................................................
Parent topic: Annex – Procedures for Port State Control, 2021
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