1 Particulars
The following information will enable the owner in cooperation with the
Administration to develop a survey programme complying with the requirements of the
Code. It is essential that the owner provides, when completing the present
questionnaire, up-to-date information. The present questionnaire, when completed, will
provide all the information and material required by the resolution.
|
Particulars
|
| Ship's name:
|
| IMO number:
|
| Flag State:
|
| Port of registry:
|
| Owner:
|
| Recognized organization (RO):
|
| Gross tonnage:
|
| Deadweight (metric tonnes):
|
| Date of build:
|
2 Information on access provision for
close-up surveys and thickness measurement
The owner shall indicate, in the table below, the means of access to the
structures subject to close-up survey and thickness measurement. A close-up survey is an
examination where the details of structural components are within the close visual
inspection range of the attending surveyor, i.e. normally within reach of hand.
|
Tank No.
|
Structure
|
C (Cargo)/B(Ballast)
|
Temporary
staging
|
Rafts
|
Ladders
|
Direct access
|
Other means
(please specify)
|
| F.P.
|
Fore peak
|
|
|
|
|
|
|
| A.P.
|
Aft peak
|
|
|
|
|
|
|
| Wing
tanks
|
Underdeck
|
|
|
|
|
|
|
| Side shell
|
|
|
|
|
|
|
| Bottom transverse
|
|
|
|
|
|
|
| Longitudinal
|
|
|
|
|
|
|
| Transverse
|
|
|
|
|
|
|
Centre
tanks
|
Under deck
|
|
|
|
|
|
|
| Bottom transverse
|
|
|
|
|
|
|
| Transverse
|
|
|
|
|
|
|
|
History of cargo with H2S content or heated cargo for the
last three years together with indication as to whether cargo was
heated and, where available, Material Safety Data Sheets (MSDS)footnote
|
|
|
|
|
|
|
|
|
3 Owner's inspections
Using a format similar to that of the table below (which is given as an
example), the owner shall provide details of the results of their inspections for the
last three years on all cargo and ballast tanks and void spaces within the cargo area,
including peak tanks.
|
Tank No.
|
Corrosion
protection (1)
|
Coating
extent (2)
|
Coating
condition (3)
|
Structural
deterioration (4)
|
Tank damage
history (5)
|
| Cargo centre tanks
|
|
|
|
|
|
| Cargo wing tanks
|
|
|
|
|
|
| Slop
|
|
|
|
|
|
| Ballast tanks
|
|
|
|
|
|
| Aft peak
|
|
|
|
|
|
| Fore peak
|
|
|
|
|
|
| Miscellaneous spaces
|
|
|
|
|
|
|
Note:
|
|
|
|
|
|
|
|
| Indicate tanks which are used for oil/ballast.
|
|
| 1)
|
HC =
hard coating; SC = soft coating;
SH = semi-hard coating;
|
|
|
NP = no
protection
|
| 2)
|
U = upper part; M = middle part;
|
|
|
L = lower part; C = complete
|
| 3)
|
G = good; F = fair; P = poor;
|
|
|
RC = recoated (during the last three years)
|
| 4)
|
N = no findings recorded; Y = findings recorded,
|
|
|
|
description of findings should be attached to this questionnaire
|
| 5)
|
DR = Damage & Repair; L = Leakages;
|
|
|
|
CV = Conversion (description to be attached to this
questionnaire)
|
|
Reports of port State control inspections
| List the reports of port State control
inspections containing hull structural related deficiencies, relevant
information on rectification of the deficiencies:
|
|
|
|
|
|
|
|
|
|
|
|
|
Safety management system
| List non-conformities related to hull
maintenance, including the associated corrective actions:
|
|
|
|
|
|
|
|
|
|
|
|
|
Name and address of the approved thickness measurement
company