Name of
ship/call sign:
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MMSI number:
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Port of registry:
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IMO Number:
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Gross tonnage:
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Date keel laid:
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1 Installation details
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Item
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Status
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1.1
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AIS transponder type:
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1.2
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Type approval certificate
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1.3
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Initial installation configuration report on board?
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1.4
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Drawings provided? (Antenna-, AIS-arrangement and block diagram)
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1.5
|
Main source of electrical power,
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1.6
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Emergency source of electrical power,
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1.7
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Capacity to be verified if the AIS is connected to a battery
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1.8
|
Pilot plug near pilots operating position?
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1.9
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120 V AC provided near pilot plug? (Panama and St. Lawrence
requirement)
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2 AIS programming - Static information
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2.1
|
MMSI number
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2.2
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IMO number
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2.3
|
Radio call sign
|
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2.4
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Name of
ship
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2.5
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Type of ship
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2.6
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Ship length and beam
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2.7
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Location of GPS antenna
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3 AIS programming - Dynamic information
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3.1
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Ships position with accuracy and integrity status (Source: GNSS)
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3.2
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Time in UTC (Source: GNSS)
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3.3
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Course over ground (COG) (will fluctuate at dockside) (Source GNSS)
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|
3.4
|
Speed over ground (SOG) (zero at dockside) (Source: GNSS)
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3.5
|
Heading (Source: Gyro)
|
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3.6
|
Navigational status
|
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3.7
|
Rate of turn, where available (ROT)
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3.8
|
Angle of heel, pitch and roll, where available
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4 AIS programming - voyage related information
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4.1
|
Ships draught
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|
4.2
|
Type of cargo
|
|
4.3
|
Destination and ETA (at masters discretion)
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4.4
|
Route plan (optional)
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4.5
|
Short safety-related messages
|
|
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|
|
|
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5 Performance test using measuring instrument
|
5.1
|
Frequency measurements AIS ch. 1 and 2, GMDSS ch. 70
|
|
5.2
|
Transmitting output, AIS ch. 1 and 2, GMDSS ch. 70
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|
5.3
|
Polling information ch. 70
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5.4
|
Read data from AIS
|
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5.5
|
Send data to AIS
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5.6
|
Check AIS response to “virtual vessels”
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|
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6 “On air” performance test
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6.1
|
Check reception performance
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6.2
|
Confirm reception of own signal from other ship/VTS
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6.3
|
Polling by VTS/shore installation
|
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Electromagnetic interference from AIS observed to other
installations?:
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Remarks:
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The AIS has been tested according to IMO SN/Circ.227 and resolution
MSC.74(69), annex 3
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Name of
Radio Inspector
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Date and
place
|
Name of
Radio Inspector Company
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