COOK ISLANDS FLAG STATE INSPECTION

Ship RegistrationSurvey Form

84A v.1

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.

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)

Page 1 of 12

1. SHIP DOCUMENTS

(To be completed by Master)

Original Certificates on-board? Required annual, intermediate or periodic surveys completed

YES NO N/AEXPIRY DATE

ISSUED

BY

Type of cert (F=Full; I=Interim; S=Short term)

1. International Tonnage Certificate                  

2. Passenger Safety Ship Certificate                  

3. Cargo Ship Safety Contruction Certificate                  

4. Cargo Ship Safety Equipment Certificate                  

5. Cargo Ship Safety Radio Certificate                  

6. International Loadline Certificate                  

7. International Oil Pollution Prevention Certificate                  

8.International Sewage Pollution Prevention Certificate

                 

9. International Air Pollution Prevention Certificate                  

10.Engine International Air Pollution Prevention Certificate

                 

11.International Pollution Prevention Certificate for the Carriges of Noxious Liquid Substances in Bulk

                 

12.Certificate of Fitnes for the Carrigage of Dangerous Chemicals in Bulk

                 

13.Certificate of Fitness for the Carriage of Liquiefied Gases in Bulk

                 

14. Safety Management Certificate                  

15. Document of Compliance                  

16. International Ship Security Certificate                  

17. Continuous Synopsis Record                  

18. Civil Liability Convention                  

19. Civil Liability Bunker Convention                  

20. International Anti-Fouling Systems Certificate                  

21. Radio Station Licence                  

Page 2 of 12

22. Conformance Test Report LRIT                  

23. Certificate of Registry                  

24. AIS Compliacne Report                  

25. Safe Manning                  

26. International Energy Efficiency Certificate                  

27. SSAS test Report                  

28. Wreck Removal                  

29. MLC                  

30.                        

31.                        

2. MANUALS AND RECORD BOOKS

(To be completed by Master)

Are the following on-board?

YES NO N/A REMARKS:

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      

12.Shipboard Oil Pollution Emergency Plan or Shipboard Marine Pollution Emergency Plan

     

13.Manual for onboard maintenace of life saving appliances

     

14. Evacuation plan      

15. Fire fighting plan      

Page 3 of 12

3. PUBLICATIONS

(To be completed by Master)

YES NO N/AREMARKS: Enter latest edition on board where applicable

1. SOLAS (Latest Edition)      

2. MARPOL      

3. STCW (Latest Edition)      

4. IMDG Code      

5. IMSBC Code      

6.Code o Safe Practices for Timber Deck Cargos (Latest 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?      

Page 4 of 12

Procedures in place for contacting the company in an emergency?      

Are the crew wearing the appropriate PPE      

Are there records of crew familiarization?      

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?      

7.Was the Ship Security Officer familiar with terminal 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

Page 5 of 12

1. Original of Maritime Labour Certificate or Declaration on board?

     

2. Original of Declaration of Maritime Labour Compliance (DMLC Part I, II)

     

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      

Page 6 of 12

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

1. Echo sounding device      

2. Course recorder      

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

4. Maneuvering Characteristics      

5. Speed and distance through the water log      

6.Voyage Data Recorder or simplified Voyaged Data Recorder

     

7. Automatic Identification System      

8. SART      

9. EPIRB      

10.Distress & Emergency Equipment stowed on or near the bridge?

     

11. VHF sets (fixed & hand held)      

12. NAVTEX      

13. GMDSS      

14.Navigation lights including duplication and failure alarm?

     

15. Charts & Publications      

16.If equipped, ECDIS up to date and crew familiar 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      

2. Is the hospital equipped and maintained ready for      

Page 7 of 12

use immediately?

3.Are Emergency Escapes accessible, free of obstructions, properly lit and well marked?

     

4.Are IMO symbols used for marking escape ways and locations of emergencies equipment?

     

5.Are Pilot ladders and related boarding arrangements clean, and in good condition?

     

PART I : LIFESAVING APPLIANCES YES NO N/A REMARKS

1.Life buoys with reflective tape, markings, lights and smoke signals on board I required numbers / locations?

     

2.Required numbers of lifejackets with whistles, retro-reflective material and lights available?

     

3.Required number of immersion suits and thermal protective aids available, proper size for crew, and serviced per manufacturers specs (≤3 yrs.)?

     

4.Muster list and emergency instructions provided to crew members and posted on the bridge, in the engine room and accommodations?

     

5. Life Rafts      

6.Embarkation ladders in good condition including forward ladder?

     

PART J: FIREFIGHTING EQUIPMENT YES NO N/A REMARKS

1.Weekly, monthly and quarterly maintenance, 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.      

Page 8 of 12

PART K: HULL YES NO N/A REMARKS

1. Plimsoll mark properly marked and painted, corresponding to the load line certificate?

     

2.Draft marks properly marked and painted on bow and stern?

     

3. Condition of shell plating satisfactory?      

4. Opening in hull satisfactory?      

5. Condition of deck plating satisfactory?      

6. Condition of hatch covers satisfactory?      

7. Condition of rails satisfactory?      

8.Deck scupper pipes free of obstructions and in good condition?

     

9.Air pipes / closing appliances in acceptable condition & operable?

     

10.Anchors. Windless and mooring arrangements satisfactory?

     

11.Maintenance of masts, cranes, and rigging satisfactory?

     

ALL TANKER VESSELS:

12.Fore and aft walkways and gangways in acceptable condition?

     

13.Cargo and ballast deck lines in good condition and free of leakages?

     

14.PV valves free of leakages, working and in 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

Page 9 of 12

1. Engine Control room

2. Emergency lights marked      

3. Main engine free of oil and water leakages?      

4.Auxiliary engines /generators in good operating condition?

     

5.Boilers and steam system appear satisfactory and free of excessive leakages?

     

6.Exhaust manifold and exhaust lines in satisfactory condition?

     

7.Engine room vent and ducting system in good condition?

     

8.Bilge and ballast pumps in good operable condition?

     

9.Feed and cooling pumps and valves in good condition?

     

10. Shipboard waste incinerator satisfactory?      

11. Purifiers and purifier space satisfactory?      

12. Fresh water coolers free of leakages      

13.Air compressors and piping, valves in good condition?

     

14.Engine room firefighting equipment is satisfactory?

     

15.Engine room bilges and other machinery areas free of oil, debris and other fire hazards?

     

PART M: STEERING YES NO REMARKS

1. Full movement of rudder verified (35 port to 35 starboard)?

     

2.Steering linkage in satisfactory condition and operating properly?

     

3. System free of excessive leaks?      

4.Means of communication between the navigation bridge and the steering compartment satisfactory?

     

Page 10 of 12

5. Change over procedure diagrams posted?      

6. Emergency steering systems operating properly?      

7.Heading information displayed visually at 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:

     

DOCUMENTATION & RECORDS:

     

HULL, DECKS & FITNESS:

     

MACHINERY & ELECTRICAL:

     

ACCOMODATION (Internal / External):

     

SAFETY & FIREFIGHTING:

     

CREW PERFORMANCE/COOPERATION:

     

Page 11 of 12

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 12 of 12