1、船舶安全检查清单PSCLIST OF SHIP SAFETY INSPECTION船 舶 安 全 检 查 清单M.V. _IMO Number_Official Number_ Call Sign:呼号：Type of ship:船型：Date of Keel Laid:龙骨铺设日期：Ship Dimensions#(L x B X D, metres):船舶尺寸（长X宽X高，单位：米。）：Gross Tonnage:总吨：FLAG STATE:船籍国：Classification Society(s):船级社1st Inspection第一次检查Surveyor检查人:Date of Ins
2、pection日期:Place of Inspection地点:2nd Inspection第二次检查Surveyor检查人:Date of Inspection日期:Place of Inspection地点:3rd Inspection第三次检查Surveyor检查人:Date of Inspection日期:Place of Inspection地点:4th Inspection第四次检查Surveyor检查人:Date of Inspection日期:Place of Inspection地点:DOCUMENTATION 证书Statutory Certificates 法定证书 No
3、te: N.A.- Not Applicable 注: N.A - 不适用 DocumentIssuingAuthority发证机关IssueDate发证日期ExpiryDate过期日期LastEndorsementDate上次签证日期Certificate of Registry国籍证书 Ships Radio Station License电台执照 International Tonnage Certificate (1969)国际吨位证书International Load Line Certificate 国际载重线证书International Load Line Exemption
4、 Certificate (if any)国际载重线免除证书(如有)Cargo Ship Safety Construction Certificate货船安全构造证书Cargo Ship Safety Construction Exemption Certificate(if any)货船安全构造免除证书(如有)Cargo Ship Safety Equipment Certificate货船安全设备证书Record of Equipment (Form E)设备记录(E表)Cargo Ship Safety Equipment Exemption Certificate (fixed fi
5、re fighting)货船安全设备免除证书(固定消防设备)Document of Compliance with the special requirements for ships carrying dangerous goods危险品适装证书Cargo Ship Safety Radio Certificate货船无线电安全证书Record of Approved Cargo Ship Radio Installation (Form R)货船无线电设备安装认可记录(R表)Cargo Ship Safety Equipment Exemption Certificate (GMDSS i
6、tems)货船安全设备免除证书(GMDSS条款)Document of Compliance (ISM Code)符合证明DOC (安全管理规则)Safety Management Certificate (ISM Code)安全管理证书SMC(安全管理规则)International Oil Pollution Prevention (IOPP) Certificate国际防油污证书(IOPP)Record of Construction and Equipment (Form A for ships other than oil tankers)构造和设备记录(A表)(除油轮以外其他船)M
7、inimum Safe Manning Certificate最低安全配员证书Other Certificates/Documents/Records其他证书文件和记录Certificate / Document证书/文件证明Issue Date发布日期Remarks备注*Certificate of Class船级证书Record of Continuous Survey of Hull and Machinery船体，机械循环检验记录Enhanced Survey Report File (for Bulk Carriers) andSupporting documents加强检验报告(散
8、货船)和支持文件Record of Conditions of Assignment of Load Lines载重线勘定状态记录Record of Approved Cargo Ship Safety Equipment货船安全设备认可记录Record of Cargo Ship Safety Radio Equipment货船无线电安全设备记录Liferaft servicing certificates救生筏检验证书Liferaft hydrostatic release servicing certificates救生筏静水压力释放器检验证书CO2 bottles and system
9、 servicing record二氧化碳系统和钢瓶检验记录CO2 bottles hydraulic test record二氧化碳钢瓶压力试验记录 Fire extinguishers servicing record灭火器检验记录Dangerous goods manifest or stowage plan (if any)危险品舱单和配载计划（若有）Certificate of compliance for the carriage of solid bulk cargoes固体散装货物适装证书Cargo gear book and testing certificates (if
10、any)(period for test: 4 years or 5 years)起重设备和试验证书（若有） （检验期：4或5年。）Shore Base Maintenance Contract for GMDSSGMDSS设备岸基维护协议书B.A. bottles hydraulic test record (period for test: 5 years)呼吸器瓶压力试验记录(试验期限:5年)* To note if there is any condition of class如有任何船级社条件证书请说明Documents and Plans to be posted up onboa
11、rd 船上需要张贴的文件和计划Documents / Plans证书和图表Posted张贴Remarks备注Yes有No无Fire Control Plan防火控制图Muster lists and emergency instruction应变部署表(Navigation bridge, engine room and crew accommodation spaces) 驾驶台，机舱，船员住舱IMO Symbols related to LSA & FFA. Res. A. 760(18), A.654(16)IMO救生,消防设备符号表Illustrations and instructi
12、ons of method of donning lifejackets(Muster stations)救生衣穿着方法的指南和图解Posters and signs in the vicinity of lifeboats, liferafts, rescue boats and their launching controls在救生艇,救生筏和救助艇及其释放控制处附近张贴图解和标示 Damage Control Plan (for ships constructed on or after 01.02.1992)(Navigation bridge)破损控制计划(图)(适用于1992.2.
13、1或以后建造的船舶) (驾驶台)Block diagram showing change over procedures for remote steeringGear control systems and steering gear power units(Navigation bridge and steering gear compartment)舵机遥控系统和舵机电源切换程序方框图.(在驾驶台与舵机房张贴)Manuals, Booklets and Record Book 手册、小册子和记录薄Manual / Booklet / Record Book手册、小册子和记录簿Provid
14、ed提供Remarks备注Yes有No无Approved stability booklet, associated stability plansand stability information认可的稳性计算书，相关的稳性计划和稳性资料Approved grain loading information booklet认可的谷物装载资料手册Approved document of authorization for the carriage of grain认可的谷物适装证书Bulk Carrier Booklet (to prevent excessive stress in ships
15、 structure, the required information may be contained in the intact stability booklet)散货船手册（为了避免船舶结构承受太大的应力，在稳性手册里应提供相关资料）Approved Shipboard Oil Pollution Emergency Plan (SOPEP) (Marpol 73/78, Annex l, Reg. 26)认可的船上油污应急计划（MARPOL 73/78）Oil Record Book Part l (Machinery Space Operations)油类记录簿（PART 1）（
16、机械处所的操作）Approved Cargo Stowage and Securing Manual认可的积载与绑扎手册Lifesaving appliances training manual救生设备训练手册Instructions for on-board maintenance of life saving Appliances救生设备船上保养指南Fire Safety Operational Booklet防火安全操作手册Fire Fighting Training Manual消防训练手册Fire fighting Systems & Appliances Maintenance P
17、lan消防系统和设备的维修保养计划Record of Drills and Inspections演习和检查记录Record of Onboard Training 船上培训记录Garbage Management Plan垃圾管理计划Garbage Record Book 垃圾记录簿Damage Control Plan (for ships built on or after 01.02.1992)破损控制计划（1992年2月1日及以后建造的船舶适用）Damage Control Booklet (for ships built on or after 01.02.1992)破损控制手册（
18、1992年2月1日以后建造的船舶适用）Muster List and Emergency Instructions应急部署表和应急说明SOPEP Drills Log Book油污应急计划演习记录簿Deck and Engineer Log Book航海和轮机日志Radio Log Book/GMDSS Log Book电台日志和GMDSS日志Battery Log Book蓄电池日志Emergency Battery Log BOOK应急蓄电池日志Please put “” in the appropriate space. 请在相关空格中划“”。PORT STATE CONTROL INS
19、PECTION RECORD 港口国检查记录Please fill in the recent one years PSC inspection record请填写最近一年的检查记录Port andCountry港口和国家Date ofInspection检查日期Detention(Yes / No)是/否滞留No. ofDeficiency缺陷数量Code number of the relevantDeficiencies缺陷相关的行动代码Any outstanding deficiencies from previous port state control inspection ove
20、rdue or detainable items raised 在上一个港口国检查出的缺陷中有无过期未纠正的遗留缺陷或出现了滞留项目_CREW CERTIFICATES 船员证书Certificate证书Provided提供IssuingAuthority签发机关Remarks备注Yes有No无Certificate of Competency forOfficers and Watchkeeping Ratings职务船员的适任证书和普通船员的值班证书License for Officers职务船员的香港证书Medical Certificate for Fitness健康证书GMDSS O
21、perators CertificateGMDSS操作员证书CREW INFORMATION 船员资料Crew Information船员资料Remarks备注*Crew Agreement (“HKENG1”) 船员协议（HKENG10）*Term & Condition of Services (attached to “HKENG1”)服务条款（HKENG1）*List of Crew (“HKENG2”)船员名单（HKENG2）*Official Log Book (“HKLOG3”)法定记录簿（HKLOG3）*Copy of current Crew Agreement (“HKEN
22、G1”) to send to Mercantile Marine Office within 28 days from the date of “HKENG1” open船员协议书（HKENG1）复印件在协议签署后28天内递交香港海事处*Record to show the delivery of the completed “HKENG1”, Term & Condition of Services, “HKENG2” & “HKLOG3” to Mercantile Marine Office有记录表明已经把完成的HKENG1，服务情况和条款，HKENG2和HKENG3送交香港海事处。N
23、umber of crew (including Master)船员人数（包括船长）Nationalities of Officers高级船员的国籍Nationalities of Ratings普通船员的国籍Working Language工作语言Any language problem among the crew船员间的语言交流问题Work schedule工作安排表* only applicable for ships with HK flag 仅适用于香港籍船舶。NAUTICAL PUBLICATIONS 航海图书Publications出版物Updated VersionProvided/Corrected提供/改正Remarks备注Yes有No无Charts海图 Notice to Mariners航海通告Tide Tables潮汐表Nautical Almanac航海天文历Sailing Directions and Supplements航路指南及补篇List of Lights灯标表
