Shipboard Potable Water Sanitation Verification Form
Ship Name
IMO Number
Inspection Date
Inspector Name
Crew Contact/Position
Potable Water System Description
Verification Checklist
Item
Status
Remarks
Visual inspection of storage tanks
Condition of pipelines and fittings
Disinfection and chlorination records
Water sampling and testing results
Distribution points (fountains, taps)
Findings and Observations
Corrective Actions Required/Recommendations
Inspector Signature
Date