Ballast Water Management PSC Inspection Form
1. Vessel Information
Ship Name
IMO Number
Flag
Port of Inspection
Date
2. Ballast Water Management Documents
Document
Available
Remarks
International Ballast Water Management Certificate (IBWMC)
Yes
No
Ballast Water Management Plan (BWMP)
Yes
No
Ballast Water Record Book
Yes
No
3. Ballast Water Management System (BWMS)/Method Used
Type of BWMS / Method
Operational?
Yes
No
4. Record Book & Procedures
Entries Properly Maintained?
Yes
No
Latest Entry Date
5. Ballast Operations/Exchange
Tank(s)
Date/Time
Location
Volume Exchanged (m³)
Method
Remarks
6. Deficiencies/Comments
Inspector Name
Inspector Signature
Date