| Vessel Name | |
|---|---|
| IMO Number | |
| Flag | |
| Port of Registry | |
| Type of Vessel | |
| Gross Tonnage | |
| Date of Inspection | |
| Location | |
| Inspector Name | |
| Inspector Organization |
| Description | Status | Remarks |
|---|---|---|
| Plimsoll Mark (centered and visible) | ||
| Fresh Water Load Line | ||
| Salt Water Load Line | ||
| Tropical Load Line | ||
| Winter Load Line | ||
| Mark Dimensions per Certificate | ||
| Correct Position Relative to Midship |
| Load Line Certificate No. | |
|---|---|
| Certificate Expiry Date | |
| Last Survey Date |
| Inspector Signature | |
| Date |