| Ship Name | IMO No. | ||
|---|---|---|---|
| Terminal | Date | ||
| Berth | Time |
| Item | Ship | Shore | Remarks |
|---|---|---|---|
| Is the mooring arrangement satisfactory? | |||
| Are gangways correctly positioned and safe? | |||
| Is adequate lighting provided? | |||
| Is emergency escape/evacuation plan agreed and posted? | |||
| Are firefighting and lifesaving appliances in good order and accessible? | |||
| Is the communication system agreed & tested (e.g. VHF, telephone)? | |||
| Are security measures in place and agreed (ISPS/Access Control)? | |||
| Are environmental protection measures in place (spill response, waste receptacles)? | |||
| Are portable/mobile equipment (vehicles, lifts) operated safely? | |||
| Are procedures for passenger movement agreed? | |||
| Are all regulatory and local requirements met? |
| Ship Representative | Terminal Representative |
|---|---|
Signature: Date/Time: |
Signature: Date/Time: |
| Name: | Name: |