| Vessel Name | IMO Number | ||
|---|---|---|---|
| Call Sign | ETA | ||
| Berth No. | Cargo |
| Ship Representative | Shore Representative | ||
|---|---|---|---|
| Contact Number | Contact Number |
| No. | Item | Check (Yes/No) | Remarks |
|---|---|---|---|
| 1 | Berthing plan and mooring arrangements agreed | ||
| 2 | Communication system established between ship and shore | ||
| 3 | Emergency procedures discussed and agreed | ||
| 4 | Fire-fighting equipment ready and checked on both sides | ||
| 5 | Ship/Shore connection arrangements in place | ||
| 6 | Cargo transfer procedures reviewed and agreed | ||
| 7 | Documentation exchanged | ||
| 8 | Personal protective equipment in use | ||
| 9 | Relevant warning signs displayed | ||
| 10 | Other (specify) |
| Ship Representative | Date/Time | ||
|---|---|---|---|
| Shore Representative | Date/Time |