| No. | Emergency Procedures/Items | Ship | Shore | Remarks |
|---|---|---|---|---|
| 1 | Has a ship/shore emergency communication signal/procedure been agreed upon? | |||
| 2 | Are emergency shutdown procedures understood and agreed? | |||
| 3 | Are fire and emergency assembly points identified? | |||
| 4 | Is the location of the nearest emergency equipment known to all? | |||
| 5 | Are the means of raising an alarm understood by both parties? | |||
| 6 | Are escape routes and muster stations identified and unobstructed? | |||
| 7 | Is the responsibility for lifeboat/life raft launching/inflation clarified? | |||
| 8 | Is the availability and use of personal protective equipment confirmed? | |||
| 9 | Is a system for notification to local authorities established? | |||
| 10 | Any additional agreed emergency procedures? |
| Ship Representative | Shore Representative |
|---|---|
|
Name: Signature: Date/Time: |
Name: Signature: Date/Time: |