PSC Inspection Report - Flag State

1. Vessel Information

Vessel Name IMO Number Call Sign Flag State Type of Ship Gross Tonnage Year Built

2. Inspection Details

Inspection Date Port Inspector Name(s) Inspection Type

3. Certificates

Certificate	Issued By	Issue Date	Expiry Date

4. Deficiencies Found

No.	Nature of Deficiency	Regulation/Convention	Action Taken

5. General Remarks

6. Inspector’s Signature

Name Date