Flag State Annual Inspection Form

Vessel Information

Vessel Name IMO Number Call Sign Flag Owner Operator Port of Registry

Inspection Details

Inspection Date Location Inspector Name Report Number

Inspection Checklist

Item	Compliant	Remarks
Certificates Validity
Safety Equipment
Navigation Equipment
Pollution Prevention
Fire Fighting Equipment
Life Saving Appliances
ISM/ISPS Compliance

Deficiencies (if any)

Inspector's Comments

Master/Owner Acknowledgement

Master/Owner Name Date Signature