Ballast Water Management Flag State Inspection Template

Vessel Details

Vessel Name IMO Number Call Sign Flag State Port of Inspection Date of Inspection

Inspector Details

Inspector Name Organization

Required Documentation

Document	Available	Remarks
International Ballast Water Management Certificate	YesNo
Ballast Water Record Book	YesNo
Ballast Water Management Plan	YesNo

Equipment and System Check

Item	Status	Remarks
Ballast Water Treatment System Operational	OperationalNot Operational
Monitoring and Control Equipment	OperationalNot Operational
Alarm and Sensors	OperationalNot Operational

Crew Awareness and Training

Crew familiar with Ballast Water Management Plan Yes No Comments

Ballast Water Record Book Review

Record Book up to date Yes No Comments

Observations / Deficiencies

Inspector Signature

Date