Ballast Water Risk Assessment Form
Ship Information
Vessel Name
IMO Number
Flag State
Call Sign
Port of Registry
Voyage Information
Previous Port
Date of Arrival
Next Port
Date of Departure
Ballast Water Summary
Tank Name/No.
Capacity (m³)
Volume on Arrival (m³)
Source Port/Location
Received Date
Method of Ballast Water Management
Details of Exchange/Discharge
Assessment of Risk
Are there any known or suspected invasive species from source region?
Yes
No
Unknown
Comments on Ballast Water Management/Operations
Potential Environmental Concerns
Inspector's Notes
Additional Comments / Observations
Inspector Name
Signature
Date