Port State Control Inspection Report

General Information

Vessel Name IMO Number Flag State Port of Inspection Date of Inspection Inspector(s)

Ship Particulars

Type
Gross Tonnage
Year Built
Owner
Operator
Master's Name

Documents Checked

Document	Checked	Remarks
Certificate of Registry
International Tonnage Certificate
Safety Management Certificate
Safe Manning Document

Deficiencies Found

No.	Description	Code	Action Taken

Inspection Summary

General Remarks Follow-up Actions Required Inspector's Name & Signature Date