Ballast Water Management Reporting Form
1. Ship Information
Vessel Name
IMO Number
Flag
Reporting Date (YYYY-MM-DD)
Arrival Port
Arrival Date
2. Ballast Water Summary
Total ballast water on board (m³)
Capacity of all ballast tanks (m³)
3. Ballast Water Tanks
Tank Name/No.
Capacity (m³)
Ballast Loaded (m³)
Ballast Discharged (m³)
Exchange or Treatment Performed
4. Ballast Water Management Methods
Type of Management (Exchange, Treatment, None)
If treatment, system description
Were all ballast water exchanges conducted according to regulations?
Yes
No
5. Additional Information
Comments / Notes
Name of Officer completing form
Signature
Date