| Vessel Name | IMO Number | ||
| Flag | Call Sign | ||
| Master's Name | Port of Arrival | ||
| ETA | Last Port |
| # | Item | Checked | Remarks |
|---|---|---|---|
| 1 | Statutory certificates valid and available | ||
| 2 | Records up to date (logbooks, drills, training) | ||
| 3 | Safety equipment in good order | ||
| 4 | Emergency systems operational | ||
| 5 | Fire detection and extinction systems/functionality | ||
| 6 | Pollution prevention equipment and records | ||
| 7 | Navigation equipment operational | ||
| 8 | Engine room, propulsion and steering checked | ||
| 9 | Accommodation and galley hygiene satisfactory | ||
| 10 | Crew familiarity with their duties |
| Name | Rank/Position | ||
| Date | Signature |