Declaration of Survey and Record of Construction and Equipment For the Periodical Survey of a Local Vessel Certificate Of Ownership No. or
Name Of Vessel:Approval-In-Principle No.:
Class II /III
Type :
Category A / B
Length Overall (m) :
Length (L) (m) :
Extreme Breath (m) :
Gross Tonnage:
Net Tonnage :
Material of Hull:
Date of Last Survey____________________________ at
(Annual / Biennial / Triennial / Quadrennial*) Periodical Survey
Type of periodical survey (Annual / Biennial / Triennial / Quadrennial*) conducted in this survey
Part 1
Periodical Survey Items @
Class/Category
Item
Survey
No
Item
/Type
of Vessel
Survey Intervals
(*1) (*11)
A
Comment
Class IIA, IIIA
Class II B,
Date
Vessel (*15)
III B Vessel (*16)
Surveyed
Surveyor
(see details
below #)
1
2
4
1
2
4
GENERAL AND SAFETY EQUIPMENT
Fixed Fire Extinguishing Installation
1
(a) CO2 system
- blowing test
3
(b) Sprinkler System - spraying test
2
(*7)
- hydraulic test
Fire Extinguisher CO2 Bottle
3
- refill and hydraulic test
3
(*8) & (*12)
4
Buoyant Apparatus
- submerging test
B
HULL AND FITTINGS
5
Hull
-
(*9)
external (incl. ship
bottom) inspection
3
3
(*10)
internal (excl. oil, water
6
-
tanks and void spaces)
inspection
internal (incl. oil, water
7
-
tanks and void spaces)
3
(*10)
inspection (*2) & (*13)
1
M.O. 929 (PER)
3
* Delete where not applicable gauging thickness of deck,
8
-
3
3
shell and bulkhead plating
(*10)
(*3) & (*13)
9
10
C&D
1
Sea Suctions, Discharging Valves
3
3
- stripped down inspection
(*10)
Anchors, Cables- ranged out for
3
inspection (*13)
MACHINERY AND ELECTRICAL INSTALLATION
Main Engine
-
hydraulic test of
3
coolers (incl. air, lub.
oil, cooling water),
(by engine
cylinder head and water
workshop) (*4)
jacket
2
-
overhaul of fuel oil
3
pump, fuel nozzles
(by engine
workshop) (*4)
3
Main Engine and Gear Box
3
- stripped down for inspection (*5)
(by engine
workshop) (*4)
Generator engine- stripped down for
4
3
inspection
(by engine
workshop) (*4)
Main fire pump, emergency fire
5
pump, bilge pump, windlass -
3
stripped down for inspection
6
Air Receiver
(P<17.2bar)
7
8
-
Air Receiver
(P≥17.2bar)
9
-
-
internal
3
inspection
hydraulic
test
3
(*13)
internal
inspection
hydraulic
(*13)
test
3
3
3
3
3
3
Tail Shaft, Propeller, Rudder and
10
Rudder Stock (*13)
3
- drawn out for inspection
2
M.O. 929 (PER)
* Delete where not applicable Independent Cement Tank
-internal inspection & thickness
11
3
gauging (*14)
Independent Cement Tank
12
3
-external inspection(*14)
Independent Fuel Oil Tank
13
3
-internal inspection & hydraulic test
Independent Water Tank for Water
14
3
Boat - hydraulic test
Oil Pollution Prevention Installation
15
(*6)
- vessel with HKOPP certificate
- vessel without HKOPP Certificate:
- hydraulic test of independent
16
3
bilge water/sludge holding tank
17
Main Circuit Breaker Load Test
18
Pump Room – inspection
(*15)
Cargo Tank Vent Piping System –
19
inspection
(*15)
Cargo Tank Lids – inspection (*15)
20
3
3
3
@ If the periodical survey items are not applicable in this year, it may be carried on final inspection at Part 2 of
t h i s form.
Remark
#
Comments on conditions
Each of the survey item in this declaration report must be classified / coded as indicated below:
A
=
AW =
N
NA
=
=
Condition satisfactory/ acceptable
Acceptable with deficiencies which would neither affect seaworthiness of the vessel nor the safety of person onboard.
Owner /agent is required to monitor for further deterioration and required to take appropriate remedial action ( see report
attached).
Not acceptable ( see report attached). Not applicable * Notes in Part 1
*1
Survey Intervals
1 2 4 -
*2
to be conducted every year to be conducted every two years to be conducted every four years
The periodical survey should be carried out in subsequent order; i.e. a 1st year survey should be followed by a 2 - yearly survey ,
a 3rd year survey should be followed by a 4- yearly survey, etc
In inner bottom spaces not provided with access holes, at least 5% of area of the inner bottom plate, in at least five sufficiently
scattered locations, should be opened up to facilitate inspection of the inner bottom spaces.
3
M.O. 929 (PER)
* Delete where not applicable *3
*4
*5
*6
*7
*8
Applicable to vessels of age exceeding 8 years. For vessels possessing International Load Line Certificate the gauging
inspections may be arranged when in the renewals of the load line certificate.
Inspection record issued by engine workshop should be submitted for reference.
For a brand new gear box, the strip down inspection should begin from the fourth anniversary the gear box is in service.
For the renewal of HKOPP Certificate, oil pollution prevention installation should be stripped down for inspection. Independent
bilge water holding/sludge tank should be hydraulic tested.
Hydraulic test for CO2 and sprinkler systems should begin from the 10th anniversary the system is in service, and thereafter at
intervals of 10 years. The hydraulic testing pressure for the CO2 system high pressure manifold should not be less than 125 bar.
Inspection for portable fire extinguishers and CO2 bottles should be in accordance with the following table. The inspection record
should be retained on board for examination.
9 l, 45 l Water, Foam,
Dry Powder Fire Extinguisher
CO2 Fire Extinguisher,
CO2 Fixed Installation Bottle
Refill/ Weighting
(*a)
Hydraulic
Test (*b)
Weighting
Refill
Hydraulic
Test (*b)
Owner (*c)
/FSIC
FSIC/MD
FSIC/MD
DG Reg 62
DG Reg 66
Abbreviation
FSIC:
Fire Service Installation Contractors registered in the Fire Service Department, or institutions acceptable to the
Director
DG Reg 62:
A person holding a Dangerous Goods Licence issued under Reg. 62, Dangerous Goods (General) Regulation
DG Reg 66:
A person approved by Fire Service Department under Reg. 66, Dangerous Goods (General) Regulation
MD :
Marine Department officer
Note
(*a)
(*b)
*9
*10
*11
*12
*13
*14
*15
*16
The need for refilling should be in accordance with the instruction of manufacturer of fire extinguisher.
Intervals of hydraulic test:
Portable Fire Extinguishers
- 5 years
CO2 bottles
- 10 years
(*c)
MD officers may examine the owner’s competence on carrying out the servicing and conduct random checks
including function test of the portable fire extinguishers.
Air case not filled with buoyant materials should be tested for air tightness by submerging in water.
Applicable to ceremonial boat and dumb lighters only.
If the hull and machinery installation of a classed vessel are inspected by a surveyor of classification society, the inspection
reports/certificates issued by classification society should be submitted for record. For dangerous goods carriers, oil carriers and
noxious liquid substances carriers, MD officer should be invited for each hull external inspection carried out according to
classification society's survey programme. Class I category A vessels should be inspected as per COP Ch. II / Pt. 7 Table 2.
Applicable to Class II Category A vessels such as DG Carrier, Oil Carrier and NLS Carrier
For guidance on machinery and hull wear down or corrosion tolerance limits and other inspection items refers to COP Annex M.
Upon satisfactory inspection, Survey Record will be issued.
Those category A vessels specified in COP Annex I-7A , I-7E, N-6A and N-7A should be referred for survey.
Those category B vessels specified in COP Annex I-7E, I-7F, I-7G, N-4B, N-4C, N-5, N-6A and N-7B should be referred for
survey .
4
M.O. 929 (PER)
* Delete where not applicable Final Inspection (*1)
Part 2
Comment
Date
Survey Items (*2)
No
(see detail
Surveyor
Surveyed
in Part 1
#)
A&B
1
GENERAL, HULL & SAFETY EQUIPMENT
Life Saving Appliances - inspection and function test
Fire Fighting Appliances (incl. CO2 fixed fire extinguishing installation, emergency fire
2
pump)
3
- inspection and function test
Navigation Lights and Sound Signals - inspection and function test
Watertight/ weather-tight Closing Appliances (incl. door, ventilator, air pipe, etc.) -
4
inspection
5
Freeboard Mark / Load Line Mark - verification
Passenger Space (incl. escape signs, 'No Smoking' signs, etc.), Crew Space, Escape
6
Arrangement, Bulwarks and Rails - general inspection
7
8
C&D
General condition in Machinery Space
(a) -
protection from injury of personnel
(b) -
prevention of fire hazard
(c) -
prevention of oil pollution hazard
Verification of principal dimensions, engine and major machinery particulars
MACHINERY AND ELECTRICAL INSTALLATION
1
Main Engines, Generator Engines, Steering Gears - running test
2
Engine Emission Assessment (*3)
Unattended Machinery Space Installation (COP Ch. IIIA/Pt 3/18 and Ch. IIIB/Pt 3/13 refer)
3
- function test
4
Air Receiver/ Cement Tank Safety Valves - function test
5
Bilge and Oily Water Pumping System - function test
6
Prevention of Oil Pollution Installation - function test
7
Electrical Circuit
-
earthing test
8
-
insulation resistance test (*4)
9
-
main circuit breaker function test (*5)
10
Meters on Switchboard - function test
11
Domestic L.P.G. Installation - inspection
E&F
RADIO & NAVIGATIONAL EQUIPMENT AND OTHERS
1
Radio Communication Equipment
2
Navigational Equipment
3
Verifying Certificates of Competency of Master and Engineer(if manoeuvring test required)
5
M.O. 929 (PER)
* Delete where not applicable 4
Permanent ballast - confirmation of amount and position
5
Fire Drill, Abandon Ship Drill (*6)
6
Ship Manoeuvring Trial (*8)
7
Operational and Safety Trial (*9)
8
Drawings required to be retained onboard - confirmation of numbers and contents (*7)
9
Survey report issued by MD/AS/AO/RA - verification
10
Inspection of remedial items in Periodical Survey
11
Marking of Safe Working Load and Certificate of Lifting Appliances – verification (*10)
Supplementary information/data and list of inspection, testing & trial requirements
relating to the type of vessel
12
Note: MD=Marine Department; AS=Authorized Surveyor; AO=Authorized Organization; RA=Recognized Authority
Remark
[initial of Surveyor]
* Notes in Part 2
*1
The Final Inspection should be carried out annually except the following types of vessels:
Category B Fishing Vessel, Ice Boat, Fish Drying Barge, Waste Water Treatment Barge and Live Fish Dealing Boat:
Vessels of length overall X extreme breadth not exceeding 25m2
(a)
2
(b)
*2
*3
Vessels of length overall X extreme breadth exceeding 25m
- triennially
- biennially. *9
Where practicable the listed items may be presented for inspection prior to the Final Inspection.
Engine emission requirements to be conducted as per COP Ch. ⅢA/Pt.7.6, Marine Department Notice 46 of 2008 and the
applicable requirements of MS (Prevention of Air Pollution) Regulation.
Applicable to all vessels other than Category B wooden construction vessel, COP Annex M refer. (Electrical system insulation test report issued by EMSD qualified registered engineer or electrician are also acceptable). Applicable to all vessels fitted with generator of each capacity exceeding 50 kW.
Applicable to launches, ferries, floating restaurants, oil carriers, dangerous goods carriers and noxious liquid substances carriers and vessels plying beyond Hong Kong waters. COP Ch. II /Pt. 6 refers. Applicable to ferry vessels only. The trial should include crash ahead and astern running, turning and windlass operation test. ( Valid sea trial permit should be produced at the time of the trial).
Applicable to vessels of the type stated in COP Ch. I/Pt. 4 /4.2 .
*10
The following document/certificates certified by competent examiner should be presented in Final Inspection for verification of
*4
*5
*6
*7
*8
validity.
i)
Register of Lifting Appliance & Lifting Gear (Form 1); ii)
Certificate of Test and Examination of Winches, Derricks and their Accessory Gear (Form 2); iii) Certificate of Test and Examination of Lifting Appliance and their Accessory Gear other than Derricks (Form 3).
6
M.O. 929 (PER)
* Delete where not applicable Part 3
Record of Equipment and Operational Conditions
Name of Vessel ..…..…..…......………………………………...………………………………
Certificate of Ownership Number……….. …..……..… Class ….. …..….............…..............………......
Category…………………………………………..………
Type.........................………………......
Length Overall (m) ..........................…………… Length (L) (m) .............…..….............
Extreme Breadth (m). ....………………..……................
Gross Tonnage..............................……………
Material of Hull……………………………………………
Net Tonnage......................…..…...…..
:
(1) This is to certify that the vessel has equipped with the followings :
(4) (a) That the minimum safe manning
(2)
…………..…
of crew
That the vessel is provided with the following life saving
(b) That the number of passengers the vessel can carry are
appliances and radio equipment :
as follows:
…….. motor lifeboat(s)
……inflatable liferaft(s)
……buoyant apparatus(es)
Deck levels
………adult lifejacket(s)
………child lifejacket(s)
………lifebuoy(s), including.
No. of Passengers
2nd upper deck level
……………………
1st upper deck level
……………………
Main deck level
……………………
Sunken deck level
……………………
………with self-igniting light(s)
………self activating smoke(s)
Other level
……………………
………with buoyant lifeline(s)
Maximum number of passengers
permitted onboard
………line-throwing appliance(s)
(c) Total number of persons
permitted to carry
………rocket parachute flare(s)
………V.H.F. radio installation
………radar transponder
………radio communications equipment
……………..………
……….……………
(5) That the vessel is required to be fitted with [Required/
radar.
Not required]
In addition, the radar operator is required to
complete a radar training course approved
by the Director.
(3)
That the vessel is provided with the following fire fighting
apparatus:
……fire detection and alarm system(s)
(6) That the vessel is permitted to ply with a
Combined Coxswain and Engineer.
[Yes/No ]
……fixed CO2 fire extinguishing system(s)
……non-portable fire extinguisher(s),
including:
(7) That the vessel is permitted to tow. (No
[Yes/No ]
…….…45L foam
…….… 16kg CO2
passengers can be carried when towing)
……portable fire extinguisher(s), including:
…………foam
…………CO2
…………dry powder
………… water type
……fire pump(s), including:
……..…manual
………power
……fire hydrant(s)
………fire hose(s)
……jet nozzle(s)
………fireman’s outfit(s)
(8)
That the safe navigation limit of the vessel is:
Specified Sheltered Waters / Waters of Hong Kong / River
Trade Limits
……fire buckets with lanyard(s)
……fire sand boxes with scoop(s)
……fire blanket(s)
……international shore connection(s)
…………………………………………………………………………
(Note: When navigating beyond Waters of Hong Kong, no
passenger is permitted to carry.)
Ownership and Related Information:
Owner of vessel :
Address: Certificate of Ownership No.
….….………….…….………….………………………… Year of build
7
M.O. 929 (PER)
………………………
* Delete where not applicable Starting date of survey cycle
….….………….……………….…………………………
Date of first final inspection
………………………
Particulars of Key Installations
(9)
This vessel has ………………………. …… tonnes of permanent ballast onboard.
[Yes/No ]
(10)
(a) The vessel is fitted with propulsion system.
(b) Number of propellers fitted in the vessel:
[Yes/No ]
(c)
………………
Number of water-jets fitted in the vessel:
………………
(11) The vessel is fitted with auxiliary machinery.
[Yes/No ]
3
(12) Fuel tank capacity (m )
(13) Main Engine Information :
No. of tanks.
in
Type of Fuel : [Diesel / Petrol ] [ N.A.]
Port
Center
Starboard
Maker & Model
Serial Number
Type / RPM
Total Power (kW)
Power (kW)
(14) Auxiliary Engine Information Type of Fuel : [ Diesel / Petrol ] [N.A.]
1
2
3
4
5
6
7
8
Maker & Model
Serial Number
Type / RPM
Power (kW)
Maker & Model
Serial Number
Type / RPM
Power (kW)
Total Power (kW)
[Yes/No ]
(15) The vessel is fitted with lifting appliances/ derrick cranes.
(a) Lifting appliances holding valid Initial and Annual / Quadrennial Certificate of Test and Examination.
(b) The Safe Working Load specified on the valid Certificate of Test and Examination is
Number of lifting appliance
1
2
3
4
Safe Working Load (tonnes)
(16)
LPG installation for domestic use is fitted onboard (the capacity of LPG not exceed 50kg).
[Yes/No ]
(17)
Compressed air system is fitted onboard.
[Yes/No ]
(18)
Comply with the applicable requirements of MS (Prevention of Air Pollution) Regulation
8
M.O. 929 (PER)
* Delete where not applicable The above survey declaration for the vessel is intended for the issue of Certificate of Survey and following certificate /
document:(1)
Survey Record of Safety Equipment ※
[ Yes / No / NA ]
(2)
Hong Kong Load Line Certificate / Freeboard Assignment Certificate
[ Yes / No / NA ]
(3)
Survey Record of Tonnage Measurement
[ Yes / No / NA]
(4)
Survey Record of Inspection for Cement Tank / Air Receiver/ Material / Equipment Test
[ Yes / No / NA ]
Are following certificates/ document required for the operation of the vessel ( if yes, relevant plans approval and information are to be
processed):(5)
Exemption Certificate/ Permit for alternative material, fitting or equipment
[ Yes / No / NA ]
(6)
International Tonnage Certificate
[ Yes / No / NA ]
(7)
Minimum Safe Manning Document
[ Yes / No / NA ]
(8)
International Load Line Certificate
[ Yes / No / NA ]
(9)
International※ / Hong Kong Oil Pollution Prevention Certificate
[ Yes / No / NA ]
(10) International※ / Hong Kong Pollution Prevention Certificate for the Carriage of Noxious Liquid Substances in Bulk
[ Yes / No / NA ]
(11) International※ / Hong Kong Air Pollution Prevention Certificate
[ Yes / No / NA ]
(12) Declaration of Fitness for the Carriage of Dangerous Goods ※
[ Yes / No / NA ]
(13) Register & Certification of Lifting Appliances and Lifting Gear ※
[ Yes / No / NA ]
(14) Other:_______________________________________________
Note:
※
Submission of Convention Certificates may be acceptable to MD
For the above required certificate(s), the survey work
(i)
for item(s) _________________ are expected completion by( date)__________________
(ii) rest of item(s) _________________
are expected completion by (date )
__________________
(iii) completion date will be separately advised by Owner.
Supplement information for the above:
9
M.O. 929 (PER)
* Delete where not applicable Remarks
I understand the approved plans and declare that the above surveys were conducted in accordance with the
requirements of the Merchant Shipping ( Local Vessels) Ordinance, Cap 548, its relevant regulations and MS
(Prevention of Air Pollution) Regulation, codes and standards as required to my satisfaction. The survey confirms
that the structure, equipment, system, fittings, arrangement, workmanship and material of the vessel and the
condition thereof are in all respects satisfactory and that the vessel will in my judgment be sufficient until
(1)
………………………………….
Supplement survey reports to be attached, if applicable. [ Yes / No ] Signature of Authorized Surveyor / Authorized Organization (AO) Representative / Recognized Authority (RA) Representative *: ___________________________________________________
Name of Authorized Surveyor / AO Representative / RA Representative* (in block letter): __________________________________________________________
Name of AO / RA*: _______________________________________________________________________
Place of Survey : _____________________________Date of Completion : _____________________________
Note(1):
The valid date is normally not more than 12 months. In case of obvious deficiencies are found, the valid date
(period from one to two months) is to be proposed by authorized surveyor / AO / RA to be agreed with Marine
Department in advance.
10
M.O. 929 (PER)
* Delete where not applicable Report of Periodical Survey & Final Inspection Comments on Conditions
Those survey items in this declaration report if classified/ coded as either “AW “or “N” are required to give details summary
of comments in the table below.
Note: AW = Acceptable with deficiencies which would neither affect seaworthiness of the vessel nor the safety of person onboard.
Owner /agent is required to monitor for further deterioration and required to take appropriate remedial action (see report
attached).
N
= Not acceptable (see report attached).
Survey Part &
Nature of defect / deficiency
Item No.
Comments, including remedial action and evidence of
rectification required before issue of Certificate
Continued on separate sheet if necessary with page numbering.
Signature of Authorized Surveyor / Authorized Organization (AO) Representative / Recognized Authority (RA) Representative *: ________________________________________________________ Name of Authorized Surveyor / AO Representative / RA Representative* (in block letter): _________________________________________________________________ Name of AO / RA*: ________________________________________ Date:_______________________________ Follow-up Inspection of Remedial Items (if applicable)
Survey Part &
Item No.
Nature of defect / deficiency
Comments, including remedial action and evidence of rectification
required before issue of Certificate
Continued on separate sheet if necessary with page numbering.
Signature of Authorized Surveyor / Authorized Organization (AO) Representative / Recognized Authority (RA) Representative *: ________________________________________________________ Name of Authorized Surveyor / AO Representative / RA Representative* (in block letter): _________________________________________________________________ Name of AO / RA*: ________________________________________ Date:_______________________________
11
M.O. 929 (PER)
* Delete where not applicable