HARMONIZED ISM/ISPS AUDIT & MLC INSPECTION

LISCR MARITIME AUDIT DEPARTMENT

e-mail: audit@liscr.com;
Tel Number: 703.790.3434
mlc@liscr.com
8619 Westwood Center Dr., Vienna, Va 22182
(Please LEAVE COPY of Pages 1, 2, 3. and 4 ONLY on Board Vessel)

PART A - COMPANY and VESSEL DETAILS CLASS SOCIETY: .

SHIP NAME:      
IMO NUMBER:       TYPE OF SHIP:      
NAME OF SHIPOWNER:      
ISM COMPANY:      
COMPANY SECURITY OFFICER:
(CSO)       CSO CONTACT NUMBER:      
DESIGNATED PERSON
ASHORE: (DPA)       DPA CONTACT NUMBER:      
CONTACT NUMBER OF
MLC CONTACT:       PERSON DESIGNATED:      
PART B – PLACE and DATE of VERIFICATION
NAME of PORT:
(where verification was conducted)       DATE:      
PART C - SCOPE of AUDIT (mark as appropriate)
Interim Initial Intermediate Renewal Special/Additional
AUDIT: ISPS ISM MLC ASI

ISSC Number:       EXPIRY DATE:      

SMC Number:       EXPIRY DATE:      
MLC Number:       EXPIRY DATE:      
CERTIFICATES ENDORSED OR
DELIVERED TO VESSEL? ISSC : YES NO SMC: YES NO MLC: YES NO

NOTE: COPIES of ALL Certificates issued to the Vessel shall be signed and stamped by the Master and submitted to the Administration.
PART D – SUMMARY of FINDINGS
IMPORTANT NOTICE
THE AUDIT REPORT IS FROM A RANDOM SAMPLING AND DOES NOT CONSTITUTE CERTIFICATION, WARRANTY OR OTHER
REPRESENTATION AS TO THE SEAWORTHINESS OF THE VESSEL OR THE WORKING AND LIVING CONDITIONS ON THE VESSEL DESCRIBED
HEREIN, NOR DOES IT RELIEVE ANY PERSON OR ORGANIZATION FROM THEIR RESPECTIVE RESPONSIBILITIES AND OBLIGATIONS TO
ENSURE THAT THE VESSEL IS MAINTAINED IN A SEAWORTHY CONDITION AND IN COMPLIANCE WITH THE ADMINISTRATIONS
REQUIREMENTS IMPLEMENTING THE PROVISIONS OF MLC, 2006.
NOTICE TO MASTER: Masters must review all entries in this Report before acknowledging it. It is recommended that they discuss with the
Auditor any deficiencies, which do not agree with actual conditions prevailing on board at the time of inspection.
NOTICE TO SHIPOWNER: If you disagree with the Auditor’s comments or recommendations please contact the Administration.
Summary:
The Auditor did not find any deficiencies. We wish to commend you and the vessel's master and crew for your professionalism and for
maintaining a high standard of safety on board this vessel.

The Auditor found Non-Conformities or deficiencies which are listed below. Please send your response regarding these listed
deficiencies and the suggested Corrective Actions to the Administration within thirty (30) days.

The vessel had serious Non-Conformities or deficiencies, which were either rectified or require a corrective action plan to be accepted by
the Administration before the vessel would be allowed to depart the port. All such deficiencies are noted on the list below. You will be contacted
to schedule the vessel for an additional inspection if needed.

Additional Verification Scheduled For: _______     _______ OR Not Applicable

See Summary on next page.

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 ISM/ISPS AUDIT
Non-Conformities: (See Form(s) 206 for ISM/ISPS)
(Revert to audit@liscr.com within 30 Days with Corrective Actions which must be Completed within 3 Months)
No. Requirment Brief Description

                 

                 

                 

                 

                 

                 

                 

                 

                 

Observations/Suggestions:
No. Brief Description

           

           

           

           

           

           

           

           

           

ely,

     

PS Auditor MASTER or Shipowner Representative

ure and Stamp) (Signature and Ship’s Stamp)
NAME:       MID #       PRINT NAME:      

Use Additional Pages if necessary.

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MARITIME LABOUR INSPECTION
Serious Deficiencies:
(Must be rectified or corrective action plan accepted by the Administration before vessel can sail)
Require- Date to be Date
No. ment Description of Serious Deficiency Corrective Action Plan Rectified rectified
                                

                                

                                

                                

                                

                                

                                

                                

                                

Deficiencies:
(Must be rectified or corrective action plan accepted by the Inspector before vessel can sail)
Require- Date to be Date
No. ment Description of Deficiency Corrective Action Plan Rectified rectified
                                

                                

                                

                                

                                

                                

                                

                                

                                

                                

                                

                                

                                

                                

                                

                                

Sincerely,

           

Maritime Labour Inspector MASTER or Shipowner Representative

(Signature and Stamp) (Signature and Ship’s Stamp)
PRINT NAME:       MID #      PRINT NAME:      

Use Additional Pages if necessary.

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 ANNUAL SAFETY INSPECTION
Serious Deficiencies:
(Must be rectified or corrective action plan accepted by the Administration before vessel can sail)
Require- Date to be Date
No. ment Description of Serious Deficiency Corrective Action Plan Rectified rectified
                                

                                

                                

                                

                                

Deficiencies:
(Must be rectified or corrective action plan accepted by the Inspector before vessel can sail)
Require- Date to be Date
No. ment Description of Deficiency Corrective Action Plan Rectified rectified
                                

                                

                                

                                

                                

                                

                                

                                

                                

                                

Recommendations:

Require-
No. ment Description of Recommendation Recommended Action Plan
                    

                    

                    

                    

                    

                    

                    

ely,

     

Inspector MASTER or Shipowner Representative

ture and Stamp) (Signature and Ship’s Stamp)
NAME:       MID #       PRINT NAME:      

Use Additional Pages if necessary.

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 HARMONIZED ISM/ISPS AUDIT & MLC INSPECTION
LISCR MARITIME AUDIT DEPARTMENT

e-mail: audit@liscr.com;
Tel Number: 703.790.3434
mlc@liscr.com
8619 Westwood Center Dr., Vienna, Va 22182

(Please DO NOT leave COPY of this REPORT on Board Vessel)

PART E - OPENING MEETING

1) Introduction of Audit Team and 4) Confirmation of Scope and
7) Arrangements for Closing Meeting
Acknowledgements Purpose
2) Fill In Attendance List 5) Confirmation of confidentiality 8) Any security issues?
3) Confirmation of working
6) Audit Arrangements 9) Any questions?
language

PART F - DOCUMENT REVIEW FOR ALL COMBINED AUDITS

CERTIFICATES: CLASS SOCIETY       RECOGNIZED ORGANIZATION       RSO       ILO RO      
APPLIC- APPLIC-
AME OF CERTIFICATE ABLE?
VALID? NAME OF CERTIFICATE ABLE?
VALID?

rgo Ship Safety Equipment Certificate and International Sewage Pollution Prevention Cert.
cord of Equipment (MARPOL Annex IV)
High Speed Craft Safety Certificate
rgo Ship Safety Radio Certificate
(SOLAS X/3 HSC Code 1.8)
Permit to Operate High Speed Craft
rgo Ship Safety Construction Certificate
(HSC Code 1.9)
Wing-In-Ground Craft Safety Certificate
emption Certificate (SOLAS protocol 1/12) (MSC Circ. 1054/9)
Permit to Operate Wing in Ground Craft
ernational Tonnage Certificate (1969)
(MSC Circ. 1054/10)
International Certificate of Fitness for Carriage of Liquefied
OC of Company (Copy only)
Gas in Bulk
Document of compliance for ships carrying Dangerous
fety Management Certificate
Good s (SOLAS II-2/19.4)
Fitness for Carriage of Dangerous Chemicals in
ernational Ship Security Certificate
Bulk (BCH Code)

International Certificate of Fitness for the Carriage of

ernational Load Line Certificate
Dangerous Chemicals in Bulk (IBC)
International Certificate for the Carriage of INF Cargo
ernational Loadline Exemption Certificate
(SOLAS VII/16)

ernational Oil Pollution Prevention Certificate International Certificate of Fitness for the Carriage of Grain

ernational Pollution Prevention Certificate for the

Special Purpose Ship Certificates (Protocol 1/12)
rriage of Noxious Liquid Substances
Offshore Support Vessel Certificate Of Fitness Resolution
nker Civil Liability Convention Certificate
A.673(16)

vil Liability Convention Diving system Safety Certificate

ernational Air Pollution Certificate DMLC I and DMLC II

ernational Antifouling Certificate MLC

ntinuous Synopsis Record (CSR): Is all information up to date with all amendments, sequential numbers included SOLAS XI-1/5? Yes No
r Bulk Carriers and Oil Tankers, is the Hull Survey Report file maintained on board (See IMO Res. A 744.18 as amended) N/A Yes No
ndition Assessment Scheme (CAS) Statement of Compliance (MARPOL Annex I /13G ) N/A Yes No
ngerous Goods Manifest and Stowage Plan (SOLAS VII/4,5 and 7.2; MARPOL Annex III/4) N/A Yes No
berian Maritime Legislation available on board (RLM 300) CD ROM or Paper Yes No
Comments:      

209/325-V1.06/08/2015 5 of 31
2. PLANS, MANUALS, RECORD BOOKS, AND PUBLICATIONS
APPLIC- APPLIC-
NAME ABLE?
Current? NAME ABLE?
Current?

Hydrostatic Balanced Loading Operational Manual

SOPEP (MARPOL Annex I /37)
(MARPOL Annex I/13G)
Oil Discharge Monitoring and Control Operational Manual
SMPEP (MARPOL Annex II/17)
(MARPOL Annex I/15(3)
Subdivision and Stability Information (Oil Tankers)
Ship’s Security Pan (ISPS Code)
MARPOL Annex I/25)
Cargo Securing Manual (SOLAS VI/5.6 and
SOLAS
VII/5)
Garbage Management Plan (MARPOL Annex
MODU Code
V/9)

Garbage Record Book(MARPOL Annex V/9) LSA & FSS Code Current Edition

Intact Stability Booklet (SOLAS II-1/25) MARPOL Latest Edition

Damage Control Plans and Booklet (SOLAS II-1

Load line Convention& Protocol
23 &25)

Fire Safety Training Manual (SOLAS II-2/15.2.3) ICS Tanker Safety Guide (Chemicals or Gas) as applicable

Fire Control Plan and Booklet (SOLAS II-2

IMO International Maritime Dangerous Goods Code
15.2.4)
On board Training and Drills Record (SOLAS II-
IMO Code of Safe Practice for Timber Deck Cargos
2/15.2.5
Fire Safety Operational Booklet (SOLAS II-
Int. Safety Guide for Oil Tankers &Terminals
2/16.2)
Lifesaving Equipment Training Manuals SOLAS
IBC Code or BC Code
III/19.4
Lifesaving Equipment Inspection and Ballast Water Management Plan & Record Book ( Ballast
Maintenance Records (SOLAS III/20.2) Water Convention)
Oil Water Separation System Manufacturers
Int. Code of Signals Latest Edition
Operations Manual
For Tankers: Approved VOC/STS Plan (as
ITU Radio Regulations
applicable)
Procedures and Arrangements Manual P&A
ITU List of Radio Dept. RSS Stations
Manual (MARPOL Annex II/5, 5A and 8
Dedicated Clean Ballast Tank Operation Manual
Vol. III of IAMSAR Manual Latest Edition
(MARPOL Annex I /13A)
Crude Oil Washing Operation and Equipment
Manual RLM 105 A
(MARPOL Annex I/13B

Maritime Labour Convention, 2006

Comments:      

Records of Drills and Exercises Check log book entries

ISPS A/10.1.1 Security Drills conducted quarterly? Yes No Date of last drill:      
SOLAS Boat and Fire Drills attended by crew monthly? Yes No Date of last drill:      
LISCR Safety Training held weekly? Yes No Last 3 sessions:      

209/325-V1.06/08/2015 6 of 31
PART G - ISPS ADDITIONAL DOCUMENT REVIEW

Clause Description Satisfactory See Remarks

ISPS A/9.1 Ship’s Security Plan Approved by the Administration? Yes No

Amendments Approved by LISCR,
ISPS A/9.5
(Check against Record of Changes page in SSP and photocopy received from the office.)
     
SSA (Ship Security Assessment)      
ISPS A/5.7 Are Declarations of Security being filled in properly and completely and kept on board the vessel?      
LISCR ISPS Are the DOS's available on board for the Last 10 Ports when applicable?      
LISCR ISPS Examination of statutory records for AIS      
LISCR ISPS Date of installation of AIS:      
Are the records being kept in English and the working language or languages of the ship if other than
ISPS A/10.2
English?
     

ISPS A/10.4 Are security records being protected from unauthorized access or disclosure?      
a) How?      

ISPS B/13.7 Company Annual Security Exercise report or copy of report from another vessel dated:      

LISCR ISPS Date of verification of SSAS:      

a) Attach a copy of SSAS verification endorsement or SSAS Verification Letter

b) If SSAS NOT INSTALLED on vessel, provide date to be installed:      
Are the records of the following activities addressed in the ship security plan being kept on board for at
ISPS A/10.1
least 3 years?
A/10.1.1 training, drills and exercises      
Company annual security exercise report dated:      

A/10.1.2 security threats and security incidents      

A/10.1.3 breaches of security      

A/10.1.4 changes in security level      

communications relating to the direct security of the ship such as specific threats to the
A/10.1.5
ship or to port facilities the ship is, or has been, in;
     
internal audits including non-conformity reports and reviews of security activities
A/10.1.6      

external audits including non-conformity reports and reviews of security activities      

A/10.1.7 periodic review of the ship security assessment      

A/10.1.8 periodic review of the ship security plan      

A/10.1.9 implementation of any amendments to the plan      

maintenance, calibration and testing of any security equipment, including testing of the
A/10.1.10
ship security alert system
     

CURRENT SECURITY LEVEL: 1 2 3

PART H - SSAS ADDITIONAL DOCUMENT REVIEW
Title Current: Remarks
Yes
SSAS Procedures stated in the SSP      
No
Yes
Manufacturer Instructions      
No
Yes
Confirmation of Test Alarm Message from Administration      
No
Yes
Maintenance Log Book with Dates of SSAS Tests      
No

209/325-V1.06/08/2015 7 of 31
PART I - ADDITIONAL ISM DOCUMENT REVIEW
Title Remarks

SMM (Safety Management Manual) on board? Yes No      

See
Clause Description Satisfactory
Remarks

The Company should establish a safety and environmental-protection policy which describes how the
ISM 2.1
objectives given in paragraph 1.2 will be achieved.
     

The safety and environmental protection policy must be signed by the Chief Executive or other senior
LISCR ISM
executive officer.
     

The Company should ensure that the SMS operating on board the ship contains a clear statement
emphasizing the Master's authority. The Company should establish in the SMS that the Master has the
overriding authority and the responsibility to make decisions with respect to safety and pollution prevention
ISM 5.2
and to request the Company's assistance as may be necessary.
     

a. Interview the Master to confirm his awareness and location of such statement in SMM.
The Company should establish and maintain procedures to control all documents and data which are
relevant to the SMS
     
ISM 11.1
a) How?      

ISM 11.2 The Company should ensure that:

11.2.1 valid documents are available at all relevant locations;      
11.2.2 changes to documents are reviewed and approved by authorized personnel; and      
11.2.3 obsolete documents are promptly removed.      
The documents used to describe and implement the SMS may be referred to as the Safety Management
ISM 11.3 Manual. Documentation should be kept in a form that the Company considers most effective. Each ship      
should carry on board all documentation relevant to that ship.

LISCR ISM The Company must conduct internal company audits and vessel audits at least annually.      
LISCR ISM Date of last internal audit:      

LISCR ISM Note: Not required to be filled in if copy of DOC is attached.

ISM 13.6
Issued by:       Expiration:       Last periodical:      
See
Clause Description Satisfactory
Remarks
The Document of Compliance should be issued by the Administration, by an organization recognized by
the Administration or, at the request of the Administration, by another Contracting Government to the
ISM 13.2 Convention to any Company complying with the requirements of this Code for a period of 5 years as      
specified by this Administration. Such a document should be accepted as evidence that the Company is
capable of complying with the requirements of this Code.

The Document of Compliance is only valid for the ship types explicitly indicated in the document. Such
indication should be based on the types of ships on which the initial verification was based. Other ship
ISM 13.3 types should only be added after verification of the Company’s capability to comply with the requirements      
of this Code applicable to such ship types. In this context, ship types are those referred to in regulation
IX/1 of the Convention.

The validity of a Document of Compliance should be subject to annual verification by the Administration or
ISM 13.4 by an organization recognized by the Administration or, at the request of the Administration by another      
Contracting Government within three months before or after the anniversary date.

As part of Company initiated Ship Safety Inspections, the shipboard SMS should include reference to the
Liberian annual safety inspections required by Maritime Regulation 7.191, as more fully described in
LISCR ISM
Marine Notice INS-001, and use of Form No. 338-1/00, the "Operational/Safety Checklist for SOLAS
     
74/78", or a similar Company developed form as addressed in Marine Notice INS-004.

IMO Res
A.744(18)
For bulkers and oil tankers, is the Hull Survey Report file maintained on board (See IMO Res A.744(18))      

(For Intermediate Audits Only) The validity of the Safety Management Certificate should be subject to at
least one intermediate verification by the Administration or an organization recognized by the
Administration or, at the request of the Administration, by another Contracting Government. If only one
ISM 13.8
intermediate verification is to be carried out and the period of validity of the Safety Management Certificate
     
is five years, it should take place between the second and third anniversary date of the Safety
Management Certificate.
See
Clause Description Satisfactory
Remarks

209/325-V1.06/08/2015 8 of 31
 (For Renewal Audits Only) Notwithstanding the requirements of paragraphs 13.2 and 13.7, when the
renewal verification is completed within three months before the expiry date of the existing Document of
Compliance or Safety Management Certificate, the new Document of Compliance or the new Safety
ISM 13.10
Management Certificate should be valid from the date of completion of the renewal verification for a
     
period not exceeding five years from the date of expiry of the existing Document of Compliance or
Safety Management Certificate.
Comments:      

PART J - ADDITIONAL MLC DOCUMENT REVIEW

Latest Revision
Title Satisfactory
(if expired):
Remarks
DMLC II on board same as provided to
inspector?
     
S.I.R.B’s, Officers licenses & all SQC’s      
Seafarers Employment Agreements , CBA      
Minimum age against passports      
Monthly account of wages            
Allotment arrangements            
Social security deductions (Check SEA)            
Payment of balance of wages
(Off-signers)
           
Overtime records (for open and guaranteed
only, not for fixed OT)
           
Records of rest hours            
Records of training of catering staff            
Records of inspection of accommodation,
food, water and catering
           
Safety Committee reports            
Accident/Injury/Near-miss reports            
Risk evaluation            
Permit to work systems            
On-board complaint handling procedures
and record of complaints.
     
External & Internal (if available) inspection
Report including deficiencies
           
Comments:      

SE, V, E: A Substantial Equivalency, or a Variation or an Exemption applies as permitted by the Administration and as
defined in the DMLC Part I
DE: Deficiency: An observed situation or defect where objective evidence indicates a non-fulfillment of a specified
requirement of MLC, 2006.
DT: Serious Deficiency: An identifiable deficiency that represents a significant danger to the safety, health and security of
seafarers and/or is a serious breach of the requirements of MLC, 2006 (including seafarers’ rights) [Detainable condition-
Requires immediate corrective action; or a corrective action plan must be accepted by the Administration before the ship
departs port (will require downgrading)].
Regulation 1.1 – Minimum age (Inspected & Yes No SE, MLC, Marine Comment
209/325-V1.06/08/2015 9 of 31
certified item, Review DMLC-II) V, 2006 Notice
E MLC-
Are all seafarer’s employed or engaged or working
on the ship, (other than a ship’s cook who shall not    A1.1.1 002/1.1.1      
be less than 18 years old) 16 years and over?
Are there any seafarers on board under 18 years? A1.1.4
If YES, are they engaged in accepted training programs A4.3.2 b 002/1.1.2
and protected from hazardous work (check DMLC II for    A1.1.2 002/1.1.4      
details) A1.1.3 a 005/3.3.3
A1.1.3 b
Regulation 1.2 - Medical certificate (Inspected & SE, MLC, Marine
certified item, Review DMLC-II) Yes No V, 2006 Notice Comment
E MLC-
a) Do all seafarers (prior to beginning work on the 002/1.2.1
A1.2.1
ship), hold a valid medical certificate    002/1.2.3      
A1.2.6
002/1.2.4
Regulation 1.3 – Training and qualifications SE, MLC, Marine
Comment
(Inspected & certified item, Review DMLC-II) Yes No V, 2006 Notice
E MLC-
Are all seafarers in possession of a Liberian S.I.R.B in
accordance with RLM-118, section 4.1.1?
A2.1.1 e 002/1.3.1
and their record of employment (without any         
A2.1.3 003/3.1.7
statement as to the quality of work and wages)
entered in this document?
Are all Seafarers covered under STCW’78 as amended
including those in positions listed in the minimum safe
manning certificate trained and certified as competent, Reg.1.3.
1 002/1.3.3
in accordance with STCW and possess appropriate   
Reg.1.3.
     
002/1.3.4
and valid Liberian certification and any additional 3
special qualifications equivalent to the duties they are
required to undertake on the ship?
Does the ship carry a trained, qualified & competent
   A3.2.3 004/5.3.3      
cook?
Regulation 1.4 – Recruitment and placement SE, MLC, Marine
Comment
(Inspected & certified item, Review DMLC-II) Yes No V, 2006 Notice
E MLC-
Is the letter(s) issued by the Administration to the 002/1.4.1
SRPS not located in Countries that have signed MLC    A1.4.9 001/2.4      
made available on board?
Regulation 2.1 - Seafarers’ employment agreements SE, MLC, Marine
Comment
(SEA) Yes No V, 2006 Notice
(Inspected & certified item, Review DMLC-II) E MLC-
Do all seafarers have a copy of the SEA signed by
A2.1.1 a
both the seafarer and the shipowner or a    003/3.1.2      
A2.1.1 c
representative of the shipowner?
Where a CBA (and/or any other relevant document)
forms all or part of the SEA, is a copy of the CBA
   A2.1.2 003/3.1.5      
and/or such other document available on board for
seafarers to review their conditions of employment?

Regulation 2.2 –Wages (Payment of Wages is a Yes No SE, MLC, Marine Comment
inspected & certified item, Review DMLC-II) V, 2006 Notice
E MLC-
Payment of Wages
Are seafarers' wages paid at no greater than monthly
intervals and the amount is in accordance with their    A2.2.1 003/3.2.1      
SEA or applicable CBA?
Are all seafarers given a monthly account of the
payments due and the amounts paid, including wages,    A2.2.2 003/3.2.2      
and any additional payments?
Regulation 2.3 – Hours of work and hours of rest SE, MLC, Marine Comment
(Inspected & certified item, Review DMLC-II) Yes No V, 2006 Notice DE/DT
E MLC-
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 Do the normal hours of rest satisfy the minimum A2.3.5 b 003/3.3.1
requirement of not less than 10 hours in any 24-hour
period and 77 hours in any 7-day?         
same vessel)

Do the minimum hours of rest comply with the

requirement that it may be divided into no more than
two periods, one of which shall be at least 6 hours in
   A2.3.6 003/3.3.2      
length, and the interval between consecutive periods of
rest shall not exceed 14 hours?

Is a table containing the following information for every

position on board the ship provided in English and the
A2.3.10
working language of the ship and displayed in an    003/3.3.6      
A2.3.11
accessible place: (a) the schedule of service at sea and
service in port and (b) the minimum hours of rest?
Are records of work/rest maintained in English and the
working language of the ship, to allow monitoring of
   A2.3.12 003/3.3.7      
compliance with the requirements in 37) to 49)
inclusive?
Do seafarers receive a copy of their records as referred
to in 49 above, endorsed by the Master, or a person    A2.3.12 003/3.3.8      
authorized by the Master, and by the seafarer?
Regulation 2.4 – Entitlement to leave (inspected SE, MLC, Marine
item) Yes No V, 2006 Notice Comment
E MLC-
Are seafarers granted shore leave taking due account Reg
   003/3.5.1      
of the operational requirements of their positions? 2.4.2
Regulation 2.7 – Manning levels (Inspected & SE, MLC, Marine
certified item, Review DMLC-II) Yes No V, 2006 Notice Comment
E MLC-
Is there an appropriate number of seafarers on board
the ship to ensure safe and secure operation under all A2.7.1
operating conditions (including an appropriate number A2.7.2 003/3.8.1
of cooks/those responsible for food preparation and    A4.1.4(c 003/3.8.2      
those who are responsible for medical care) and in ) 003/3.8.3
accordance with the minimum safe manning A3.2.3
document(MSMC) issued by Liberia?
Regulation 4.1 – Medical care on board ship and SE, MLC, Marine
ashore (Inspected and certified item, Review Yes No V, 2006 Notice Comment
DMLC-II) E MLC-
Are seafarers given the right to visit a qualified medical
doctor or dentist without delay in ports of call, where    A4.1.1c 005/3.1.2      
practicable?
Is a medical log maintained for all medical treatment on
   005/3.1.6      
board and ashore?
Is a medical chest & medical equipment provided that
complies with the requirements in the current edition of
the International Medical Guide for Ships (to be used
with Marine Operations Note 08/2009), or a similar    A4.1.4a 005/3.1.7      
national standard such as MSN 1768 (M+F) from the
UK’s MCA and bearing in mind the number of persons
on board and the nature and duration of the voyage?
Are the medicines & equipment inspected at intervals
not exceeding 12 months by a designated medical
   A4.1.4a 005/3.1.8      
officer on board or a pharmacist for labelling, expiry
dates and conditions of storage?
Is the WHO International Medical Guide current edition
   A4.1.4(a) 005/3.1.11      
available on board?
Is the Medical First Aid Guide (MFAG) available on
005/3.1.11
ships that are carrying IMDG cargoes available on    A4.1.4(a)      
board?
If the ship is carrying dangerous goods not listed in    A4.1.4(a) 005/3.1.12      

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MFAG, than is Material Safety Data Sheets available
for these goods?
Is there a complete and up-to-date list of radio stations
through which medical advice can be obtained; and, If
equipped with a system of satellite communication, an
up-to-date and complete list of coast earth stations
through which medical advice can be obtained?
   A4.1.4(d) 005/3.1.13      
(Such publications shall include, but not be limited to:
the current editions of the ITU publication ‘List VI-List of
radio determination and special service stations’ the
‘Admiralty List of Radio Signals Vol.1 and the
‘International Code of Signals’)
Regulation 4.3 – Health &safety protection & SE, MLC, Marine
accident prevention (Inspected & certified item, Yes No V, 2006 Notice Comment
Review DMLC-II) E MLC-
Is there an occupational safety and health policy 005/3.3.1
   A4.3.1 a      
provided by the ship owner? 001/2.4
Are reasonable precautions being taken to prevent
occupational accidents, injuries and diseases on board
ship, including measures to reduce and prevent the risk
of exposure to harmful levels of noise and vibration and
   A4.3.1 b 005/3.3.2      
other ambient factors and chemicals as well as the risk
of injury or disease that may arise from the use of
equipment and machinery on board ships?
(Checked during rounds of the ship)
Are the occupational health & safety programmes A4.3.1 a
being effectively implemented on board for the A4.3.1 b
following? A4.3.1 c
(Done during document review stage) A4.3.1 d
   005/3.3.3      
A3.1.6 h
A4.3.2 a
A4.3.7
A4.3.8
a) Hazard identification & risk evaluation?         
b) initial vessel orientation or familiarization,
covering shipowners’ safety policy, emergency
procedures, access and egress, fire protection,
job hazards, and information on hazardous
materials before beginning work?
c) Periodic health and safety training and
instruction of seafarers, including bringing to
their attention information concerning particular
hazards (health & safety related which should
include audio-visual material, display of
posters, articles and periodicals)?
d) Periodic safety Inspections at least once every
three (3) months or more frequently if there
have been substantial changes in the
conditions of work?
e) reporting and correcting hazardous conditions
and unsafe practices?
f) Investigation and reporting of occupational
accidents and injuries, while ensuring the
protection of seafarer’s personal data?
g) prevention of occupational accidents, injuries
and diseases on board ship, and for
continuous improvement in occupational safety
and health protection, involving seafarers’
representatives and all other persons
concerned in their implementation, taking
account of preventive measures, including
engineering and design control, substitution of
processes and procedures and procedures for
collective and individual tasks, and the use of
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 personal protective equipment?
h) Fire-prevention and fire-fighting (Fire drills)?
i) Handling anchors, chains and mooring lines?
j) The effects of drugs and alcohol abuse and
dependency (Policy, posters, notices)?
k) Responding to accidents and emergencies
(Other Emergency Drills & Exercises)?
l) Loading & Unloading Equipment?
m) Working on deck, below deck and in machinery
spaces?
n) Work involving electrical equipment, working at
heights/over side & in enclosed spaces (permit
to work systems)?
o) Safe access to ship?
p) Safe movement about the ship?
q) Dangerous cargo & ballast?
r) HIV/AIDS protection and prevention?
Potentially hazardous work for young seafarers under
the age of 18 years undertaken only under appropriate
supervision and instruction?
If there are five or more seafarers on board, has a
   A4.3.2 d 005/3.3.5      
safety & health committee been established?
Are safety & health committee meetings held at least
   A4.3.2 d 005/3.3.6      
once every month?

PART K – ISM/ISPS AUDIT of the VESSEL-

SECTION 1- MASTER
Clause Description- ONLY MARK IF CHECKED Checked? Remarks
To ensure the safe operation of each ship and to provide a link between the Company and those on
board, every Company, as appropriate, should Designate a Person or persons Ashore (DPA) having
ISM 4
direct access to the highest level of management. The responsibility and authority of the Designated      
Person or persons should include monitoring the safety and pollution prevention aspects of the operation
of each ship and ensuring that adequate resources and shore-based support are applied, as required.
The Company should ensure that the Safety and Environmental policy is implemented and maintained at
ISM 2.2
all levels of the organization, both ship-based and shore-based.
     

The Company should define and document the responsibility, authority, and interrelation of all ship
ISM 3.2
personnel who manage, perform, and verify work relating to and affecting safety and pollution prevention.
     

The Company is responsible for ensuring that adequate resources and shore-based support are provided
ISM 3.3
to enable the DPA to carry out their functions.
     

Has the Company ensured that the ship security plan contains a clear statement emphasizing the
ISPS A/6.1 Master’s authority and his overriding authority to make decisions with respect to security?      
Note: Interview the Master to confirm his awareness and location of such statement in SSP.
ISM 5.1 The Company should clearly define and document the Master's responsibility with regard to:
5.1.1 implementing the safety and environmental-protection policy of the Company;      
5.1.2 motivating the crew in the observation of that policy;      
5.1.3 issuing appropriate orders and instructions in a clear and simple manner;      
5.1.4 verifying that specified requirements are observed; and      
5.1.5 reviewing the SMS and reporting its deficiencies to the shore-based management.      
ISM 6.1 The Company should ensure that the Master is:
6.1.1 properly qualified for command;      
6.1.2 fully conversant with the Company's SMS; and      

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 6.1.3 given the necessary support so that the Master's duties can be safely performed.      
The Company should ensure that each ship is manned with qualified, certificated, and medically fit
ISM 6.2
seafarers in accordance with national and international requirements (RLM-118).
     

The Company should establish procedures for the preparation of plans and instructions, including
ISM 7 checklist as appropriate, for key shipboard operations concerning the safety of the ship and the      
prevention of pollution. The various tasks involved should be defined and assigned to qualified personnel.
The ship's operations plans should include procedures to ensure the required Liberian annual safety
LISCR ISM
inspection is conducted on time and in accordance with the regulations (ISM-001).
     
The SMS should include procedures ensuring that non-conformities, accidents and hazardous situations
ISM 9.1 are reported to the Company, investigated and analyzed with the objective of improving safety and      
pollution prevention.

Master
ISM 9.2 The Company should establish procedures for the implementation of corrective actions.      
The shipboard SMS procedures for reporting accidents and incidents should incorporate the provisions of      
Chapter IX of the Maritime Regulations (RLM-108) which require the immediate notice and reporting of
LISCR ISM
incidents to the Administration and establishes duties and responsibilities for the Company, ship officers,
and crew.
The Company SMS should also incorporate the provisions of Article IV and Article X of the "Rules of
LISCR ISM
Marine Investigations and Hearings" (RLM-260).
     

The Company SMS should incorporate the provisions of Maritime Regulation 10.296(7) on accident
LISCR ISM
prevention and appointment of a Safety Officer.
     

The Company and shipboard SMS should contain procedures for immediately reporting Port State
LISCR ISM
detentions to the Administration.
     

The Company should establish procedures in its SMS to identify equipment and technical systems the
sudden operational failure of which may result in hazardous situations. The SMS should provide for
ISM 10.3 specific measures aimed at promoting the reliability of such equipment or systems. These measures      
should include the regular testing of stand-by arrangements and equipment or technical systems that are
not in continuous use.
ISPS Are personnel conducting internal audits or evaluating its implementation independent of the activities
A/9.4.1 being audited?
     

Clause Description- ONLY MARK IF CHECKED Checked? Remarks

Personnel carrying out audits should be independent of the areas being audited unless this is
ISM 12.4
impracticable due to the size and the nature of the Company.
     

ISPS A/9.6 Is the SSP in electronic format?      

a) How is it protected from unauthorized deletion, destruction or amendment?      
ISPS A/9.7 Is the plan (hardcopy and/or electronic copy) being protected from unauthorized access or disclosure?      
The Company should carry out internal safety audits to verify whether safety and pollution-prevention
ISM 12.1
activities comply with the SMS.
     

The Company should periodically evaluate the efficiency and, when needed, review the SMS in
ISM 12.2
accordance with procedures established by the Company
     

The audits and possible corrective actions should be carried out in accordance with documented
ISM 12.3
procedures.
     

The results of the audits and reviews should be brought to the attention of all personnel having
ISM 12.5
responsibility in the area involved.
     

The management personnel responsible for the area involved should take timely corrective action on
ISM 12.6
deficiencies found.
     

The Company should establish procedures to ensure that the ship is maintained in conformity with the
ISM 10.1 provisions of the relevant rules and regulations and with any additional requirements which may be      
established by the Company.
In meeting these requirements the Company should ensure
ISM 10.2
that:
10.2.1 inspections are held at appropriate intervals;      
10.2.2 any non-conformity is reported, with its possible cause, if known;      
10.2.3 appropriate corrective action is taken; and      
10.2.4 records of these activities are maintained.      
SECTION 2- MASTER/ SHIP SECURITY OFFICER (SSO)

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 Master/ SSO
How the Company ensures that the CSO, the Master and the SSO are given the necessary support to
ISPS A/6.2
fulfill their duties and responsibilities in accordance with chapter XI-2 and this part of the Code?
     

ISPS B/6.1 Has the following information been included?

B/6.1 parties responsible for appointing shipboard personnel, such as ship management companies,
.1 manning agents, contractors, concessionaries, for example, retail sales outlets, casinos etc
     

B/6.1 parties responsible for deciding the employment of the ship including, time or bareboat
.2 Charterer(s) or any other entity acting in such capacity
     

B/6.1 in cases when the ship is employed under the terms of a charter party, the contact details of those
.3 parties including time or voyage charters
     

ISPS
A/12.2
Is the SSO familiar with the duties specified in this section?      
A/12.2.1 security inspections to ensure that appropriate security measures are maintained      
A/12.2.2 maintaining and supervising the implementation of the ship security plan,      
A/12.2.3 coordinating the security aspects of the handling of cargo and ship stores      
A/12.2.4 proposing modifications to the ship security plan      
reporting to the CSO any deficiencies identified during internal audits, periodic reviews,
A/12.2.5
security inspections and implementing any corrective actions
     

A/12.2.6 enhancing security awareness and vigilance on board      

A/12.2.7 ensuring that adequate training has been provided to shipboard personnel, as appropriate      
A/12.2.8 reporting all security incidents      
A/12.2.9 coordinating implementation of the ship security plan with the CSO and the relevant PFSO      
A/12.2.10 ensuring that security equipment is properly operated, tested, calibrated and maintained      
ISPS
A/7.5
Has the ship acknowledged the security level 2 or 3 when set by the Administration?      
ISPS Prior to entering port or whilst in port, has the ship acknowledged the security level 2 or 3 when set by the
A/7.6 Contracting Government and confirmed this to the PFSO and Administration?
     
SECTION 3- SSO
Checked
Clause Description- ONLY MARK IF CHECKED ?
Remarks
ISPS
Does the Ship Security Officer (SSO) have knowledge of, and received training, in the following?
A/13.2
*Auditor should interview SSO on each of the following through unique questions or scenarios.*
B/13.1.1 security administration      
ISPS relevant international conventions, codes and
     

SSO
B/13.1.2
B/13.1 recommendations
B/13.1.3 relevant Government legislation and regulations      
B/13.1.4 responsibilities and functions of other security organizations      
B/13.1.5 methodology of ship security assessment      
B/13.1.6 methods of ship security surveys and inspections      
B/13.1.7 ship and port operations and conditions      
B/13.1.8 ship and port facility security measures      
B/13.1.9 emergency preparedness and response and contingency planning      
instruction techniques for security training and education, including security measures and
B/13.1.10
procedures
     

B/13.1.11 handling sensitive security related information and security related communications      
B/13.1.12 knowledge of current security threats and patterns      
B/13.1.13 recognition and detection of weapons, dangerous substances and devices      
recognition, on a non-discriminatory basis, of characteristics and behavioral patterns of
B/13.1.14
persons who are likely to threaten security
     

B/13.1.15 techniques used to circumvent security measures      

B/13.1.16 security equipment and systems and their operational limitations      
B/13.1.17 methods of conducting audits, inspection, control and monitoring;      
B/13.1.18 Methods & Frequency of physical searches, frequency (SEE EVIDENCE)      
B/13.1.19 security drills and exercises, including those with port facilities (SEE RECORDS)      
B/13.1.20 assessment of security drills and exercises (Look for Evidence of Improvement)      

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 B/13.2.1 the layout of the ship      
the ship security plan and related procedures (including scenario-based training on how to
B/13.2.2
respond)
     
B/13.2.3 crowd management and control techniques      
operations of security equipment and
B/13.2.4
systems
     
testing, calibration and whilst at sea maintenance of security equipment and systems (SEE
B/13.2.5 RECORDS)      
ISPS
Have the drills tested elements of the plan such as those security threats listed in paragraph 8.9?
B/13.6
damage to, or destruction of, the ship or of a port facility, e.g. by explosive devices, arson,
B/8.9.1
sabotage or vandalism
     

B/8.9.2 hijacking or seizure of the ship or of persons on board      

B/8.9.3 tampering with cargo, essential ship equipment or systems or ship stores      
B/8.9.4 unauthorized access or use, including presence of stowaways      
B/8.9.5 smuggling weapons or equipment, including weapons of mass destruction      
B/8.9.6 use of the ship to carry those intending to cause a security incident and/or their equipment      
B/8.9.7 use of the ship itself as a weapon or as a means to cause damage or destruction      
B/8.9.8 attacks from seaward whilst at berth or at anchor      
B/8.9.9 attacks whilst at sea      
Has the vessel conducted an ISPS drill at Security Level 2 or
a)
3?
     
ISPS
Handling unaccompanied baggage (State the security measures taken. At a minimum should be searched 100% at all levels)
B/9.38
1. How unaccompanied baggage is identified:      

2. How unaccompanied baggage is screened and the frequency:      

ISPS
A/11.1
Is a Company Security Officer designated for the ship?      
a) Where is the CSO’s 24 Hour contact number located onboard?      
b) By what means is the CSO contacted in an Emergency?      
SECTION 4- CHIEF OFFICER

Clause Description ONLY MARK IF CHECKED Checked? Remarks

ISPS
B/9.25
Handling of cargo (state the security measures taken)      

C/O
1. prevent tampering:      
2. prevent cargo that is not meant for carriage from being accepted:      
ISPS
Delivery of vessel stores
B/9.33
1. checking of ship’s stores and package integrity      
2. prevent vessel’s stores from being accepted without inspection      
3. prevent tampering      
4. prevent ship’s stores from being accepted unless ordered      
The Company should establish procedures to ensure that new personnel and personnel transferred to
ISM 6.3
new assignments related to safety and protection of the environment are given proper familiarization
with their duties. Instructions which are essential to be provided prior to sailing should be identified,
     
documented and given.
The shipboard SMS should include procedures for the transfer of command, documented hand-over
LISCR ISM
notes, documented vessel and duties instructions, and familiarization training in accordance with      
STCW A-I/6.
The Company should ensure that all personnel involved in the Company's SMS have an adequate
ISM 6.4
understanding of relevant rules, regulations, codes, and guidelines.
     

ISM 6.5 The Company should establish and maintain procedures for identifying any training which may be
required in support of the SMS and ensure that such training is provided for all personnel concerned.
     

ISM 6.6 The Company should establish procedures by which the ship's personnel receive relevant information
on the SMS in a working language or languages understood by them.
     

ISM 6.7 The Company should ensure that the ship's personnel are able to communicate effectively in the
execution of their duties related to the SMS.
     

LISCR ISM The ship's operations plans should incorporate the Maritime Regulations requirement for emergency
drills and weekly training sessions.
     

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 ISM 8.1 The Company should establish procedures to identify describe and respond to potential emergency
shipboard situations.
     

ISM 8.2 The Company should establish programs for drills and exercises to prepare for emergency actions.      
The SMS should provide for measures ensuring that the Company's organization can respond at any
ISM 8.3
time to hazards, accidents and emergency situations involving its ships.
     
ISPS
A/13.4
Are the drills to ensure effective implementation of the SSP being carried out at appropriate intervals?      
ISPS
B/13.6
Are the drills conducted at least once every three months?      
a) What are the intervals between ISPS Drills on this vessel?      
b) Have any Drills been conducted at security level 2 and 3? YES NO
In cases where more than 25 percent of the ship’s personnel has been changed, at any one time, with
ISPS
B/13.6
personnel that has not previously participated in any drill on that ship, within the last 3 months, is the      
drill being conducted within one week of the change?
ISPS Has the company security officer ensured the effective coordination and implementation of ship security
A/13.5 plans by participating in exercises at appropriate intervals?
     

Have the exercises which include participation of company security officers, port facility security
ISPS
B/13.7
officers, relevant authorities of Contracting Governments as well as ship security officers, been carried      
out at least once each calendar year with no more than 18 months between the exercises?
ISPS
B/13.7
Have the exercises tested communications, coordination, resource availability, and response?      
ISPS Is the company participation in an exercise with another Contracting Government been recognized by
B/13.8 the Administration?
     
ISM 10.4 The inspections mentioned in 10.2 as well as the measures referred to in 10.3 should be integrated into
the ship's operational maintenance routine.
     
The maintenance system established by the Company and documented in its SMS should include
LISCR ISM systematic plans and actions designed to address all those items and systems covered by class and      
statutory survey and ensure that the Vessel's condition is satisfactorily maintained at all times.
SECTION 5- SECOND OFFICER
LISCR ASI Navigation, Charts, Publications, and Records
Electronic Charts (Specify)       Last Update      

2/O
Chart List or Catalog (Specify Publisher)       Year of Issue      
Navigational Charts       Last Correction      
Pilot Books/Sailing Directions       Date      
Notices to Mariners       Latest Issues      
List of Lights/Radio Aids       Last Correction      
Tide Tables       Year of Issue      
Nautical Almanac       Year of Issue      
Voyage or Passage Planning regularly used? Yes No
LISCR ASI Medicine Chest and Medical Publications Satisfactory Unsatisfactory Comments
Accident Prevention Guide      
LISCR ASI Logbooks
Language:      
Date lifeboats last lowered into water:      
LISCR ASI Navigational Aids / Emergency Communications
ONBOARD OPERABLE
REMARKS
Yes No Yes No
Radar No. 1      
Radar No. 2      
ARPA/Radar Plotting Facilities      
AIS      
Magnetic compass Last Adjustment      
Compass Error Book Last Entry      
Gyro Compass Master, Repeaters      
Echo Sounding Device      
Suitable electronic navigation system.      
Course Recorder      

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 Voyage Data Recorder (VDR)      
Rate of Turn Indicator      
Speed and Distance Indicator      
Steering Gear Test (Arrival/Departure) Date last tested      
Emergency Steering Drills (Qrtly) Date last drill      
SART      
EPIRB      
VHF/PORTABLES      
NAVTEX      

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 SECTION 6- THIRD OFFICER

LISCR ASI General Safety

Pilot Boarding Arrangements Satisfactory Unsatisfactory Comments
Boat and fire drills carried out by inspector Yes No      

3/O
Satisfactory Unsatisfactory
Performance of crew during drills      
Lifesaving equipment maintenance manuals available to crew Yes No      
Firefighting equipment maintenance manuals available to crew Yes No      
Inflatable liferaft servicing dates:            
Inflatable liferaft hydrostatic release service dates:            
LISCR ASI Lifesaving / Firefighting Equipment
Check condition of lifesaving equipment, including: Satisfactory Unsatisfactory Comments
Life boat/Rescue boat davits-foundations      
Lifeboat/Rescue boat- structural      
Properly outfitted - equipment serviceable      
Lifejackets/TPA’s/immersion suits      
Lights/whistles/retro material - serviceable      
Pyrotechnics      
Line throwing equipment      
Man overboard signals      
Muster List and Emergency Instructions checked      
Check condition of Fire Fighting Equipment, including: Satisfactory Unsatisfactory Comments
Fire pumps and fire main      
Fixed and portable extinguishers - serviced annually      
Water Mist Systems      
Emergency Fire Pump      
Foam analysis      
Vent closures      
Emergency escapes      
Emergency generator      
EEBDs      
Fireman’s Outfits      
International Shore Connection      
Fire control Plan checked      

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 SECTION 7- CHIEF ENGINEER
These inspections should be integrated into the ship's operational maintenance routine (EVIDENCE):
.1 inspections are held at appropriate intervals;
ISM 10.2
ISM 10.4
.2 any non-conformity is reported, with its possible cause, if known;      
.3 appropriate corrective action is taken; and
.4 records of these activities are maintained.
The Company should establish procedures in its SMS to identify equipment and technical systems the

CHENG
sudden operational failure of which may result in hazardous situations. The SMS should provide for
ISM 10.3
ISM 10.4
specific measures aimed at promoting the reliability of such equipment or systems. These measures      
should include the regular testing of stand-by arrangements and equipment or technical systems that
are not in continuous use. These should be integrated into the ship's operational maintenance routine.
The maintenance system established by the Company and documented in its SMS should include
LISCR ISM systematic plans and actions designed to address all those items and systems covered by class and      
statutory survey and ensure that the Vessel's condition is satisfactorily maintained at all times.
SOLAS
Location of IMO Numbers to be permanently inside the hull as per SOLAS: YES NO
XI-1/3

SECTION 8- CREW
Find Satisfactory Evidence for Activities Listed Below at All Security Levels
Clause Description ONLY MARK IF CHECKED Checked? Remarks

ISPS A/7.2 At Security Level 1, have the following activities being carried out, through appropriate measures?

A/7.2.1 ensuring the performance of all ship security duties      

A/7.2.2 controlling access to the ship      

CREW
A/7.2.3 controlling the embarkation of persons and their effects      

A/7.2.4 monitoring restricted areas to ensure that only authorized persons have access      

A/7.2.5 monitoring of deck areas and areas surrounding the ship      

A/7.2.6 supervising the handling of cargo and ship’s stores;      

A/7.2.7 ensuring that security communication is readily available      

At Security Level 2, have the additional protective measures, specified in the ship security plan, being
ISPS A/7.3
implemented for each activity detailed in section 7.2?

A/7.3.1 ensuring the performance of all ship security duties      

A/7.3.2 controlling access to the ship      

A/7.3.3 controlling the embarkation of persons and their effects      
A/7.3.4 monitoring restricted areas to ensure that only authorized persons have access      
A/7.3.5 monitoring of deck areas and areas surrounding the ship      
A/7.3.6 supervising the handling of cargo and ship’s stores;      
A/7.3.7 ensuring that security communication is readily available      
At Security Level 3, have further specific protective measures, specified in the ship security plan,
ISPS A/7.4
being implemented for each activity detailed in section 7.2?
A/7.4.1 ensuring the performance of all ship security duties      
A/7.4.2 controlling access to the ship      
A/7.4.3 controlling the embarkation of persons and their effects      
A/7.4.4 monitoring restricted areas to ensure that only authorized persons have access      
A/7.4.5 monitoring of deck areas and areas surrounding the ship      
A/7.4.6 supervising the handling of cargo and ship’s stores;      
A/7.4.7 ensuring that security communication is readily available      
Do shipboard personnel having specific security duties and responsibilities understand their
ISPS
responsibilities for ship security as described in the ship security plan, and do they have sufficient
A/13.3
knowledge and ability to perform their assigned duties including:
*Auditor should interview crew on all of the following through unique questions or scenarios.*
B/13.3.1 knowledge of current security threats and patterns      
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 B/13.3.2 recognition and detection of weapons, dangerous substances and devices      
recognition of characteristics and behavioral patterns of persons who are likely to
B/13.3.3
threaten security
     
B/13.3.4 techniques used to circumvent security measures      
B/13.3.5 crowd management and control techniques      
B/13.3.6 security related communications      
B/13.3.7 knowledge of the emergency procedures and contingency plans      
B/13.3.8 operations of security equipment and systems      
B/13.3.10 inspection, control, and monitoring techniques (SEE RECORDS)      
methods of physical searches of persons, personal effects, baggage, cargo, and ship’s
B/13.3.11
stores
     

What is the Rate of Sec Lvl 1:       Sec Lvl 2:       Sec Lvl 3:
Search at:      
ISPS Are all other shipboard personnel having sufficient knowledge of the following and are familiar with
B/13.4 relevant provisions of the SSP?
*Auditor should interview crew on all of the following through unique questions or scenarios.*
B/13.4.1 the meaning and the consequential requirements of the different security levels      
B/13.4.2 knowledge of the emergency procedures and contingency plans      
B/13.4.3 recognition and detection of weapons, dangerous substances and devices      
recognition, on a non discriminatory basis, of characteristics and behavioral patterns of
B/13.4.4
persons who are likely to threaten security
     

B/13.4.5 techniques used to circumvent security measures      

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PART L - MLC ACCOMMODATION TOUR
SE, V, E: A Substantial Equivalency, or a Variation or an Exemption applies as permitted by the Administration and as
defined in the DMLC Part I
DE: Deficiency: An observed situation or defect where objective evidence indicates a non-fulfillment of a specified
requirement of MLC, 2006.
DT: Serious Deficiency: An identifiable deficiency that represents a significant danger to the safety, health and security of
seafarers and/or is a serious breach of the requirements of MLC, 2006 (including seafarers’ rights) [Detainable condition-
Requires immediate corrective action; or a corrective action plan must be accepted by the Administration before the ship
departs port (will require downgrading)].
Regulation 3.1 - Accommodation and recreational SE, MLC, Marine Comment
facilities V, 2006 Notice
Yes No
(Inspected & certified item, Review DMLC-II) E MLC-

Liberian Requirements
Is the accommodation & recreational facilities decent Reg.3.1.      
and consistent with health, safety and accident 1
prevention, including heating, ventilation, noise and    A3.1.2a
vibration, and lighting? A3.1.6(h
)
Noise and vibration and other ambient factors
Is approved hearing protection equipment available to B4.3.2 004/4.6.4      
  
seafarers where necessary? B4.3.3
Sanitary Facilities (SF)
Is hot and cold running potable water available in all A3.1.11f 004/4.7.3      
  
wash places?
Laundry Facilities
Are there appropriately furnished laundry facilities A3.1.13 004/4.8      
  
provided on board the ship?
Hospital Accommodation (HA)
Is the hospital accommodation used exclusively for A3.1.12 004/4.9.1      
  
medical purposes?
Are the sanitary facilities provided used exclusively by B/3.1.8. 004/4.9.2      
  
the occupants of the hospital? 4
Documented inspections of Accommodation &
recreation facilities
Are inspections of the seafarer’s accommodation A3.1.18 004/4.13      
carried out by or under the authority of the Master to
ensure that it is clean, decently habitable and   
maintained in good state of repair at intervals not
exceeding one week?
Are the results of the inspections recorded on board A3.1.18 004/4.13      
and available for review?   

Regulation 3.2 – Food and catering (Inspected & SE, MLC, Marine Comment
certified item, Review DMLC-II) Yes No V, 2006 Notice
E MLC-
Liberian Requirements
Food and catering standards
Is there adequate quantities of food and water A3.2.2a 004/5.1.1      
supplies on board taking due regard of the number of
seafarers on board, their religious requirements and   
cultural practices as they pertain to food, and the
duration and nature of the voyage?
Is food provided to the seafarers without any charge? Reg. 004/5.1.5      
  
3.2.2
Galley & Equipments
Are the catering equipment and facilities including A3.2.2 b 004/5.2.1      
food preparation areas, galley, and store rooms   
hygienic and maintained in a hygienic condition?
Is the drainage clear so as to prevent accumulation of    004/5.2.3      

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water?

Is there an adequate supply of hot and cold water 004/5.2.4      

available in the galley for washing food?   

Catering Staff
Are the catering staff wearing clean and suitable A4.3.1 a 004/5.3.8      
  
personal protective clothing?
Food storage arrangements
Are there a sufficient number of temperature A3.2.2 004/5.4.1      
controlled food storage and handling rooms for the
  
number of persons on board and the duration of the
voyage?
Are the temperatures of the deep freezers and cold A3.2.2 004/5.4.2      
store rooms maintained below – (minus) 12 degrees
C for deep freezers and not above + (plus) 5 degrees
C for chill cabinets, cold store rooms and   
refrigerators?
(Recommended–However, Is a serious deficiency, if
food is showing any sign of deterioration)
Is the food (meat, vegetables fruit and dry provisions) A3.2.2 004/5.4.4      
safely and hygienically stored on the shelves with   
respect to stock rotation, segregation and spillages?
Potable water supplies
Are records available to confirm that the potable water A3.2.2a 004/5.5.2      
storage tanks have been cleaned and disinfected   
within the last 12 months?
Does the colour and odour of a sample of potable A3.2.2a 004/5.5.5      
water
indicate possible bacterial and/or chemical
contamination?   
(If there is any indication, a sample should be sent
ashore for water analysis in accordance with WHO
guidelines for drinking water quality)
Documented inspections by the Master
Are inspections at intervals not exceeding one week A3.2.7 004/5.7.1      
carried out on board with respect to:
a. the supplies of food and potable water?
b. all spaces and equipment used for the   
storage and handling of food and drinking
water?
c. galley and other equipment for the
preparation and the service of meals
Are the results of the inspections recorded on board A3.2.7 004/5.7.2      
  
and available for review?

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PART M - ASI and ISPS TOUR
LISCR ASI General Condition:
Check condition of decks and superstructure: Yes No Remarks
Weather Deck including forecastle      
Cargo gear /cargo manifold
Line handling equipment
Anchors and anchor windlass -
Electrical fixtures, alarms and lighting
Deck openings; hatches, doors, pipe penetrations, vents
Tank gauging equipment
Upper decks including bridge
Pump room or Cargo room if applicable
Check condition of Engine room, and steering gear space:
Control Room      
Electrical Systems (cable, outlets, fittings, and junction boxes)
Lighting
Ventilation
Alarms
Guards
Main engine & Auxiliaries
Fuel Lines (spray shields and fittings)
Protective Guards around moving parts
Piping for Fresh and Salt Water Systems
Pumps
Sea chest
Excessive oil and water leaks
Steering Gear Room
Questions on condition of Oil Water Separator and ODME Yes No Comments:      
Is the separator is operating properly?
Is the Oil Discharge Monitoring Equipment (ODME) operating
properly?
Is the automatic recorder operating properly?

Is there a pipe or hose used to bypass the OWS?

Do the oil record book entries match OWS record?
Any evidence of disassembling pipe flanges,
blocks, or valves tied to any overboard systems?
Has the sensor been modified or bypassed?
Has water with an oil content of 15 PPM or more ever been
discharged over the side?
Are there any spare filters?
When were the filters last replaced?      

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ISPS B/9.9 Access to the Vessel (state the security measures found in place for each of the following)

1. access ladder:      

2. access gangways:      

3. access ramps:      

4. access doors, side scuttles:      

5. mooring lines and anchor chains:      

6. cranes and hoisting gear:      

ISPS Are Restricted Areas clearly marked, indicating that access to the area is restricted and that
B/9.20 unauthorized presence within the area constitutes a breach of security?
Yes No

ISPS
Restricted Areas of the Vessel (check and fill in the security measures taken to prevent unauthorized access to RA’s )
B/9.21

1. navigation bridge:      

2. machinery spaces:      

3. spaces containing security and surveillance equipment & systems:      

4. above control and lighting system control:      

5. ventilation and air-conditioning systems and other similar systems:      

TOUR
6. spaces with access to portable water tanks, pumps and manifolds:      

7. spaces containing cargo pumps and their control, if any:      

8. cargo spaces:      

9. spaces containing vessel’s stores:      

10. crew accommodation:      

11. any other spaces as determined by the CSO:      

ISPS
Monitoring the Security of the Ship (check and fill in the specific security measures taken for each)
B/9.42

1. monitoring the ship:      

2. monitoring the restricted areas:      

3. monitoring areas surrounding the vessel:      

SOLAS
XI-1/3
Location of IMO Number outside the hull:      
SOLAS
XI-1/3
Location of IMO Number inside the hull:      

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PART N - INTERIM CERTIFICATION (ISM 14, ISPS 19.4. MLC)

NOTE: For Interim Audits, in addition to this checklist, please fill in: Pages 1 and 2; Page 3 & 4 Sections E,F; and Page 5 Section H
See
Clause Description Satisfactory
Remarks
LISCR ISM Verify that the ship is manned in accordance with her Safe Manning Certificate      

Document of Compliance Number:       Note: Not required to

LISCR ISM be filled in if copy of
ISM 13.6 Scope of ship types: DOC is attached.
     

Issued by:       Expiration:       Last periodical:      

An Interim Document of Compliance may be issued to facilitate initial implementation of this Code when
ISM 14.1
(Check one if Applicable):

14.1.1 a Company is newly established      

INTERIM
new ship types are to be added to an existing Document of Compliance, following verification that
14.1.2 the Company has a Safety Management System that meets the objectives of paragraph 1.2.3 of
this Code, provided the Company demonstrates plans to implement a Safety Management System      
meeting the full requirements of this code within the period of validity of the Interim Document of
Compliance.
ISM 14.2 An Interim Safety Management Certificate is issued (Check the Applicable Box):
14.2.1 New ships on delivery;      
14.2.2 Company takes on responsibility for the operation of a ship which is new to the Company      
14.2.3 Ship changes flag      
Such an Interim Safety Management Certificate should be issued for a period not exceeding 6 months by the
Administration or an organization recognized by the Administration or, at the request of the Administration, by
another Contracting Government.

ISM 14.4 An Interim Safety Management Certificate may be issued following verification that:
the Document of Compliance, or the Interim Document of Compliance, is relevant to the ship
14.4.1
concerned (Type of Ship being audited must be listed on DOC)
     

the Safety Management System provided by the Company for the ship concerned includes key
14.4.2 elements of this Code and has been assessed during the audit for issuance of the Document of      
Compliance or demonstrated for issuance of the Interim Document of Compliance;

14.4.3 the Company has planned the internal audit of the ship within three months;      
the Master and officers are familiar with the Safety Management System and the planned
14.4.4
arrangements for its implementation;
     

14.4.5 instructions, which have been identified as being essential, are provided prior to sailing; and      
relevant information on the Safety Management System has been given in a working language or
14.4.6
languages understood by the ship's personnel.
     

ISPS
A Vessel shall be issued an Interim ISSC for the following purposes only (Check the applicable box):
A/19.4.1

19.4.1.1 a ship without a certificate, on delivery or prior to its entry or re-entry into service;      
transfer of a ship from the flag of a Contracting Government to the flag of another Contracting
19.4.1.2
Government;
     

transfer of a ship to the flag of a Contracting Government from a State which is not a
19.4.1.3
Contracting Government; or
     

when a Company assumes the responsibility for the operation of a ship not previously operated
19.4.1.4
by that Company;
     

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 See
Clause Description Satisfactory
Remarks
ISPS
An Interim International Ship Security Certificate shall only be issued when a Liberian Auditor, has verified
A/19.4.2
the following:

19.4.2.1 the Ship Security Assessment required by this Part of the Code has been completed,      

INTERIM
a copy of the Ship Security Plan meeting the requirements of chapter XI-2 and part A of this
19.4.2.2 Code is provided on board, has been submitted for review and approval, and is being      
implemented on the ship;

the ship is provided with a Ship Security Alert System meeting the requirements of regulation
19.4.2.3
XI-2/6, if required,
     

19.4.2.4 the Company Security Officer:

19.4.2.4.1 has ensured:
19.4.2.4.1.1 the review of the Ship Security Plan for compliance with this Part
of the Code,
     

19.4.2.4.1.2 that the plan has been submitted for approval, and      
19.4.2.4.1.3 that the plan is being implemented on the ship, and      
has established the necessary arrangements, including arrangements for drills,
exercises and internal audits, through which the Company Security Officer is
19.4.2.4.2
satisfied that the ship will successfully complete the required verification in
     
accordance with section 19.1.1.1 within 6 months;
19.4.2.5 arrangements have been made for carrying out the required verifications under section
19.1.1.1;
     
19.4.2.6 the Master, the Ship's Security Officer and other ship's personnel with specific security duties
are familiar with their duties and responsibilities as specified in this Part of the Code; and with
the relevant provisions of the ship security plan placed onboard in the working language of the
     
ship’s personnel;
19.4.2.7 the Ship Security Officer meets the requirements of this Part of the Code.      
For the purposes of regulation XI-2/9, Contracting Governments may, prior to accepting an Interim
ISPS
A/19.4.6
International Ship Security Certificate as a valid certificate, ensure that the requirements of sections 19.4.2.4      
to 19.4.2.6 have been met.

Examination of statutory records for AIS:      

LISCR
ISPS
Examination of statutory records for SSAS:      
Examination of statutory records for Continuous Synopsis Record (CSR):      
SOLAS
Location of IMO Number outside the hull:
XI-1/3
SOLAS
Location of IMO Number inside the hull:
XI-1/3
ISPS Auditor to Advise Master: An Interim International Ship Security Certificate shall be valid for 6 months, or
A/19.4.4 until the certificate required by section 19.2 is issued, whichever comes first, and may not be extended.
     

Auditor to Advise Master: No Contracting Government shall cause a subsequent, consecutive Interim
International Ship Security Certificate to be issued to a ship if, in the judgment of the Administration or the
ISPS
A/19.4.5
recognized security organization, one of the purposes of the ship or a Company in requesting such      
Certificate is to avoid full compliance with chapter XI-2/9 and this part of the Code beyond the period of the
initial Interim certificate as specified in section 19.4.4.
Interim ML Certificates may only be issued by the Administration to:
MLC
Only Applicable to: Satisfactory See Remarks
A5.1.3.5
New ships on delivery;      

Existing ships on reactivation;      

Transfer from another flag, or      

A shipowner takes on responsibility for the operation of a ship which is new to that shipowner      

Until the certificate referred to in section A/5.1.3.1 is issued, the Administration may cause an Interim Maritime Labour Certificate to be issued, in a form
corresponding to the model given in the Appendix A5-II of the code.

An Interim Maritime Labour Certificate may only be issued when the Administration has verified that:

MLC-001
An email is available on board the ship confirming receipt of the information in 136 and 138;      
4.5.2
The ship has been inspected , as far as reasonable and practicable, for the 14 matters (areas) listed in
A/5.1.3.7      
Appendix A5-I of the Convention
The Shipowner has demonstrated to the Administration that the ship has adequate procedures to comply
A/5.1.3.7      
with the requirements of the Convention;

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A/5.1.3.7 The Master is familiar with the requirements of this Convention and the responsibilities for implementation;      

The Shipowner has submitted a draft of the DMLC-II to the Administration which outlines the measures that
A/5.1.3.7      
the shipowner proposes to implement on board the ship; and
An interim ML Certificate may be issued for a period not exceeding six (6) months by the Administration and
A/5.1.3.7      
cannot be extended.
An interim ML Certificate may be issued for a period not exceeding five (5) months by the Administration
A/5.1.3.6      
and may be extended for a period not exceeding one (1) month.

PART O - CLOSING MEETING

1) Statement of Thanks 5) State N/C's and Observations 9) Confirm limit dates
2) Complete Attendance List 6) Provide Audit Summary 10) Issue certificate
3) Restate Audit Scope and Purpose 7) Clarification of N/C's and Observations
4) Explain that only sample of vessel was audited.
8) Answer any Questions
Other N/C's may exist

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PART P - SHIP SECURITY ALERT SYSTEM VERIFICATION (SOLAS XI-2 /6)
(ONLY CONDUCT SSAS WITH MASTER'S APPROVAL)
See
Description Yes / No
Remarks
Is confirmation of a “Test Message” from the Administration onboard? Y N      

SSAS
Is “type approval” certificate available for this equipment? Y N      
Is the SSP amended to include SSAS procedures? Y N      
Where are the 2 activation points located? 1) 2)
Are two activation points designated as to prevent inadvertent initiation? Y N      
Can any part of the SSAS Equipment be easily sighted by an unauthorized person? Y N      
Where is the location of equipment and its components?      
Is there an alternative power supply (i.e. batteries)? Y N      
Does the system raise any alarm onboard? Y N      
Does the system send any alarm to other ships? Y N      
Where are the means of deactivation and/or reset? Y N      

Is the Master familiar with the system in respect to the procedure of:
1. Testing
How often?      
 To whom is the test message sent?      
 Who receives the true alert?      
2. Activation in real mode? (how and when to activate)      
3. Deactivation?      
4. Maintenance of equipment
 By Whom?      
 When?      
 Frequency?      
Additional Comments:      
     
     
     
     

Is the SSO familiar with the system in respect to the procedure of:
1. Testing
 How often?      
 To whom is the test message sent?      
 Who receives the true alert?      
2. Activation in real mode? (how and when to activate)      
3. Deactivation?      
4. Maintenance of equipment
 By Whom?      
 When?      
 Frequency?      
Additional Comments:      
     
     
     
     

IMPORTANT: DO NOT LEAVE ON BOARD VESSEL.

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PART Q – Harmonized Audit Summary

DURATION OF AUDIT:      

ATTACHED CHECKLIST:
Checklist and Applicable Form 206s
Parts O and Q of this Checklist
Signed Copy of ISSC and Copy of SSO Certificate
Signed Copy of SMC
Signed Copy of MLCCopy of SSO Certificate
Invoice and Receipts
Old ISSC and/or SMC if replaced by newly issued ISSC and/or SMC
Copy of SSAS Verification Endorsement or Letter (if issued)
Photos
Other:      

Harmonized Audit Information

Note: Please provide a description of your overall feeling of the vessel's dedication to the ISM, ISPS, and MLC Codes
and implementation of the Safety Management System and Ship Security Plan. Provide a brief summary of the Audit.
     
     

     

     

     

     

     

     

     

     

     

     

IMPORTANT: DO NOT LEAVE ON BOARD VESSEL.

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PART R - AUDITOR'S TIMELINE

Start Time End Time Miles/Km Comments

Travel Time                  
     
Opening Meeting            
     
Document Review            
     
Interview Master            
     
Interview SSO            
     
Interview Deck Officers            
     
Interview Crew            
     
Lunch            
     
Tour            
     
Drill            
     
Preparing the Report            
     
Closing Meeting            
     
Travel Time                  
     
Total Audit Time            
Total Travel Time                        
Additional Comments:
     
     
     
     
     
     

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