FORM D-4

PRE-DEPARTURE INSPECTION CHECKLIST

For Domestic PASSENGER-CARGO VESSEL
FOR OFFICIAL USE OF PHILIPPINE COAST GUARD VSEI TEAM

Name of Vessel: __________________________ Port of Inspection: __________________________

Owner/ Operator: _________________________ Date of Inspection: __________________________
Vessel Type: ____________________________ Next Port of Call: ___________________________
Hull Material: ____________________________ Time Inspection Started: _____________________
GT: _______________NT:__________________ Time Inspection Completed: __________________

REF TO REG ITEMS FOR INSPECTION CODE YES NO REMARKS

COMPLETE AND VALID SHIP SAFETY CERTIFICATES AND DOCUMENTS
MARINA MC 1. Certificate of Public Convenience (CPC)
161/MC 2006-06 is valid
VS8113
(If Not Valid, DETAINABLE)
MC 177 2. Certificate of Vessel Registry is valid
VS8115
(If Not Valid, DETAINABLE)
MC 177 3. Certificate of Ownership is valid
VS8112
(If Not Valid, DETAINABLE)
MC 110 4. Coastwise/ Bay & River License is valid
VS8118
(If Not Valid, DETAINABLE)
MC 203 5. Passenger Ship Safety Certificate is valid
VS8148
(If Not Valid, DETAINABLE)
MC 89, MC 148, 6. Minimum Safe Manning Certificate is valid
MC 179 VS8142
(If Not Valid, DETAINABLE)
PMMRR 1997 7. Ship Station License is valid
Chapter X VS8157
(If Not Valid, DETAINABLE)
MC 2007-04 8. Tonnage Measurement Certificate is valid
VS8165
(If Not Valid, DETAINABLE)
MC 2007-03 9. Load Line Certificate is valid (SHOULD BE
ENDORSED ANUALLY – NOT APPLICABLE TO SHIPS LESS
THAN 15 METERS IN LENGTH) VS8140
(If Not Valid, DETAINABLE)
MC 124 10. Class Society Certificate is valid.
(for 500 GT and above)
Class Society:________________ VS8117
(If Not Valid, DETAINABLE)
MC 143 11. Document of Compliance is valid (ISM/NSM
MC159 Code)
VS8124
(If Not Valid, DETAINABLE)
MC148,MC 179 12. Safety Management Certificate is valid
(ISM/NSM Code)
VS8154
(If Not Valid, DETAINABLE)
MC.105/105-A; 13. Special Permit to temporarily operate in
domestic trade is valid (applicable to Foreign-
registered ships operating in the domestic VS8161
route)
(If Not Valid, DETAINABLE)
REF TO REG ITEMS FOR INSPECTION CODE YES NO REMARKS
MC 161/MC 2006- 14. Special Permit to operate in route not
06 mentioned in the CPC is valid. VS8160
(If Not Valid, DETAINABLE)
MC 2007-05 15. Certificate of Stability or Exemption
Certificate (SHOULD BE ENDORSED EVERY 5 YRS. –
NOT APPLICABLE TO SHIP AUTHORIZED TO CARRY 12 VS8114
PASSENGERS AND BELOW)
(If Not Valid, DETAINABLE)
MC 2007-05 16. Intact Stability Booklet approved by MARINA
is available onboard. VS8114
(If No, to be RECTIFIED)
HPCG MC NR 05- 17. Shipboard Oil Pollution Emergency Plan
2005 (SOPEP) for all Oil Tankers of 150 GT and
above and every ship other than Oil Tankers VS8158
of 400 GT and above is valid
(If Not Valid, DETAINABLE)
HPCG MC NR 06- 18. International Oil Pollution Prevention
2005 Certificate (IOPPC) for Philippine registered
vessels engaged in international and VS8135
domestic trade is valid
(If Not Valid, DETAINABLE)
HPCG MC NR 07- 19. International Sewage Pollution Preventive
2005 Certificate (ISPPC) for registered vessels of
200 GT and above, vessels less than 200 GT
which are certified to carry more than fifty VS8136
(50) persons whether engaged in domestic or
international trade is valid.
(If Not Valid, DETAINABLE)
HPCG MC 02- 20. Garbage Management Plan and Garbage
2005 Record Book to all Philippine registered
vessels engaged in international trade and to VS8130
all small crafts are valid.
(If No, to be RECTIFIED)
HPCG MC 07- 21. Sewage Treatment Plan / Holding Tank for
2005 the collection and storage of sewage is valid. VS81751
(If No, to be DETAINABLE)
HPCG MC 01- 22. Oil Water Separator installed onboard vessel
2005 of 400 GT and above and Oil Tankers 150
GT and above shall be duly approved by the VS81718
PCG is valid
(If Not Valid, DETAINABLE)
HPCG MC 06- 23. Oil Record Book Part 1 for 400GT and above
2005 is valid. VS8145
(If Not Valid, to be RECTIFIED)
HPCG MC 08-12 24. Master’s Declaration of Safe Departure
(MDSD) properly accomplished, submitted
with the necessary attachments. VS8144

(If incomplete, to be RECTIFIED)

 REF TO REG ITEMS FOR INSPECTION CODE YES NO REMARKS
RA 9295; MC 25. Passenger Insurance Cover is valid and
2009-18 adequate for the total number of passenger
VS8147
the ships is authorized to carry.
(If Not Valid, DETAINABLE)
HPCG MC 00 -
2011
26. Vessel Safety Inspection Booklet VS8166
OVERLOADING OF CARGO AND EXCESS PASSENGERS STRICTLY NOT ALLOWED
MC 2007-03 27. Load line / Plimsoll marks are clearly visible,
not tampered, well-above the waterline and
VS81211
do not indicate that the ship is overloaded.
(If No, to be RECTIFIED)
MC 175; MC 180 28. Passenger manifest indicates that the vessel
is carrying passengers within the authorized
VS82606
number per MARINA PSSC.
(If No, to be RECTIFIED)
MC 180, MC 120, 29. Conducted random check of passengers to
MC 2009-13, MC verify the correctness of entries in the
2009-18 VS82603
manifest.
(If No, to be RECTIFIED)
MC 180, MC 120 30. Conducted head counting of passengers and
MC 2009-13, MC finds the ship to be carrying only the
2009-18
authorized number of passengers per
MARINA issued PSSC.
Mandatory if:
• Vessel authorized passenger capacity is
500 or less; or VS82606
• Vessel authorized passenger capacity is
more than 500 and passenger manifest
indicates 90% filled-up of its authorized
capacity or upon clear indication of
overcrowding or excess passengers.
(If No, to be RECTIFIED)
ADEQUATE/ ACCESSIBLE LIFEJACKETS
MC 123 31. Master / Patron declares the adequacy of
lifejackets, liferafts and other life saving
VS8642
appliances.
(If No, DETAINABLE)
MC 123 32. Random check reveals availability of
authorized MARINA type-approved life
VS8652
jackets and liferafts / lifeboats.
(If No, DETAINABLE)
MC 123 33. Lifejacket compartments were randomly
checked to verify if they are unlocked and
VS8633
accessible to passengers.
(If No, to be RECTIFIED)
SHIP STABILITY AND TRIM, CARGO SECURING / LASHING ASCERTAINED
HPCG MC 04-98 34. No signs of listing per ship’s clinometers
reading and no other visual indicators of
VS81215
instability.
(If No, DETAINABLE)
35. Cargo securing or lashing employed by
ship’s crew. VS81205
(If No, to be RECTIFIED)
 REF TO REG ITEMS FOR INSPECTION CODE YES NO REMARKS
TOTAL NUMBER OF OFFICERS AND CREW MEETS MINIMUM SAFE MANNING REQUIREMENT
MC 89, MC 148, 36. The actual number, composition and
MC 179 qualifications of crew conform with the
VS8422
Minimum Safe Manning Certificate.
(If No, DETAINABLE)
MC 151, 170 37. Ship’s Officers possess valid licenses.
VS8216
(If No, DETAINABLE)
MC 114 38. Officers and crew on duty are wearing proper
uniform. VS82413
(If No, to be RECTIFIED)
GOOD WEATHER/ SEA CONDITION PREVAILING
HPCG MC 01-09, 39. Ship allowed to sail per HPCG MC 01-09 or
MC 03-01 VS8321
MC 03-01.
PCG MC 01-09 40. Latest PAGASA Weather Bulletin available
VS8309
and plotted in the weather chart.
41. Latest Notice to Mariner and Updated
Nautical Chart is available on board VS8308
(If No, to be RECTIFIED)
UPKEEP OF EQUIPMENT AND RUNNING LIGHTS VERIFIED
PMMRR 1997 42. Required / fitted communications /
Chapter X and XI navigational equipment per Ship Station
VS8745
License or PSSC are in operating condition.
(If No, DETAINABLE)
PMMRR 1997 43. Running lights are operating.
Chapter XI VS8746
(If No, DETAINABLE)
ALL ENGINES IN OPERATING CONDITION
PMMR 1997 44. Master and Chief Engineer declares that all
Chapter V, HPCG main and auxiliary engines including fire
MC 04-98 VS81509
pumps are in operating condition.
(If No, DETAINABLE)
RESPONSIBLE SHIPOWNER / CREW / TERMINAL CONTROL
MC 180, MC 45. Complete Passenger Manifest submitted
2009-13, MC prior departure. VS82404
2009-18
(If No, to be RECTIFIED)
MC 191 46. No indication observed that any Officer is
under the influence of alcohol or prohibited
VS82412
drugs.
(If No, DETAINABLE)
MC 114 47. Random check of passageways reveals that
they are unobstructed and escape routes are
VS8652
passable.
(If No, to be RECTIFIED)
MC 134: MC____ 48. Embarkation / Disembarkation ladder is
Sec III.A.24 provided with non-skid steps and guardrails. VS82408
(If No, to be RECTIFIED)
INSTRUCTIONS:

1. No vessel shall be cleared to depart for voyage unless it complies with all the applicable conditions
(items of inspection) of this checklist.
2. PDI shall be conducted “prior to a vessel’s departure”. The phrase “prior to a vessel’s departure” shall
be reckoned from the time the Master has declared his intention to depart a port thru the submission of
the Master’s Declaration of Safe Departure (MDSD) to a PCG Station or Detachment.
3. For the use of this checklist, the term “passenger” shall mean any person carried onboard the vessel,
whether paying or non-paying, except official members of the crew.
4. When PDI is completed, ensure that no more passenger(s) shall be allowed to board and no cargo is
loaded in the vessel for the voyage.
5. PCG inspector(s) shall personally witness the departure of the vessel from port/ point of origin to
ensure compliance to instruction 2.
6. In areas where the same vessel makes multiple departures on the same port on the same day,
inspection may be conducted on the first departure except for checking the passenger manifest,
carriage of excess passengers, loadline/stability, cargo lashings or reported deficiency or
malfunctioning of ship’s equipment/machinery, verification shall be on a by trip basis.
7. Appropriate MVR or EIAR shall be issued for violations of regulations discovered or observed during
the inspection.
8. Accomplished copies of this vessel departure checklist shall be maintained by each Coast Guard
Station and Detachment for ready reference.
9. VSEI team shall video record the specified points of inspection in reference to HPCG Memorandum
dated 26 June 2012 re “Guidelines for Video Recording During MPDI”.

Inspection conducted by:

___________________________ _____________________________________
Coast Guard Station/ Detachment Name and Signature of Inspector

NOTE: PCG INSPECTORS SHOULD ALWAYS ENSURE THE ATTACHMENT OF FORM “B” AFTER THE INSPECTION