STATEMENT (LIFE SAVING EQUIPMENTS) Checklist_and_Forms.pdf · 2011. 3. 14. · Lifeboat Location...

F103/R2 Issue Date: 18 Mar. 2009

Marland Boat Service Ltd.

STATEMENT (LIFE SAVING EQUIPMENTS) This is to confirm that the following life saving equipments have been carried out period maintenance by the undersigned licensed service engineer in accordance with SOLAS Regulation III 20.3.2 and MSC/Circular 1206 and that the launching appliances have been found to be fit for purpose.

Certificate Number:

Name of ship： IMO No.：

Lifeboat

Type: Date of manufacture: Manufacturer: Date of servicing: Port of servicing:

Kind of Servicing: Annual 5 yearly

Result (Details depend on the attached check list)

Starboard Side Port Side

Note: This statement is based on an agreement in the deliberation of the 48th IMO Ship Design and Equipment (DE) subcommittee.

Service Company： Service Engineer： (signature) Name: Date:

Certificate No.

Annual Inspection 5-yearly Inspection

Remark

Part Exchange Repair


















Item

Hull - Inner Structure

1.3

1.2

Satisfactory

Type of Lifeboat

Service Location

Lifeboat Location

Hull No.

Manufacturer

Manufacturing Date:

Hull - Outside

Ship Owner

Flag

Satisfactory

Satisfactory

Satisfactory

Maintenance Check List

1.1

Result of Inspection and Servicing

Builder

Description

Serial Number

1.5 Embarkation Door

1.4 Canopy - Inner Structure

Satisfactory

1.6 Top Access Hatch Satisfactory

1.7 Fore Access Hatch Satisfactory

1.8 Aft Access Hatch Satisfactory

1.9 Hand Rails Satisfactory

1.10 Bottom Plug Satisfactory

1.11 Bilge Hand Pump Satisfactory

1.12 Lifeline Satisfactory

Satisfactory

1.13 Painter Release Device Satisfactory

1.16 Head Cushions Satisfactory

1.17

1 18 Rubber Fender Satisfactory

SatisfactoryRetro-reflective material

Rain Water Collector

Safety Belt Satisfactory

1. General Outfit

Canopy - Outside

1.15

1.14

Class

Type of Service

IMO Number

Name of Ship

Type of Ship




Remark

Part Exchange Repair 5-yearly examination: condition overhual



Part Exchange Repair renew - every 10 years





Part Exchange Repair Annual examination: light load

Part Exchange Repair 5-yearly examination: 1.1 times load

F101/R2Issue Date: 18 Mar. 2009 Marland Boat Service Ltd.

1.20 Windows Satisfactory

1.19 Skates Satisfactory

1.18 Rubber Fender Satisfactory

Certificate Nr. :

Date of Servicing :

Owner's Representative: Service Company:Service Engineer :Name:

2.2 Central Release Unit

2. Release MechanismItem Description Result of Inspection and Servicing

2.1 Satisfactory

2.6

Interlock Unit

Satisfactory

2.5 Hydrostatic Interlock Device

2.8

Fore and Aft release cables

Satisfactory

2.7 Satisfactory

2.10

Spring for Hydro. Device

Satisfactory

2.9 Satisfactory

Satisfactory

Hook Release & reseting operation

Hook Release & reseting operation

Cable for Hydro. Device

Rubber Diaphragm

Satisfactory

2.2

Hook Device

Satisfactory

Notice:

Satisfactory

2.4

Remark























4. Electric Parts

3.14 Cooling water pipe

4.2

3.16 Rudder Nozzle

3.13 Fuel Oil pipe Satisfactory

Satisfactory

3.12 V-belt of Generator Satisfactory

Satisfactory

3.15 Propeller

3.11 Engine Control Panel Satisfactory

3.10 Stern Tube Satisfactory

3.9 Start/Stop Button Satisfactory

3.8 Main Switch Satisfactory

Gear oil level

3.6 Lub oil level

Satisfactory3.7

3.4 Steering Gear

Fuel oil level Satisfactory3.5

Start engine

3.3

3.2

Engine gear control

Maintenance Check List

3.1

Result of Inspection and Servicing

3. Engine Plant

Item Description

Engine and gear box Satisfactory

Satisfactory

Satisfactory

Satisfactory

4.1 Batteries Satisfactory

Battery charger Satisfactory

Satisfactory

Satisfactory

4.3 Ceiling Light Satisfactory

4.4 Indication Light Satisfactory

4.5 Search Light Satisfactory

5 Ai S l S t (f T k i l )

4.6 Electric wiring Satisfactory





6. Water Spray System (for Tanker version only)Part Exchange Repair




F101/R2Issue Date: 18 Mar. 2009 Marland Boat Service Ltd.

Date of Servicing :

Service Engineer :Name:

Notice:

Owner's Representative: Service Company:

5. Air Supply System (for Tanker version only)5.1 air bottles Satisfactory

5.2 air bottles' pressure Satisfactory

5.3 pressure hoses Satisfactory

5.4 air regulator Satisfactory

6.1 Water Spray Pump Satisfactory

6.2 Water Spray Lines Satisfactory

6.3 Spray Nozzles Satisfactory

6.4 Inlet Control Valve & Gear Satisfactory

Certificate Nr. :

F103/R2 Issue Date: 18 Mar. 2009 Marland Boat Service Ltd.

STATEMENT (LAUNCHING APPLIANCES) This is to confirm that the following life saving equipments have been carried out period maintenance by the undersigned licensed service engineer in accordance with SOLAS Regulation III 20.3.2 and MSC/Circular 1206 and that the launching appliances have been found to be fit for purpose.

Certificate Number:


Davit Type: Date of manufacture: Manufacturer:

Winch Type: Date of manufacture: Manufacturer:

Date of servicing: Port of servicing:

Kind of Servicing: Annual 5 yearly


Starboard Side Port Side


Service Company：

MARLAND BOAT SERVICE LTD.

Service Engineer： (signature) Name: Date:

Certificate No.

DAVIT AND WINCH EXAMINATION CHECK LIST This check list should be issued by the manufacturer’s representative or the person certified by the manufacturer for the work.


BOAT DAVIT ☒No.1 □No.2 DATE: Name of vessel Type of Davit IMO number Serial number No Items Result of inspection and servicing Remarks 01 Sheave Suspension block □Good □Part exchange □Repair

02 Hinge pin Rollerpin □Good □Part exchange □Repair

03 Suspension block Link □Good □Part exchange □Repair

04 Boat fall □Good □Part exchange □Repair

05 Lashing wire rope □Good □Part exchange □Repair

06 Remote control device □Good □Part exchange □Repair

07 Frame, Davit arm □Good □Part exchange □Repair

08 Davit arm horn □Good □Part exchange □Repair

09 Trigger hook □Good □Part exchange □Repair

10 Cradle stopper □Good □Part exchange □Repair

11 Shackle, Thimble Turn buckle □Good □Part exchange □Repair

12 Slip hook □Good □Part exchange □Repair

13 Bolt, Nut, etc □Good □Part exchange □Repair

14 Welding part with deck □Good □Part exchange □Repair

15 Recovery strap □Good □Part exchange □Repair

16 Maintenance pendant □Good □Part exchange □Repair

17 Spare parts □Good □Part exchange □Repair

18 Wire adjuster □Good □Part exchange □Repair

19 Turning out Operation □Good □Part exchange □Repair

20 Turning in Operation □Good □Part exchange □Repair

Notice：＊Erase an unnecessary item in the slash.

Captain signature：

Service engineer：（Signature） Name：

Service company： MARLAND BOAT SERVICE LTD.

Certificate number：

Date of servicing：



BOAT WINCH ☒No.1 □No.2 DATE: Name of Vessel IMO Number Type of winch Serial number Date of manufacturer Name of manufacturer No Items Result of inspection and servicing Remarks 01 Gear case □Good □Part exchange □Repair

02 Gear □Good □Part exchange □Repair

03 Bearing □Good □Part exchange □Repair

04 Disk brake □Good □Part exchange □Repair

05 Brake lever □Good □Part exchange □Repair

06 Hand break device □Good □Part exchange □Repair

07 Centrifugal brake □Good □Part exchange □Repair

08 Cam clutch □Good □Part exchange □Repair

09 Wire dram □Good □Part exchange □Repair

10 Manual handle □Good □Part exchange □Repair

11 Dynamic winch Brake test □Good □Part exchange □Repair Annual

12 Dynamic winch Brake test □Good □Part exchange □Repair 1.1 times load(5-yearly)

13 Induction motor □Good □Part exchange □Repair

14 Push button switch □Good □Part exchange □Repair

15 Plug & receptacle □Good □Part exchange □Repair

16 Magnetic switchbox □Good □Part exchange □Repair

17 Limit switch □Good □Part exchange □Repair

18 Air motor □Good □Part exchange □Repair

19 Oiler, Filter □Good □Part exchange □Repair

20 Limit valve □Good □Part exchange □Repair









BOAT DAVIT □No.1 ☒No.2 DATE: Name of vessel Type of Davit IMO number Serial number No Items Result of inspection and servicing Remarks 01 Sheave Suspension block □Good □Part exchange □Repair

02 Hinge pin Rollerpin □Good □Part exchange □Repair

03 Suspension block Link □Good □Part exchange □Repair

04 Boat fall □Good □Part exchange □Repair

05 Lashing wire rope □Good □Part exchange □Repair

06 Remote control device □Good □Part exchange □Repair

07 Frame, Davit arm □Good □Part exchange □Repair

08 Davit arm horn □Good □Part exchange □Repair

09 Trigger hook □Good □Part exchange □Repair

10 Cradle stopper □Good □Part exchange □Repair

11 Shackle, Thimble Turn buckle □Good □Part exchange □Repair

12 Slip hook □Good □Part exchange □Repair

13 Bolt, Nut, etc □Good □Part exchange □Repair

14 Welding part with deck □Good □Part exchange □Repair

15 Recovery strap □Good □Part exchange □Repair

16 Maintenance pendant □Good □Part exchange □Repair

17 Spare parts □Good □Part exchange □Repair

18 Wire adjuster □Good □Part exchange □Repair

19 Turning out Operation □Good □Part exchange □Repair

20 Turning in Operation □Good □Part exchange □Repair









BOAT WINCH □No.1 ☒No.2 DATE: Name of Vessel IMO Number Type of winch Serial number Date of manufacturer Name of manufacturer No Items Result of inspection and servicing Remarks 01 Gear case □Good □Part exchange □Repair

02 Gear □Good □Part exchange □Repair

03 Bearing □Good □Part exchange □Repair

04 Disk brake □Good □Part exchange □Repair

05 Brake lever □Good □Part exchange □Repair

06 Hand break device □Good □Part exchange □Repair

07 Centrifugal brake □Good □Part exchange □Repair

08 Cam clutch □Good □Part exchange □Repair

09 Wire dram □Good □Part exchange □Repair

10 Manual handle □Good □Part exchange □Repair

11 Dynamic winch Brake test □Good □Part exchange □Repair Annual

12 Dynamic winch Brake test □Good □Part exchange □Repair 1.1 times load(5-yearly)

13 Induction motor □Good □Part exchange □Repair

14 Push button switch □Good □Part exchange □Repair

15 Plug & receptacle □Good □Part exchange □Repair

16 Magnetic switchbox □Good □Part exchange □Repair

17 Limit switch □Good □Part exchange □Repair

18 Air motor □Good □Part exchange □Repair

19 Oiler, Filter □Good □Part exchange □Repair

20 Limit valve □Good □Part exchange □Repair








STATEMENT (LIFE SAVING EQUIPMENTS) This is to confirm that the following life saving equipments have been carried out period maintenance by the undersigned licensed service engineer in accordance with SOLAS Regulation III 20.3.2 and MSC/Circular 1206 and that the life saving equipments have been found to be fit for purpose.

Certificate Number:


Freefall Lifeboat Type: Date of manufacture: Manufacturer:

Freefall Lifeboat Davit Type: Date of manufacture: Manufacturer:

Freefall Lifeboat Winch Type: Date of manufacture: Manufacturer:


Kind of Servicing: Annual Servicing 5 yearly Servicing Repair


Freefall Lifeboat Freefall Lifeboat Davit Freefall Lifeboat Winch


Service Company：

MARLAND BOAT SERVICE LTD.

Service Engineer：(signature) Name: Date:

FREE FALL LIFEBOAT EXAMINATION CHECK LIST


FREE FALL LIFEBOAT Name of ship Manufacturer IMO number Type Ship Owner Serial Number Port of Registry Service Location Class Inspection Date

External Checklist of Free-fall Lifeboat NO Items Result of inspection and servicing Remarks 01 FRP Hull □Good □Part exchange □Repair

02 Marking □Good □Part exchange □Repair Seals □Good □Part exchange □Repair

Hatches & Doors □Good □Part exchange □Repair

Painter Release □Good □Part exchange □Repair

Sliding Rail □Good □Part exchange □Repair Handrails □Good □Part exchange □Repair Door Handle □Good □Part exchange □Repair Lifeline □Good □Part exchange □Repair Window □Good □Part exchange □Repair Lifting Eye □Good □Part exchange □Repair Retro Reflective Tape □Good □Part exchange □Repair Skate Rail □Good □Part exchange □Repair Recovering Ring □Good □Part exchange □Repair

03 Fitting

Lashing Eyes □Good □Part exchange □Repair Spray Tube □Good □Part exchange □Repair

04 Water Spray

System Under Nozzle □Good □Part exchange □Repair

05 Steering System Rudder □Good □Part exchange □Repair

06 Bilge System Drain Plug □Good □Part exchange □Repair

Canopy □Good □Part exchange □Repair 07 Electrics

Socket & Plug □Good □Part exchange □Repair

Notice：

Service company：


Signature of Vessel Representative：

Service engineer：（Signature）

Name： Date of servicing：

FREE FALL LIFEBOAT EXAMINATION CHECK LIST


FREE FALL LIFEBOAT Name of ship Manufacturer IMO number Type Ship Owner Serial Number Port of Registry Service Location Class Inspection Date

Internal Checklist of Free-fall Lifeboat NO Items Result of inspection and servicing Remarks

Stuffing Box □Good □Part exchange □Repair 01 Propulsion /

Shaft Bearings □Good □Part exchange □Repair

Rudder Bearing □Good □Part exchange □RepairEmergency Tiller □Good □Part exchange □Repair02 Steering

System Steering Cable □Good □Part exchange □Repair

Hydro-Pump □Good □Part exchange □Repair03 Release

Mechanism Emergency Pump □Good □Part exchange □Repair

Safety Belt □Good □Part exchange □RepairHead Protection □Good □Part exchange □RepairCompass □Good □Part exchange □Repair04 Fitting

Symbols □Good □Part exchange □Repair

Valves □Good □Part exchange □Repair 05 Water Spray

System Hose Connection □Good □Part exchange □Repair Pressure Valves □Good □Part exchange □Repair Air Cylinder □Good □Part exchange □Repair 06 Air Supply

System Pressure Gauge □Good □Part exchange □Repair

07 Bilge System Bilge Pump □Good □Part exchange □Repair

Interior Light □Good □Part exchange □Repair Search Light □Good □Part exchange □Repair Batteries □Good □Part exchange □Repair 08 Electrics

Charger □Good □Part exchange □Repair Notice：

Service company：





FREE FALL LIFEBOAT DAVIT & WINCH CHECK LIST


Name of ship Manufacturer IMO number Type Ship Owner Serial Number Port of Registry Davit Location Class Inspection Date DAVIT FOR FREE-FALL TYPE NO Items Result of inspection and servicing Remarks 01 Slide Track □Good □Part exchange □Repair

02 Davit Arms □Good □Part exchange □Repair 03 Hinge □Good □Part exchange □Repair 04 Sheave □Good □Part exchange □Repair 05 Roller □Good □Part exchange □Repair 06 Traverse □Good □Part exchange □Repair 07 Suspension □Good □Part exchange □Repair 08 Lashing Bollard □Good □Part exchange □Repair 09 Main Lashing □Good □Part exchange □Repair 10 Boat Fall □Good □Part exchange □Repair 11 Hook Lashing Line □Good □Part exchange □Repair 12 Wire for Lashing Plate □Good □Part exchange □Repair 13 Reset Wire for Lashing Plate □Good □Part exchange □Repair 14 Hydraulic Cylinder □Good □Part exchange □Repair 15 Spare Parts □Good □Part exchange □Repair 16 Others □Good □Part exchange □Repair

Notice：

Service company：





FREE FALL LIFEBOAT DAVIT & WINCH CHECK LIST


Name of ship Manufacturer IMO number Type Ship Owner Serial Number Port of Registry Winch Location Class Inspection Date WINCH FOR FREE-FALL TYPE NO Items Result of inspection and servicing Remarks 01 Gear Box □Good □Part exchange □Repair

02 Lubrication Oil □Good □Part exchange □Repair 03 Gear □Good □Part exchange □Repair 04 Bearing □Good □Part exchange □Repair 05 Oil Seal □Good □Part exchange □Repair 06 Hydraulic Brake Device □Good □Part exchange □Repair 07 Hydraulic Motor □Good □Part exchange □Repair 08 Wire Drum □Good □Part exchange □Repair 09 Power Pack □Good □Part exchange □Repair 10 Hydraulic Pump □Good □Part exchange □Repair 11 Hydraulic Control Valve □Good □Part exchange □Repair 12 Electric Motor □Good □Part exchange □Repair 13 Starter Panel □Good □Part exchange □Repair 14 Push Button Box □Good □Part exchange □Repair 15 Rubber Hose & Joint □Good □Part exchange □Repair

16 Launching Test by the Operation of Davit Arm □Good □Part exchange □Repair Empty Boat

(For Annual Inspection Only)

17 Brake Test by the Operation of Davit Arm □Good □Part exchange □Repair Full Load x 1.1times

(for 5-yearly Only) Notice：

Service company：







Certificate Number:


Type: Date of manufacture: Rescue Boat Manufacturer: Type: Date of manufacture: Rescue Boat Davit Manufacturer: Type: Date of manufacture: Rescue Boat Winch Manufacturer:




Rescue Boat Rescue Boat Davit Rescue Boat Winch


Service Company： Service Engineer：(signature) Name: Date:

RESCUEBOAT EXAMINATION CHECK LIST

F101/R2 Issue Date: 18 Mar. 2009


Name of ship Manufacturer IMO number Type Ship Owner Serial Number Port of Registry Service Location Class Inspection Date NO Items Result of inspection and servicing Remarks 01 FRP Hull □Good □Part exchange □Repair

02 Marking □Good □Part exchange □Repair Seals □Good □Part exchange □Repair

Symbol □Good □Part exchange □Repair

Handrails □Good □Part exchange □Repair

Lifeline □Good □Part exchange □Repair Retro Reflective Tape □Good □Part exchange □Repair Painter Release □Good □Part exchange □Repair Towing Eye □Good □Part exchange □Repair Lifting Hook □Good □Part exchange □Repair Rubber Fender □Good □Part exchange □Repair Compass □Good □Part exchange □Repair Fuel Tank □Good □Part exchange □Repair Arch □Good □Part exchange □Repair Lashing Guide □Good □Part exchange □Repair Under Foot Step □Good □Part exchange □Repair Impact Protection Rubber □Good □Part exchange □Repair Locker / Hatch □Good □Part exchange □Repair

03 Fitting

Paddle □Good □Part exchange □Repair

05 Steering System Rudder □Good □Part exchange □Repair

06 Bilge System Drain Plug □Good □Part exchange □Repair

Canopy □Good □Part exchange □Repair

Search Light □Good □Part exchange □Repair 07 Electrics

Socket & Plug □Good □Part exchange □Repair

Notice：

Service company：





LIFE RAFT / RESCUE BOAT DAVIT & WINCH CHECK LIST


Name of ship Manufacturer IMO number Type of Davit Ship Owner Serial Number Port of Registry Service Location Class Inspection Date DAVIT FOR LIFE RAFT / RESCUE BOAT NO Items Result of inspection and servicing Remarks 01 Post Stand □Good □Part exchange □Repair

02 Post □Good □Part exchange □Repair 03 Davit Arm □Good □Part exchange □Repair 04 Sheave □Good □Part exchange □Repair 05 Suspension Block □Good □Part exchange □Repair 06 Slewing Bearing □Good □Part exchange □Repair 07 Slewing Stopper □Good □Part exchange □Repair 08 Slewing Reducer □Good □Part exchange □Repair 09 Lubrication Oil □Good □Part exchange □Repair 10 Slewing Hydraulic Motor □Good □Part exchange □Repair 11 Release Hook □Good □Part exchange □Repair 12 Boat Fall □Good □Part exchange □Repair 13 Remote Control Device □Good □Part exchange □Repair 14 Deck Operation Device □Good □Part exchange □Repair 15 Recovery Trap □Good □Part exchange □Repair 16 Hanging Off Pendant □Good □Part exchange □Repair 17 Spare Part □Good □Part exchange □Repair 18 Others □Good □Part exchange □Repair

Notice：

Service company：







WINCH FOR LIFE RAFT / RESCUE BOAT NO Items Result of inspection and servicing Remarks 01 Gear Box □Good □Part exchange □Repair

02 Lubrication Oil □Good □Part exchange □Repair 03 Gear □Good □Part exchange □Repair 04 Bearing □Good □Part exchange □Repair 05 Oil Seal □Good □Part exchange □Repair 06 Hand Brake Device □Good □Part exchange □Repair 07 Governor Brake Device □Good □Part exchange □Repair 08 Cam Clutch □Good □Part exchange □Repair 09 Manual Handle □Good □Part exchange □Repair 10 Wire Drum □Good □Part exchange □Repair 11 Power Pack □Good □Part exchange □Repair 12 Hydraulic Pump □Good □Part exchange □Repair 13 Hydraulic Control Valve □Good □Part exchange □Repair 14 Accumulator □Good □Part exchange □Repair 15 Electric Motor □Good □Part exchange □Repair 16 Starter Panel □Good □Part exchange □Repair 17 Limit Switch □Good □Part exchange □Repair 18 Hydraulic Hose & Joint □Good □Part exchange □Repair

19 Dynamic Winch Brake Test □Good □Part exchange □Repair Empty Boat (For Annual Inspection Only)

20 Dynamic Winch Brake Test □Good □Part exchange □Repair Full Load x 1.1times (for 5-yearly Only)

Notice：

Service company：





Name of ship Manufacturer IMO number Type of Winch Ship Owner Serial Number Port of Registry Service Location Class Inspection Date



Certificate Number:


Type: Date of manufacture: Liferaft Davit Manufacturer: Type: Date of manufacture: Liferaft Winch Manufacturer:




Liferaft Davit Liferaft Winch


Service Company：

Service Engineer：(signature) Name: Date:



Name of ship Manufacturer IMO number Type of Davit Ship Owner Serial Number Port of Registry Service Location Class Inspection Date DAVIT FOR LIFE RAFT / RESCUE BOAT NO Items Result of inspection and servicing Remarks 01 Post Stand □Good □Part exchange □Repair

02 Post □Good □Part exchange □Repair 03 Davit Arm □Good □Part exchange □Repair 04 Sheave □Good □Part exchange □Repair 05 Suspension Block □Good □Part exchange □Repair 06 Slewing Bearing □Good □Part exchange □Repair 07 Slewing Stopper □Good □Part exchange □Repair 08 Slewing Reducer □Good □Part exchange □Repair 09 Lubrication Oil □Good □Part exchange □Repair 10 Slewing Hydraulic Motor □Good □Part exchange □Repair 11 Release Hook □Good □Part exchange □Repair 12 Boat Fall □Good □Part exchange □Repair 13 Remote Control Device □Good □Part exchange □Repair 14 Deck Operation Device □Good □Part exchange □Repair 15 Recovery Trap □Good □Part exchange □Repair 16 Hanging Off Pendant □Good □Part exchange □Repair 17 Spare Part □Good □Part exchange □Repair 18 Others □Good □Part exchange □Repair

Notice：

Service company：







WINCH FOR LIFE RAFT / RESCUE BOAT NO Items Result of inspection and servicing Remarks 01 Gear Box □Good □Part exchange □Repair

02 Lubrication Oil □Good □Part exchange □Repair 03 Gear □Good □Part exchange □Repair 04 Bearing □Good □Part exchange □Repair 05 Oil Seal □Good □Part exchange □Repair 06 Hand Brake Device □Good □Part exchange □Repair 07 Governor Brake Device □Good □Part exchange □Repair 08 Cam Clutch □Good □Part exchange □Repair 09 Manual Handle □Good □Part exchange □Repair 10 Wire Drum □Good □Part exchange □Repair 11 Power Pack □Good □Part exchange □Repair 12 Hydraulic Pump □Good □Part exchange □Repair 13 Hydraulic Control Valve □Good □Part exchange □Repair 14 Accumulator □Good □Part exchange □Repair 15 Electric Motor □Good □Part exchange □Repair 16 Starter Panel □Good □Part exchange □Repair 17 Limit Switch □Good □Part exchange □Repair 18 Hydraulic Hose & Joint □Good □Part exchange □Repair

19 Dynamic Winch Brake Test □Good □Part exchange □Repair Empty Boat (For Annual Inspection Only)

20 Dynamic Winch Brake Test □Good □Part exchange □Repair Full Load x 1.1times (for 5-yearly Only)

Notice：

Service company：





Name of ship Manufacturer IMO number Type of Winch Ship Owner Serial Number Port of Registry Service Location Class Inspection Date

M/V _

LIFEBOAT & LAUNCHING APPLIANCE SERVICE

WORK DONE LIST

This is to confirm that “Marland Boat Service Ltd.”

has performed the Annual / 5 Yearly maintenance for

□ Lifeboat and / or Rescue Boat

□ Launching Appliance

in accordance with Solas Regulation III 20.3.2 and

MSC/Circular 1206. on __________________

certificate issued and received.

Accepted and Signed by:

________________ ________________

Vessel Representative Marland Boat Service Ltd.

___________________________________________________________________

Add: Rm 702, Fortress Tower, 250 King’s Road, Northpoint, Hong Kong SAR, China Tel: (852) 2571 9322 Fax: (852) 2806 3153 Email: [email protected]

F102/R2 Issue Date: 18 Mar 2009


___________________________________________________________

___________________________________________________________ Add: Rm 702, Fortress Tower, 250 King’s Road, Northpoint, Hong Kong SAR, China

Tel: (852) 2571 9322 Fax: (852) 2806 3153 Email: [email protected] F106/R2 Issue Date: 18 Mar 2009


Work Done & Delivery Note Vessel Name: Shipbuilder:

IMO Number: Hull No:

Date: Date of Build:

Location: Flag / Class:

Kind of Work: 5 yearly Service / Repair or Parts Renewal / General Inspection

This is to confirm the below job to the above mentioned vessel has been carried out.

Item Descriptions Qty

Accepted and Signed by Marland Boat Service Ltd.

Vessel Representative:

________________________ __________________________

___________________________________________________________

___________________________________________________________ Add: Rm 702, Fortress Tower, 250 King’s Road, Northpoint, Hong Kong SAR, China

Tel: (852) 2571 9322 Fax: (852) 2806 3153 Email: [email protected] F107/R2 Issue Date: 18 Mar 2009


Time Sheet Vessel Name: Shipbuilder:

IMO Number: Hull No:

Date: Date of Build:

Location: Flag / Class:

Kind of Work: 5 yearly Service / Repair or Parts Renewal / General Inspection

Traveling Time

Date: Name Traveling Time (HH:MM ~ HH:MM) Total Hours

Working Time

Date Name Working Time (HH:MM ~ HH:MM) Total Hours

Accepted and Signed by Marland Boat Service Ltd.

Vessel Representative:

________________________ __________________________

STATEMENT (LIFE SAVING EQUIPMENTS) Checklist_and_Forms.pdf · 2011. 3. 14. · Lifeboat Location...

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