NAME OF VESSEL Date: 18 April 2016

Rev: 01
HSE SURVEY REPORT
Page 1 of 8

HSE SURVEY REPORT

Surfer Boat XXXX

Prepared by:

Agung Sudrajat
HSE Engineer
PT Saipem Indonesia
 NAME OF VESSEL Date: 18 April 2016
Rev: 01
HSE SURVEY REPORT
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TABLE OF CONTENTS

1.0 INTRODUCTION

2.0 VESSEL GENERAL PARTICULARS

3.0 FINDINGS

4.0 RECOMMENDATIONS
 NAME OF VESSEL Date: 18 April 2016
Rev: 01
HSE SURVEY REPORT
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1 INTRODUCTION
In compliance with Saipem requirement, Company has to assess the ferry services to be used for
travelling to and from Karimun.

This survey will evaluate the life saving facilities, medical facilities; fire and safety equipments,
emergency preparedness onboard the vessel.

2 VESSEL GENERAL PARTICULARS

1 Name of Vessel
2 IMO Number
3 Type of Vessel
4 Previous Name
5 Year Built
6 Name of Master
7 Vessel Operator Detail
Name:
Address:
Tel / Fax :

Email:
8 Vessel Owner Detail
Name:
Address:
Tel / Fax :
Email:
9 Class
10 Port of Registry
11 Registered Tonnage Gross
12 Registered Tonnage Nett
13 Registered length (Loa,)
14 Registered Breadth (Lbp)
15 Registered Depth (Dp)
16 Minimum Safe Manning
17 Engine
18 Estimate speed
19 Passenger
 NAME OF VESSEL Date: 18 April 2016
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HSE SURVEY REPORT
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3 FINDINGS

A General Comments
1 Status of Certificates?

B SAFETY MANAGEMENT Remarks

1. Does the vessel have current
Health, Safety and
Environmental Policies?
2. Safety Management Manual
3. Emergency / Contingency Plan

4. Documentations
5. Are all Risk Assessments
available?
6. Maintenance System
7. DPA
8. Key personnel to understand the
safety management system
9. Safety / Fire control plan
exhibited
10. Safety signs and other important
information to be prominently
displayed
11. Personal protective equipment
such as safety harnesses, boiler
suits, safety footwear, eye and
ear protection, etc., to be
provided and in use;
12. Safety meetings - note the
stated frequency of and verify by
reference to the minutes;

C GENERAL CONDITION Remarks

1. Hull to be visibly free of
extensive coating breakdown
2. Hull to be free of fractures or
indentations which may
significantly weaken the
structure or affect the watertight
integrity
3. Inspection of weather decks
shall include checking for any
evidence of wastage, structural
problems, collision contact or
distortion from heavy weather on
fore end of accommodation
4. Non-slip surfaces to be provided
on external walkways
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C GENERAL CONDITION Remarks

5. Are all deck openings, including
watertight doors and portholes,
in good condition and capable of
being properly secured?
6. Bridge windows to be effectively
sealed and where vulnerable to
wave action, provided with
shutters

D INSTRUCTIONS Remarks
1. Is there a safety induction /
briefing / video / pamphlet /
safety handbook given to
passenger?
2. Are safety rules prominently
displayed?
3. Instructions for donning life
jackets
4. Instructions for launching life
rafts
5. Safety Plan
6. Electric Shock Poster.
7. Battery Bank Poster

E LIFE SAVING APPLIANCES Remarks

1. Life-rafts are evenly distributed
on Both sides of the vessel &
can be easily launched.
Life raft shall have a valid
inspection certificate;
Casings shall be in good
condition;
Life rafts shall be stowed in
such a position that they
can be easily and
successfully launched;
Painter length shall be
appropriate for the height of
stowage;
Boarding ladders to be in
good condition (check for
missing steps, rope
deterioration and lashings);
Hydrostatic releases, if
fitted, shall be correctly
attached, in good condition
and in date;
Life raft operating
instructions shall be
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HSE SURVEY REPORT
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E LIFE SAVING APPLIANCES Remarks

prominently displayed;
2. Life buoys, life buoy lights, self
activating smoke floats and
quick release mechanisms to be
in good order, in date and
functional;
Life-buoy MOB
Life-buoy with Self Igniting
lights
Life-buoy with line
3. Radar transponders to be fitted
one to each side of the vessel
and stowed to permit rapid use
in survival craft.
4. Life jackets total number of
personnel allowed onboard
marked with vessels name
and Port of registry.
fitted with lights, whistles &
reflective tape
Life jackets to be in good
condition.
Life jacket donning
instruction notices to be
posted on each deck;
Compliance to Saipem
Standard
5. Portable VHF Emergency Radio

F FIRE FIGHTING APPLIANCES Remarks

1. Fixed systems;
2. Portable fire extinguishers to be
in apparent good order with
operating instructions clearly
marked
3. Emergency Generator
4. Is Fire Detection System smoke
installed?
5. Fire Axe

G WALKWAYS / EXIT Remarks

1. Is Lighting/Emergency Lighting
Adequate?
2. Are all walkways, Emergency
route exit, stairways and escape
are un-obstructed and clear of
trip hazards
3. Exit Routes Clearly Marked and
Illuminated.
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4. No Locks/Fastening Restricting
Escape.
5. More Than One Exit From
Accommodation Area.

H FIRST AID Remarks

1. First Aid Kit box
2. Are First Aid Stations Identified/
Stocked?
3. Are First Aiders Appointed?

I PASSENGER ITEMS Remarks

1. Seats & cover condition
2. Cleanliness/Housekeeping,
Paper trash
3. TV & video entertainment
4. Safety window glass (crack,
water tight, film)
5. Flooring condition
6. AC (cold, smell,
cleanliness/housekeeping/fungu
s, remote control,
compressor/blower, visual
condition, rubber tight for drain
pipe, capacity)
7. Toilet

Bridge, Navigation &

L Remarks
Communications
1. Does the vessel maintain an
indexed library of procedures,
publications and navigation
equipment?
2. Logbooks and movement books
shall be checked to ensure that
rough logs in pencil are not
being maintained and that the
logbooks are up to date, with
entries properly made in ink
3. Has a system been established
to ensure that nautical
publications, charts and
information are both onboard
and current
4. Ensure that charts in use have
been corrected in accordance
with the latest notices to
mariners received and that all
publications used are up to date
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Bridge, Navigation &

L Remarks
Communications
5. Charts in use to be appropriate
for the port note
6. Is a copy of the International
Code of Signals onboard?
7. Magnetic compass
A standard magnetic compass
shall be fitted for ships of 150
GRT or more (unless exempted
by vessels Administration). A
spare magnetic compass,
interchangeable with the
standard magnetic compass
shall be carried unless a
steering compass or gyro
compass is fitted
8. Radars
A radar shall be installed on
ships of 500 GRT or more
constructed on or after 1
September 1984. Ships of
10,000 GRT or more shall be
fitted with 2 radars (one of which
shall have ARPA fitted).
9. Signal lamps (Aldis)
Batteries charged and ready for
use
10. VHF radio with internationally
agreed channels. Notice on
proper procedures shall be
displayed

M Others Remarks
1. Search Lights
2. Personnel transfer procedure via
boat landing
3. Handrail of the bow stairwell
4. State of bow fender (Suitably
adhesive material)
5. Safety ropes for guiding
passenger toward bow stairwell
6. Eligibility of surfer skipper and
surfer deckhand (Knowledge,
experience, etc.)

4 RECOMMENDATION
No recommendation