Ship Shore Safety Check List

SHIP SHORE
SAFETY CHECK LIST
Form No
Date
Revision
Page
708
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APPENDIX A
This Appendix comprises the Ship/Shore Safety Check List, Guidelines relating to the Check List and
a specimen letter for issue by the terminal representative to masters of tankers at terminals.
Ships name:
Berth:
Port:
Date of Arrival:
Time of Arrival:
INSTRUCTIONS FOR COMPLETION:

The safety of operations requires that all questions should be answered affirmatively by clearly
ticking () the appropriate box. If an affirmative answer is not possible, the reason should be given
and agreement reached upon appropriate precautions to be taken between the ship and the
terminal. Where any question is considered to be not applicable, then a note to that effect should
be inserted in the remarks column.
A box in the columns ship and terminal indicates that the party concerned should carry out
checks.
The presence of the letters A, P or R in the column entitled Code indicates the following:
A
(Agreement). This indicates an agreement or procedure that should be identified in the

Remarks column of the Check-List or communicated in some other mutually acceptable form.
(Permission). In the case of a negative answer to the statements coded P, operations should
not be conducted without the written permission from the appropriate authority.
(Re-check). This indicates items to be re-checked at appropriate intervals, as agreed between

both parties, at periods stated in the declaration.
The joint declaration should not be signed until both parties have checked and accepted their
assigned responsibilities and accountabilities.
SHIP SHORE
SAFETY CHECK LIST
Form No
Date
Revision
Page
PART A BULK LIQUID GENERAL Physical Checks

General
Ship
Terminal
Code
1.
There is safe access between the ship

and shore.
2.
Is the ship securely moored?
3.
The agreed ship/shore communication

system is operative.
AR
4.
Emergency towing-off pennants are

correctly rigged and positioned.
5.
The ship's fire hoses and fire-fighting

equipment are positioned and ready
for immediate use.
6.
The terminal's fire-fighting equipment

is positioned and ready for immediate
use.
7.
The ship's cargo and bunker hoses,

pipelines and manifolds are in good
condition, properly rigged and
appropriate for the service intended.
8.
The terminal's cargo and bunker hoses

or arms are in good condition, properly
rigged and appropriate for the service
intended.
9.
The cargo transfer system is

sufficiently isolated and drained to
allow safe removal of blank flanges
prior to connection.
10. Scuppers and save-alls on board are

effectively plugged and drip trays are
in position and empty.
11. Temporarily removed scupper plugs

will be constantly monitored.
12. Shore spill containment and sumps are

correctly managed.
13. The ship's unused cargo and bunker

connections are properly secured with
blank flanges fully bolted.
14. The terminal's unused cargo and

bunker connections are properly
secured with blank flanges fully bolted.
15. All cargo, ballast and bunker tank lids

are closed.
R
R
Remarks
System:
Backup System:
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SHIP SHORE
SAFETY CHECK LIST
Form No
Date
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16. Sea and overboard discharge valves,

when not in use, are closed and visibly
secured.
17. All external doors, ports and windows

in the accommodation, stores and
machinery spaces are closed. Engine
room vents may be open.
Location:
18. The ship's emergency fire control

plans are located externally.
If the ship is fitted, or is required to be fitted, with an inert gas system (IGS), the following
points should be physically checked:
19. Fixed IGS pressure and oxygen
content recorders are working.
20. All cargo tank atmospheres are at

positive pressure with oxygen content
of 8% or less by volume.
PR
PART B BULK LIQUID GENERAL Verbal Verification

21. The ship is ready to move under its
own power.
PR
22. There is an effective deck watch in

attendance on board and adequate
supervision of operations on the ship
and in the terminal.
23. There are sufficient personnel on

board and ashore to deal with an
emergency.
24. The procedures for cargo, bunker and

ballast handling have been agreed.
AR
25. The emergency signal and shutdown

procedure to be used by the ship and
shore have been explained and
understood.
26. Material Safety Data Sheets (MSDS)

for the cargo transfer have been
exchanged where requested.
PR
H2S Content:
27. The hazards associated with toxic

substances in the cargo being handled
have been identified and understood.
Benzene Content:
28. An International Shore Fire Connection

has been provided.
29. The agreed tank venting system will be

used.
30. The requirements for closed

operations have been agreed.
31. The operation of the P/V system has

been verified.
AR
R
Method:
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SHIP SHORE
SAFETY CHECK LIST
32. Where a vapour return line is
connected, operating parameters have
been agreed.
33. Where a vapour return line is

connected, operating parameters have
been agreed.
34. Adequate electrical insulating means

are in place in the ship/shore
connection.
35. Shore lines are fitted with a non-return

valve, or procedures to avoid back
filling have been discussed
36. Smoking rooms have been identified
and smoking requirements are being
observed.
37. Naked light regulations are being

observed.
38. Ship/shore telephones, mobile phones

and pager requirements are being
observed.
AR
AR
AR
PR
Nominated smoking rooms:
AR
AR
AR
39. Hand torches (flashlights) are of an

approved type.
40. Fixed VHF/UHF transceivers and AIS

equipment are on the correct power
mode or switched off.
41. Portable VHF/UHF transceivers are of

an approved type.
42. The ship's main radio transmitter

aerials are earthed and radars are
switched off.
43. Electric cables to portable electrical

equipment within the hazardous area
are disconnected from power.
44. Window type air conditioning units are

disconnected.
45. Positive pressure is being maintained

inside the accommodation, and air
conditioning intakes, which may
permit the entry of cargo vapours, are
closed.
46. Measures have been taken to ensure

sufficient mechanical ventilation in the
pump room.
47. There is provision for an emergency

escape.
Stop cargo at:
48. The maximum wind and swell criteria

for operations have been agreed.
Form No
Date
Revision
Page
Disconnect at:
Unberth at:
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SAFETY CHECK LIST
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49. Security protocols have been agreed

between the Ship Security Officer and
the Port Facility Security Officer, if
appropriate.
50. Where appropriate, procedures have

been agreed for receiving nitrogen
supplied from shore, either for inerting
or purging ship's tanks, or for line
clearing into the ship.
AP
If the ship is fitted, or is required to be fitted, with an inert gas system (IGS) the following
Inert Gas System
Ship
Terminal
51. Is the Inert Gas System fully

operational and in a good
working order?
Code
Remarks
52. Deck seals, or equivalent, are in
good working order.
53. Liquid levels in
pressure/vacuum breakers are

correct.
54. The fixed and portable oxygen
analysers have been calibrated

and are working properly.
55. All the individual tank IG valves
(if fitted) are correctly set and

locked.
56. All personnel in charge of cargo

operations are aware that, in
the case of failure of the inert
gas plant, discharge operations
should cease and the terminal
be advised.
If the ship is fitted with a Crude Oil Washing (COW) system, and intends to crude oil wash,
the following statements should be addressed:
57. The Pre-Arrival COW check-list,
as contained in the approved
COW manual, has been
satisfactorily completed.
58. The COW check-lists for use

before, during and after COW,
as contained in the approved
COW manual, are available
and being used.
If the ship is planning to tank clean alongside, the following statements should be addressed:
59. Tank cleaning operations are
planned during the ship's stay
alongside the shore installation.
Yes/No*
Yes/No*
SHIP SHORE
SAFETY CHECK LIST
Form No
Date
Revision
Page
60. If `yes', the procedures and

approvals for tank cleaning
have been agreed.
61. Permission has been granted

for gas freeing operations.
Yes/No*
Yes/No*
* Delete Yes or No as appropriate
PART C BULK LIQUID CHEMICALS

Bulk Liquid Chemicals
1.
Material Safety Data Sheets

are available giving the
necessary data for the safe
handling of the cargo.
2.
A manufacturer's inhibition
certificate, where applicable,
has been provided.
3.
Sufficient protective clothing

and equipment (including selfcontained breathing
apparatus) is ready for
immediate use and is suitable
for the product being handled.
4.
Countermeasures against
accidental personal contact
with the cargo have been
agreed.
5.
The cargo handling rate is

compatible with the automatic
shutdown system, if in use.
6.
Cargo system gauges and

alarms are correctly set and in
good order.
7.
Portable vapour detection

instruments are readily
available for the products
being handled.
8.
Information on fire-fighting
media and procedures has
been exchanged.
9.
Transfer hoses are of suitable

material, resistant to the action
of the products being handled.
10. Cargo handling is being

performed with the permanent
installed pipeline system.
Ship
Terminal
Code
Remarks
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SAFETY CHECK LIST
Form No
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11. Where appropriate,

procedures have been agreed
for receiving nitrogen supplied
from shore, either for inerting
or purging ship's tanks, or for
line clearing into the ship.
AP
DECLARATION
We, the undersigned, have checked the above items in Parts A and B, and where appropriate
Part C , in accordance with the instructions, and have satisfied ourselves that the entries we
have made are correct to the best of our knowledge.
We have also made arrangements to carry out repetitive checks as necessary and agreed that
those items with code `R' in the Check-List should be re-checked at intervals not exceeding
_____ hours.
If to our knowledge the status of any item changes, we will immediately inform the other party.
For Ship
For Shore
Name:
Name:
Rank:
Position:
Signature:
Signature:
Date:
Time:
Record of repetitive checks:
Date:
Time:
Initials for Ship:
Initials for Shore:
Date:
Time:
Initials for Ship:
Initials for Shore:
Date:
Time:
Initials for Ship:
Initials for Shore:
Date:
Time:
Initials for Ship:
Initials for Shore:
R item No: 1 ,2 ,3 ,4 ,5 ,6 ,8 ,11 ,13 ,17 ,23 , 26 ,27 ,28 ,30 ,32 ,33 ,38 ,39 ,40 ,41 ,42 ,43 re-checked at
intervals not exceeding .. hours.
SHIP SHORE
SAFETY CHECK LIST
Date
Time
Observation and remarks
Form No
Date
Revision
Page
Signature of OOW
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SHIP SHORE

SAFETY CHECK LIST

INSTRUCTIONS FOR COMPLETION:

(Agreement). This indicates an agreement or procedure that should be identified in the

(Re-check). This indicates items to be re-checked at appropriate intervals, as agreed between

PART A BULK LIQUID GENERAL Physical Checks

There is safe access between the ship

Is the ship securely moored?

The agreed ship/shore communication

Emergency towing-off pennants are

The ship's fire hoses and fire-fighting

The terminal's fire-fighting equipment

The ship's cargo and bunker hoses,

The terminal's cargo and bunker hoses

The cargo transfer system is

10. Scuppers and save-alls on board are

11. Temporarily removed scupper plugs

12. Shore spill containment and sumps are

13. The ship's unused cargo and bunker

14. The terminal's unused cargo and

15. All cargo, ballast and bunker tank lids

16. Sea and overboard discharge valves,

17. All external doors, ports and windows

18. The ship's emergency fire control

20. All cargo tank atmospheres are at

PART B BULK LIQUID GENERAL Verbal Verification

22. There is an effective deck watch in

23. There are sufficient personnel on

24. The procedures for cargo, bunker and

25. The emergency signal and shutdown

26. Material Safety Data Sheets (MSDS)

27. The hazards associated with toxic

28. An International Shore Fire Connection

29. The agreed tank venting system will be

30. The requirements for closed

31. The operation of the P/V system has

33. Where a vapour return line is

34. Adequate electrical insulating means

35. Shore lines are fitted with a non-return

37. Naked light regulations are being

38. Ship/shore telephones, mobile phones

39. Hand torches (flashlights) are of an

40. Fixed VHF/UHF transceivers and AIS

41. Portable VHF/UHF transceivers are of

42. The ship's main radio transmitter

43. Electric cables to portable electrical

44. Window type air conditioning units are

45. Positive pressure is being maintained

46. Measures have been taken to ensure

47. There is provision for an emergency

48. The maximum wind and swell criteria

49. Security protocols have been agreed

50. Where appropriate, procedures have

51. Is the Inert Gas System fully

52. Deck seals, or equivalent, are in

good working order.

53. Liquid levels in

pressure/vacuum breakers are

54. The fixed and portable oxygen