Report no: Page 1 of 5

MARPOL Annex I Survey Checklist

Ships Name IMO Number

Notes:NON-TANKERS complete PART 1 (except section BC), PART 1A and at initial surveys PART 3 TANKERS complete PART 1 (all sections), Part 1A and 2 and at initial surreys PART 3 Items marked 'I' and 'R' are additional items to be completed at intermediate and renewal surveys respectively Mark boxes 'Yes' for complied with 'No' for not complied with or 'NA' for not applicable Part 1 - All Ships AA General - All Ship Types
050 100 100 a Are all Statutory Certificates and Classification Certificates valid? Have any alterations been made or any new equipment installed? If so have they been approved and are changes reflected in the appropriate certificate?

Yes/No* Yes/No* Yes/No/NA*

AB
050 100

National Administration Requirements

Have the country files been checked to ascertain any flag administration requirements? Have all flag administration technical and reporting requirements been complied with?

Yes/No/NA* Yes/No/NA*

BA
050 100

Manning
Does the ships complement comply with the Minimum Safe Manning Document (SOLAS 74/88 reg.V/13(b))? Are the master, officers and ratings certificated as required by the STCW Convention?

Yes/No* Yes/No*

BB
050 050 a 050 b 050 c 100 150

Documentation - All Ship Types

Are type approval certificates onboard for the following:Oil filtering equipment (15 ppm equipment)? (Reg. 14 and 16) Oil content meter (15ppm alarm) and automatic stopping device? (Reg. 14) Process units (ancillary unit attached to 100 ppm equipment to convert it to 15 ppm equipment)? Is Part I of the Oil Record Book onboard and have appropriate and regular entries been made? (Reg. 17) Is there an approved Shipboard Oil Pollution Emergency Plan or a Shipboard Marine Pollution Emergency Plan on board? (Reg. 37) Approval date

Yes/No/NA* Yes/No/NA* Yes/No/NA* Yes/No* Yes/No/NA*

BC
050 050 a 050 b 100 150 150 a 150 b 150 c 150 d 150 e 150 f 200 250

Documentation - Oil Tankers

Are type approval certificates onboard for the following:Oil Discharge Monitoring and Control System? (Reg. 31) Oil/water interface detector(s)? (Reg. 32) Is there evidence that the survey of the inert gas system has been carried out? Are copies of the following approved manuals onboard:Oil Discharge Monitoring and Control System (ODME) Operational Manual? Crude Oil Washing (COW) Operations and Equipment Manual? Loading and Stability Information? Dedicated Clean Ballast Tank (DCBT) Manual? Hydrostatic Balanced Loading Manual? Operational procedures for special ballast arrangements? Approval date Approval date Approval date Approval date Approval date Approval date

Yes/No/NA* Yes/No/NA* Yes/No/NA* Yes/No/NA* Yes/No/NA* Yes/No/NA* Yes/No/NA* Yes/No/NA* Yes/No/NA* Yes/No/NA* Yes/No/NA*

Are records (print outs) of the Oil Discharge Monitoring and Control System operations onboard? Is Part II of the Oil Record Book onboard and have appropriate and regular entries been made?

* Delete as applicable Form 2136A (2008.01)

Report no: Page 2 of 5

BC
300 300 a 300 b 400 400 a 400 b 400 c

Documentation - Oil Tankers (Continued)

For tankers to which the Condition Assessment Scheme (CAS) is applicable in accordance with Regs 20 and/orCAS Statement of Compliance on board? Is the 21: Issued By: Approved by

Yes/No/NA* Yes/No/NA*

Date: Dated

Yes/No/NA* Yes/No/NA* Yes/No/NA* Yes/No/NA*

Is an approved CAS final report review record onboard? Does the tanker have prompt access to computerised, shore-based damage stability and residual structural strength calculation programs? (Reg. 37.4) Is there a contract onboard linking the ship with a shore based Firm applying the service in 400. Is there a statement onboard from the shore based Firm indicating that it is capable of providing the service required by item 400. Has it been confirmed that the ship has a means to access the shore based Firm at any time 24 hours a day, 7 days a week.

CA
050 050 a 050 b 050 c 050 d 050 e 100 150 200 a 200 b 250

Survey of the Condition of the Ship and its Equipment - All Ship Types (see note 1)
Are the following in a satisfactory condition, free from obvious damage or defects including pumps, pipes fittings and tested as operating satisfactorily:Oil filtering equipment (15 ppm equipment). (Reg. 14) Oil content meter (15 ppm alarm). (Reg. 14) Was it confirmed from onboard records that the oil content meter has been calibrated in accordance with the manufacturers instructions? (Reg. 14) Was the satisfactory operation of the alarm confirmed? (Reg. 14) Was the satisfactory operation of the automatic stopping device confirmed? (Reg. 14) Is the fuel oil and water ballast system segregated? Is a standard discharge connection provided? (Reg. 12) Is the sludge tank(s) capacity sufficient? (Reg. 12) Is the only connection overboard from the sludge tank(s) via the standard discharge connection? (Reg. 13) Are means of sludge control such as homogenisers and sludge incinerators in a satisfactory condition, free from obvious damage or defects including pumps, pipes fittings and operating satisfactorily?

Yes/No/NA* Yes/No/NA* Yes/No/NA* Yes/No/NA* Yes/No/NA* Yes/No/NA* Yes/No/NA* Yes/No/NA* Yes/No/NA* Yes/No/NA*

I, R R

Note 1 Testing to include both manual and automatic operation, observing that indicators and recording devices are operable and a sufficient supply of consumables are available for recording devices (where provided). At an annual survey the test should be carried out as far as practicable. At an intermediate survey the equipment, including associated pumps, piping and fittings should be examined for wear and corrosion. At a renewal survey the operation of the equipment is to be confirmed, if necessary by simulated test or equivalent. It should also be verified that the piping arrangements are in compliance with the regulations and that there are no unauthorised modifications to the piping system. Part 1A
The following survey has been carried out Initial/Annual/Intermediate/Renewal/GE*

Checklist parts 1, 1A, 2 and 3* have been completed Place of Survey

Date of Survey

Surveyor to Lloyd's Register EMEA

A member of the Lloyds Register Group Remarks:

* Delete as applicable Form 2136A (2008.01)

Report no: Page 3 of 5

Part 2 Tankers Survey of the Condition of the Ship and its Equipment Tankers DA Pumping and Piping
050 100 150 200 250 Is the arrangement of slop tanks, or cargo tanks designated as slop tanks, and associated piping systems satisfactory? Are the means of draining cargo pumps, lines, and stripping device to the slop or cargo tanks or ashore satisfactory? Are the piping systems for discharge of dirty ballast water or oil contaminated water satisfactory? Are the valves/closing devices in the cargo system installed and operational? Is the means of communication between the overboard observation point and cargo control station operational?

Yes/No/NA* Yes/No/NA* Yes/No/NA* Yes/No/NA* Yes/No/NA* R

DB
050

Oil Water Interface Detector

Is the oil/water interface detector(s) in satisfactory condition and operating correctly?

Yes/No/NA*

DC
050 100 150 200

Double Hull
Are the arrangements for compliance with regulation 19 as approved and satisfactory? Are the arrangements for compliance with regulation 20 as approved and satisfactory? Are the arrangements for compliance with regulation 21 as approved and satisfactory? Is the ship allowed continued operation according to the phase-out scheme of MARPOL 73/78 Annex I and is the phase-out date correctly stated on the FORM B

Yes/No/NA* Yes/No/NA* Yes/No/NA* Yes/No/NA*

DD
050 100 100 a 100 b 100 c 100 d 150

Oil Discharge Monitoring and Control System (see note 1) (Regulation 31)
Was the system examined for obvious defects, deterioration or damage and absence of leaks? Was the operation of the system, including the oil content meter, confirmed as far as practicable by ensuring the operation of:Automatic and/or manual means to stop the discharge overboard, starting interlock, manual override control Audible and visual alarms, system reset to normal after alarm condition Recording device, including confirmation that there are adequate consumables for the recording device Pumps, valves, flushing arrangements, and sampling probes Was it confirmed from onboard records that the oil content meter has been calibrated in accordance with the manufacturers instructions?

Yes/No/NA*

Yes/No/NA* Yes/No/NA* Yes/No/NA* Yes/No/NA* Yes/No/NA* I, R

DE
050 100 150 150 a 150 b 150 c 200 250 300

Segregated Ballast Tanks- SBT (Regulation 18)

Has it been confirmed that there is no cross connection between the cargo and segregated ballast tank systems? Are the arrangements of pumps, pipes and valves in accordance with the requirements for SBT Systems? If a spool piece for the emergency discharge of segregated ballast is fitted is it: Fitted with non-return valves? Mounted in a conspicuous position? Provided with a permanent prominently displayed notice restricting its use? Has it been confirmed by sighting that the segregated ballast tanks are free from contamination by oil? Are the ballast pipelines passing through cargo tanks and vice versa free from any sign of leakage? Are the valves/closing devices in the cargo system (required to be closed at sea) installed and operational?

Yes/No/NA* Yes/No/NA* Yes/No/NA* Yes/No/NA* Yes/No/NA* Yes/No/NA* Yes/No/NA* Yes/No/NA* R I, R

DF
050 100 100a 150 200 250 300 350 400

Crude Oil Washing COW (Regulation 18)

Are the COW arrangements, in accordance with the approved COW manual? Were the COW piping, pumps, valves and deck mounted machines examined for obvious defects, deterioration, damage and absence of leaks (paying particular attention to any repairs such as welded doublers)? any doubt as to the condition of the COW piping outside the cargo tanks, was the piping If there was pressure tested, gauged, or both? Are the anchoring arrangements for the COW supply lines intact and secure? Can steam heaters be isolated by double valves or blanked and are the valves operable? Is the means of communication between deck watch keeper and cargo control operational? Are the correct number of portable drive units onboard? Are the means of draining cargo pumps, lines, and stripping devices to the slop or cargo tanks or ashore satisfactory? Is the overpressure relief device for the pumps supplying the crude oil washing system operational?

Yes/No/NA* Yes/No/NA* Yes/No/NA* Yes/No/NA* Yes/No/NA* Yes/No/NA* Yes/No/NA* Yes/No/NA* Yes/No/NA* I

* Delete as applicable Form 2136A (2008.01)

Report no: Page 4 of 5 DF

450 450 a 450 b 450c 500 550 600 650 700 750

>

Crude Oil Washing COW Continued

Has the effectiveness of the COW system and stripping system verified by:Checking that the COW machines, stripping system and monitoring equipment are operational? Hand dipping tanks on completion of COW? Inspecting tanks containing departure and/or arrival ballast for signs of oil? Are flexible supply hoses for COW supply approved, properly stored and in good condition? (OBO only) Have at least two cargo tanks been internally examined to verify the effectiveness of the COW (Tankers overit been confirmed that the COW system remains effective and internal equipment and arrangements Has 10 years old)? are satisfactory? Was a pressure test of the crude oil washing system to at least the working pressure carried out? Has an oil on top test been carried out in the departure ballast tanks and heavy weather ballast tanks? Have the steam heater isolating valves been internally inspected?

Yes/No/NA* Yes/No/NA* Yes/No/NA* Yes/No/NA* Yes/No/NA* Yes/No/NA* Yes/No/NA* Yes/No/NA* Yes/No/NA* I, R I, R R R R

DG
050 150 200 250 300 350 400

Dedicated Clean Ballast Tanks DCBT ( Regulation 18)

Are the DCBT arrangements, in accordance with the approved DCBT Manual and if applicable the COW manual and remain in a satisfactory condition? Has it been confirmed by sighting that the dedicated clean ballast tanks are free from contamination by oil? Are the inert gas and/or common vent lines blanked from the DCB tanks and alternative venting arrangements operational and in a satisfactory condition? Are fixed tank washing machines blanked and the pipelines on deck adequately supported? For common systems, is there two-valve separation between the DCBT system and cargo system? For separate and independent systems, are there two valves or a single blank separating the ballast and cargo systems? Are ballast pipelines passing through cargo tanks, and cargo pipelines passing through ballast tanks, free from any sign of leakage?

Yes/No/NA* Yes/No/NA* Yes/No/NA* Yes/No/NA* Yes/No/NA* Yes/No/NA* Yes/No/NA* R R R R R

DH
050 100 150

Part Flow ( Regulation 18)

Is the part flow system (if fitted) as described in the ODME Manual and examined for obvious defects? Was the communication system between the observation and discharge control positions tested? Was a functional test carried out including the sampling probe(s), sample water piping system, sample feed pump(s), display arrangement, sample discharge arrangement and where fitted flushing arrangements?

Yes/No/NA* Yes/No/NA* Yes/No/NA* I, R

DI
050

Other ( Regulation 18)

For tankers with special ballast arrangements are there approved operational procedures on board and are the arrangements satisfactory?

Yes/No/NA*

* Delete as applicable Form 2136A (2008.01)

Report no: Page 5 of 5 Part 3 Initial Surveys Initial Survey Plan Approval EA All Ship Types
050 100 150 200 250 300 350 Have the following plans/calculations been examined and approved? Installation of the oily-water filtering equipment, 15ppm alarm and automatic stop device (Reg. 14) Segregation of fuel/lub oil and water ballast systems and location of fuel oil tanks (Reg. 16) Sludge tank capacity (Reg. 12) Discharge piping arrangements including standard discharge pipe (Reg. 13) Shipboard Oil Pollution Emergency Plan or Shipboard Marine Pollution Emergency Plan (Reg. 37) Oil fuel tank protection (Reg. 12A)

Yes/No/NA* Yes/No/NA* Yes/No/NA* Yes/No/NA* Yes/No/NA* Yes/No/NA*

EB
050 100 150 200 250 300 350 400 450 500 550 600 650 700 750 800 850

Tankers
Have the plans/calculations for the following been examined and approved? Arrangements and capacity of SBT (Reg. 18) Minimum draft and trim requirements (Reg. 33) Arrangements of the COW system, including checking to ensure that an inert gas system is fitted Shadow area diagrams (Reg. 33) Crude Oil Washing Operations and Equipment Manual (Reg. 35) Has the Crude Oil Washing System Initial Survey checklist been completed? Protective location of segregated ballast spaces (Reg. 18) Slop tank arrangements (Reg. 29) Oil Discharge Monitoring and Control System (Reg. 31) Oil Discharge Monitoring and Control System Operations Manual (Reg. 31) Pumping, piping and discharge arrangements (Reg. 30) Size and arrangement of cargo tanks (Reg. 26) Subdivision and stability, and loading and stability information (Reg. 24, 27 and 28) Design and construction for the prevention of pollution in the event of collision or stranding. Pump Room Bottom Protection. (Reg. 22) Accidental oil out flow performance. (Applicable for tankers delivered on after (January 2010). (Reg. 25)

Yes/No/NA* Yes/No/NA* Yes/No/NA* Yes/No/NA* Yes/No/NA* Yes/No/NA* Yes/No/NA* Yes/No/NA* Yes/No/NA* Yes/No/NA* Yes/No/NA* Yes/No/NA* Yes/No/NA* Yes/No/NA* Yes/No/NA* Yes/No/NA*

* Delete as applicable Form 2136A (2008.01)