Clasification Society Rulefinder 2020 - Version 9.33 - Fix
Statutory Documents - IMO Publications and Documents - Resolutions - Assembly - IMO Resolution A.1052(27) – Procedures for Port State Control, 2011 – (Adopted on 30 November 2011) - Annex – Procedures for Port State Control, 2011 - Appendix 13 – Report of Inspection in Accordance with IMO Port State Control Procedures 1

Appendix 13 – Report of Inspection in Accordance with IMO Port State Control Procedures footnote

FORM A
         
(Reporting authority) Copy to: Master  
(Address)   Head office  
(Telephone)   PSCO  
(Telefax)
  If ship is detained, copy to:
    Flag State  
    IMO  
  Recognized organization, if applicable
1 Name of reporting authority....................................... 2 Name of ship..........................................
3 Flag of ship.......................... 4 Type of ship.............................
5 Call sign.................................... 6 IMO number........................
7 Gross tonnage .......................................... 8 Deadweight (where applicable)...............
9 Year of build ............................................. 10 Date of inspection ....................................
11 Place of inspection ................................... 12 Classification society ...............................
13 Date of release from detention** ...............
14 Particulars of ISM company (details or IMO Company Number)** ............................................
 
15 Relevant certificate(s)**
  a) Title b) Issuing authority c) Dates of issue and expiry
1 .................................... ...................................... ...................................................
2 .................................... ...................................... ...................................................
3 .................................... ...................................... ...................................................
4 .................................... ...................................... ...................................................
5 .................................... ...................................... ...................................................
6 .................................... ...................................... ...................................................
7 .................................... ...................................... ...................................................
8 .................................... ...................................... ...................................................
9 .................................... ...................................... ...................................................
10 ................................... ...................................... ...................................................
11 ................................... ...................................... ...................................................
12 ................................... ...................................... ...................................................
d) information on last intermediate or annual survey**  
  Date Surveying authority Place
1 .................................... ...................................... ...................................................
2 .................................... ...................................... ...................................................
3 .................................... ...................................... ...................................................
4 .................................... ...................................... ...................................................
5 .................................... ...................................... ...................................................
6 .................................... ...................................... ...................................................
7 .................................... ...................................... ...................................................
8 .................................... ...................................... ...................................................
9 .................................... ...................................... ...................................................
10 ................................... ...................................... ...................................................
11 ................................... ...................................... ...................................................
12 ................................... ...................................... ...................................................
16 Deficiencies No Yes (see attached FORM B)
17 Penalty imposed No Yes
18 Ship detained No Yes ***
19 Supporting documentation No   Yes (see annex)
Issuing office ............................................... Name ......................................................
      (duly authorized PSCO of reporting authority)
Telephone ...................................................  
Telefax ....................................................... Signature .................................................
This report must be retained on board for a period of two years and must be available for consultation by port State control officers at all times.
* This inspection report has been issued solely for the purposes of informing the master and other port States that an inspection by the port State, mentioned in the heading, has taken place. This inspection report cannot be construed as a seaworthiness certificate in excess of the certificate the ship is required to carry.
** To be completed in the event of a detention.
*** Masters, shipowners and/or operators are advised that detailed information on a detention may be subject to future publication.
Report of Inspection in Accordance with IMO Port State Control Procedures
FORM B
(Reporting authority)   Copy to: Master
(Address) Head office
(Telephone) PSCO
(Telefax)
    If ship is detained, copy to:
      Flag State
      IMO
      Recognized organization, if applicable
         
2Name of ship ............................................   6IMO number .............................................
10 Date of inspection .....................................   4 Place of inspection ..................................
         
21Nature of deficiencyfootnote Conventionfootnote 22 Action takenfootnote
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    Name ......................................................
    (duly authorized PSCO of reporting authority)
       
    Signature .................................................
Parent topic: Annex – Procedures for Port State Control, 2011
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