Annex - Record of Equipment for the Special Purpose Ship Safety Certificate (Form SPS)

This Record should be permanently attached to the Special Purpose Ship Safety Certificate.

RECORD OF EQUIPMENT FOR COMPLIANCE WITH THE CODE OF SAFETY FOR SPECIAL PURPOSE SHIPS

1 Particulars of ship

Name of ship ............................................................................................................

Distinctive number or letters .....................................................................................

Number of special personnel on board (including passengers) for which certified..............................................................................................................................

Minimum number of persons on board with required qualifications to operate the radio installations ................................................................................................

2 Details of life-saving appliances

1 Total number of persons for which life-saving appliances are provided	. . . . . . . . . . . . . . . . . . . . . . . .
	Port side	Starboard side
2 Total number of lifeboats	. . . . . . . . . .	. . . . . . . . . .
2.1 Total number of persons accommodated by them	. . . . . . . . . .	. . . . . . . . . .
2.2 Number of partially enclosed lifeboats (SOLAS regulation III/42)	. . . . . . . . . .	. . . . . . . . . .
2.3 Number of self-righting partially enclosed lifeboats (SOLAS regulation III/43)	. . . . . . . . . .	. . . . . . . . . .
2.4 Number of totally enclosed lifeboats (SOLAS regulation III/44)	. . . . . . . . . .	. . . . . . . . . .
2.5 Other lifeboats	. . . . . . . . . .	. . . . . . . . . .
2.5.1 Number	. . . . . . . . . .	. . . . . . . . . .
2.5.2 Type	. . . . . . . . . .	. . . . . . . . . .
3 Number of motor lifeboats (included in the total lifeboats shown above)	. . . . . . . . . . . . . . . . .
3.1 Number of lifeboats fitted with searchlights	. . . . . . . . . . . . . . . . .
4 Number of rescue boats	. . . . . . . . . . . . . . . . .
4.1 Number of boats which are included in the total lifeboats shown above	. . . . . . . . . . . . . . . . .
5 Liferafts	. . . . . . . . . . . . . . . . .
5.1 Those for which approved launching appliances are required	. . . . . . . . . . . . . . . . .
5.1.1 Number of liferafts	. . . . . . . . . . . . . . . . .
5.1.2 Number of persons accommodated by them	. . . . . . . . . . . . . . . . .
5.2 Those for which approved launching appliances are not required	. . . . . . . . . . . . . . . . .
5.2.1 Number of liferafts	. . . . . . . . . . . . . . . . .
5.2.2 Number of persons accommodated by them	. . . . . . . . . . . . . . . . .
6 Buoyant apparatus	. . . . . . . . . . . . . . . . .
6.1 Number of apparatus	. . . . . . . . . . . . . . . . .
6.2 Number of persons capable of being supported	. . . . . . . . . . . . . . . . .
7 Number of lifebuoys	. . . . . . . . . . . . . . . . .
8 Number of lifejackets	. . . . . . . . . . . . . . . . .
9 Immersion suits	. . . . . . . . . . . . . . . . .
9.1 Total number	. . . . . . . . . . . . . . . . .
9.2 Number of suits complying with the requirements for lifejackets	. . . . . . . . . . . . . . . . .
10 Number of thermal protective aids^footnote	. . . . . . . . . . . . . . . . .
11 Radio installations used in life-saving appliances	. . . . . . . . . . . . . . . . .
11.1 Number of radar transponders (SART)	. . . . . . . . . . . . . . . . .
11.2 AIS search and rescue transmitters (AIS-SART)	. . . . . . . . . . . . . . . . .
11.3 Number of two-way VHF radiotelephone apparatus	. . . . . . . . . . . . . . . . .

3 Details of radio facilities

Item	Actual provision
1 Primary systems	. . . . . . . . . . . . . . . . .
1.1 VHF radio installation
1.1.1 DSC encoder	. . . . . . . . . . . . . . . . .
1.1.2 DSC watch receiver	. . . . . . . . . . . . . . . . .
1.1.3 Radiotelephony	. . . . . . . . . . . . . . . . .
1.2 MF radio installation	. . . . . . . . . . . . . . . . .
1.2.1 DSC encoder	. . . . . . . . . . . . . . . . .
1.2.2 DSC watch receiver	. . . . . . . . . . . . . . . . .
1.2.3 Radiotelephony	. . . . . . . . . . . . . . . . .
1.3 MF/HF radio installation	. . . . . . . . . . . . . . . . .
1.3.1 DSC encoder	. . . . . . . . . . . . . . . . .
1.3.2 DSC watch receiver	. . . . . . . . . . . . . . . . .
1.3.3 Radiotelephony	. . . . . . . . . . . . . . . . .
1.3.4 Direct-printing radiotelegraphy	. . . . . . . . . . . . . . . . .
1.4 Ship earth station providing a recognized mobile satellite service	. . . . . . . . . . . . . . . . .
2 Secondary means of alerting	. . . . . . . . . . . . . . . . .
3 Facilities for reception of maritime safety information	. . . . . . . . . . . . . . . . .
3.1 NAVTEX receiver	. . . . . . . . . . . . . . . . .
3.2 EGC receiver	. . . . . . . . . . . . . . . . .
3.3 HF direct-printing radiotelegraph receiver	. . . . . . . . . . . . . . . . .
4 Satellite EPIRB	. . . . . . . . . . . . . . . . .
4.1 COSPAS-SARSAT	. . . . . . . . . . . . . . . . .
5 VHF EPIRB	. . . . . . . . . . . . . . . . .
6 Ship's search and rescue locating device	. . . . . . . . . . . . . . . . .
6.1 Radar search and rescue transponder (SART)	. . . . . . . . . . . . . . . . .
6.2 AIS search and rescue transmitters (AIS-SART)	. . . . . . . . . . . . . . . . .

4 Methods used to ensure availability of radio facilities (SOLAS regulations IV/15.6 and 15.7)

4.1 Duplication of equipment ...........................................................................................

4.2 Shore-based maintenance .........................................................................................

4.3 At-sea maintenance capability ...................................................................................

5 Special Purpose Ships constructed before 1 February 1995 which do not comply with all the applicable requirements of chapter IV of the SOLAS Convention, as amended^footnote

	Requirements of regulations	Actual provision
Hours of listening by operator	. . . . . . . . . . . . . . . . .	. . . . . . . . . . . . . . . . .
Number of operators	. . . . . . . . . . . . . . . . .	. . . . . . . . . . . . . . . . .
Whether auto alarm fitted	. . . . . . . . . . . . . . . . .	. . . . . . . . . . . . . . . . .
Whether main installation fitted	. . . . . . . . . . . . . . . . .	. . . . . . . . . . . . . . . . .
Whether reserve installation fitted	. . . . . . . . . . . . . . . . .	. . . . . . . . . . . . . . . . .
Whether main and reserve transmitters electrically separated or combined	. . . . . . . . . . . . . . . . .	. . . . . . . . . . . . . . . . .

6 Ship's search and rescue locating device

	Actual provision
Radiotelegraph installation for lifeboat	. . . . . . . . . . . . . . . . .
Portable radio apparatus for survival craft	. . . . . . . . . . . . . . . . .
Survival craft EPIRB (121.5 MHz and 243.0 MHz)	. . . . . . . . . . . . . . . . .
Two-way radiotelephone apparatus	. . . . . . . . . . . . . . . . .

	THIS IS TO CERTIFY that this Record is correct in all respects.
	Issued at ..................................................................................................................
	(Place of issue of the Record)

………………………………………		………………………………………
(Date of issue)		(Signature of authorized official issuing the Record)
(Seal or stamp of the issuing authority, as appropriate)