FORM S/1
Clasification Society 2024 - Version 9.40
Statutory Documents - IMO Publications and Documents - Resolutions - Marine Environment Protection Committee - Resolution MEPC.357(78) - 2022 Guidelines for Inspection of Anti-Fouling Systems on Ships - (adopted on 10 June 2022) - Annex - 2022 Guidelines for Inspection of Anti-Fouling Systems on Ships - Appendix 1 - Sampling - FORM S/1

FORM S/1

REPORT OF INSPECTION OF A SHIP'S ANTI-FOULING SYSTEM (AFS)
 
SHIP PARTICULARS
1. Name of ship : 2. IMO number :
3. Type of ship : 4. Call sign :
5. Flag of ship : ___________________________ 6. Gross tonnage :
7. Date keel laid / major conversion commenced : ____________________________________________________________________________________
 
INSPECTION PARTICULARS
8. Date & time : ___________________________________________________________________________________________________________________
9. Name of facility:
(dry-dock, quay, location ) 		___________________________________________________________________________________________________________________
  Place & country: ___________________________________________________________________________________________________________________
10. Areas inspected     Ship's logbook Certificates   Ship's hull
11. Relevant certificate(s)
    (a) title   (b) issuing authority   (c) dates of issue
  1. IAFS Certificate      
  2. Record of AFS      
  3. Declaration of AFS      
  4.        
12. Dry-dock period AFS applied : ___________________________________________________________________________________________
13. Name of facility AFS applied : ___________________________________________________________________________________________
14. Place & country AFS applied :  
15. AFS samples taken   No   Yes Nature of sampling :   Brief   Extent
16. Reason for sampling of AFS:

17. Record sheet attached :
(country-code / IMO number / dd-mm-yy) 		_____________________________________________________________________________________________
18.   Copy to:     PSCO   Flag State   Recognized organization
          Head office   Master   Other: ___________________________________________
   
PORT STATE PARTICULARS
Reporting authority: __________________________________________ District office _______________________________
Address: __________________________________________________________________________________________________________________
      __________________________________________________________________________________________________________________
Telephone/Fax/ Mobile: __________________________________________________________________________________________________________________
E-mail: __________________________________________________________________________________________________________________
Name:
(duly authorized inspector of reporting authority) 		__________________________________________________________________________________________________________________
Date: ___________________________ Signature: ______________________________________________________________________
Parent topic: Appendix 1 - Sampling
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