1、1 船/岸安全检查表 SHIP/SHORE SAFETY CHECK LIST Ships Name 船名船名 . Berth 泊位泊位 Port 港口港口 . Date of Arrival 抵达日期抵达日期 . Time of Arrival 抵达时间抵达时间 . 填表须知填表须知 INSTRUCTIONS FOR COMPLETION: 为保证安全作业，下列所有问题的答复均是肯定的,可在相应的方格内清楚地打上()标号。如果不能给予肯定回答，应说明理由，而且船舶和码头之间均达成关于应采取的适当预防措施的协议。如果认为有的问题不适用，应在备注栏里加以说明。 The safety of ope
2、rations requires that all questions should be answered affirmatively by clearly ticking () in the appropriate box. If an affirmative answer is not available, the reason should be given and agreement reached upon appropriate precautions to be taken between the ship and the terminal. Where any questio
3、n is considered to be not applicable, then a note to that effect should be inserted in the remarks column. “船舶”和“码头”栏目下的方格，表示由负责方实施检查。 A box in the column ship and terminal indicates that the party concerned should carry out checks. 在“代码”栏目里的 A，P或 R字母，分别表示如下的意义： The presence of the letters A, P or R
4、 in the column Code indicates the following: A （协议）表示该检查项应通过协议或程序来处理，并在检查表中的“备注”栏中明确或者通过其它一些双方可接受的表格来交流这些协议和程序。 A (Agreement). This indicates that the referenced consideration should be addressed by an agreement or procedure that should be identified in the Remarks column of the Check List, or commu
5、nicated in some other mutually acceptable form. P（批准）在否定回答的情况下，未经主管当局的书面许可，不可进行作业。 P (Permission). In the case of a negative answer to the statements coded P, no operations are to be conducted without the written permission from the appropriate authority. R（复查） 表示在不超出声明同意的时间间隔须重复检查的项目。 R (Re-check).
6、 This indicates items to be re-checked at appropriate intervals, as agreed between both 记录保存期：一年7 . 5 . 1 - 0 2parties and stated in the declaration. 仅在所有方检查和接受他们分配的职责和责任后方可签署共同声明The joint declaration should not be signed until all parties have checked and accepted their assigned responsibilities an
7、d accountabilities. PART A BULK LIQUID GENERAL - PHYSICAL CHECKS A 部分部分 散装普通液货散装普通液货 现场核实现场核实 Bulk Liquid General 散装液体散装液体 普通普通 Ship 船舶船舶 Terminal 码头码头 Code 代码代码 Remarks 备注备注 1. There is safe access between the ship and shore. 船岸之间有安全通道. R 2. The ship is securely moored. 船舶已安全系泊. R 3. The agreed shi
8、p/shore communication system is operative. 商定的船/岸通信系统可用. A R System 系统 . Back up system 备用系统. 4. Emergency towing-off pennants are correctly rigged and positioned. 应急拖缆已带好并处于正确位置. R 5. The ships fire hoses and fire-fighting equipment are positioned and ready for immediate use. 船方消防水带和消防设备配置在位并立即可用.
9、R 6. The terminals fire-fighting equipment is positioned and ready for immediate use. 岸方消防设备配置在位并立即可用. R 7. The ships cargo and bunker hoses, pipelines and manifolds are in good condition, properly rigged and appropriate for the service intended. 船方的货物、燃油软管, 管线和集管处于良好状态，适当固定并适用于预计的货物作业. 8. The termi
10、nals cargo and bunker hoses/arms are in good condition, properly rigged and appropriate for the service intended. 岸方的货物、燃油软管/装卸臂处于良好状态，适当固定并适用于预计的货物作业. 9. The cargo transfer system is sufficiently isolated and drained to allow safe removal of blank flanges prior to connection. 接管前，货物转移系统有效隔离并放残以能够安全
11、地拆除盲板. 10. Scuppers and save alls on board are effectively plugged and drip trays are in position and empty. 船上的排水孔和积油槽有效塞堵，空的集液盘放置到位。 R 211. Temporarily removed scupper plugs will be constantly monitored. 临时移开流水孔塞需保持监控。R12. Shore spill containment and sumps are correctly managed. 岸方的溢油围堰和积油槽正确管理 R
12、13. The ships unused cargo and bunker connections are properly secured with blank flanges fully bolted. 船方不用的货物、燃油管接头已装妥盲板并上紧全部螺栓. 14. The terminals unused cargo and bunker connections are properly secured with blank flanges fully bolted. 岸方不用的货物、燃油管接头已装妥盲板并上紧全部螺栓. 15. All cargo, ballast and bunker
13、tank lids are closed. 所有货舱、压载舱和燃油舱舱盖都保持关闭。 16. Sea and overboard discharge valves, when not in use, are closed and visibly secured. 海底阀和舷外排出阀在不使用时已关闭和确实关妥. 17. All external doors, ports and windows in the accommodation, stores and machinery spaces are closed. Engine room vents may be open. 居住舱室、储物间和
14、机器处所的所有外部门,开口和窗户已关闭. 机舱的通风可以打开. R 18. The ships emergency fire control plans are located externally. 船舶紧急消防控制图放置在外部. Location 位置 . If the ship is fitted, or is required to be fitted, with an Inert Gas System (IGS) the following points should be physically checked: 如船舶安装有，或要求安装惰气系统如船舶安装有，或要求安装惰气系统(IG
15、S)，下列各条应进行现场核查：，下列各条应进行现场核查： Inert Gas System 惰气系统惰气系统 Ship 船舶船舶 Terminal 码头码头 Code 代码代码 Remarks 备注备注 19. Fixed IGS pressure and oxygen content recorders are working. 固定式的惰气系统压力和氧含量记录器正常工作 R 20. All cargo tank atmospheres are at positive pressure with oxygen content of 8% or less by volume. 所有货舱均为正压
16、，氧气含量8% (体积) P R PART B BULK LIQUID GENERAL VERBAL VERIFICATION B 部分散装普通液货部分散装普通液货 口头确认口头确认 3Bulk Liquid General 散装液体 普通散装液体 普通Ship 船舶船舶Terminal 码头码头Code 代码代码Remarks 备注备注21. The ship is ready to move under its own power. 船舶能够随时靠自航移位. P R 22. There is an effective deck watch in attendance on board an
17、d adequate supervision of operations on the ship and in the terminal. 船上安排了有效的甲板值班, 码头和船上有足够的监督人员. R 23. There are sufficient personnel on board and ashore to deal with an emergency. 船上和岸上有足够人员应付紧急情况. R 24. The procedures for cargo, bunker and ballast handling have been agreed 货物、燃油和压载的装卸程序已议定. A R
18、25. The emergency signal and shutdown procedure to be used by the ship and shore have been explained and understood 解释并理解船岸之间使用的应急信号和应急关闭程序 A 26. Material Safety Data Sheets (MSDS) for the cargo transfer have been exchanged where requested. 作业货物的物质安全数据单已按要求进行交换 P R 27. The hazards associated with to
19、xic substances in the cargo being handled have been identified and understood. 作业货物中所含有毒物质的相关危害已辨识并清楚。 H2S Content . 硫化氢含量： Benzene Content 苯含量：. 28. An International Shore Fire Connection has been provided. 已提供国际通岸接头 29. The agreed tank venting system will be used. 将使用协议的货舱透气系统 A R Method方法 . Bulk
20、Liquid General 散装液体散装液体 普通普通 Ship 船舶船舶 Terminal 码头码头 Code 代码代码 Remarks 备注备注 30. The requirements for closed operations have been agreed. 封闭作业要求已达成协议 R 31. The operation of the P/V system has been verified. 压力/真空系统的操作已核验 32. Where a vapour return line is connected, operating parameters have been agre
21、ed. 如果接气相回流管，操作参数已达成协议 A R 33. Independent high level alarms, if fitted, are operational and have been tested. A R 4如果安装了独立的高液位报警，应处于工作状态并经测试. 34. Adequate electrical insulating means are in place in the ship/shore connection. 船/岸接管处有足够的电气绝缘方式 A R35. Shore lines are fitted with a non-return valve or
22、 procedures to avoid back filling have been discussed. 岸线装有止回阀，或已讨论如何避免“倒灌”的程序. P R36. Smoking rooms have been identified and smoking requirements are being observed. 指定吸烟室，遵守吸烟规则. A R Nominated smoking rooms 指定的吸烟室: . 37. Naked light regulations are being observed. 遵守明火规则 A R 38. Ship/shore telepho
23、nes, mobile phones and pager requirements are being observed. 遵守船/岸电话、手机和传呼机使用规则 A R 39. Hand torches (flashlights) are of an approved type. 手电筒（闪光灯）为认可型 40. Fixed VHF/UHF transceivers and AIS equipment are on the correct power mode or switched off. 固定式高频/甚高频电话和自动识别系统设备处于正确的发射功率模式或关闭. 41. Portable V
24、HF/UHF transceivers are of an approved type. 便携式高频/甚高频无线电收发机为认可型. 42. The ships main radio transmitter aerials are earthed and radars are switched off. 船舶主无线电发射天线接地，雷达处关闭状态 43. Electric cables to portable electrical equipment within the hazardous area are disconnected from power. 在危险区域内便携式电气设备的电缆断开电
25、源 44. Window type air conditioning units are disconnected. 窗式空调电源断开 45. Positive pressure is being maintained inside the accommodation, and air conditioning intakes, which may permit the entry of cargo vapours, are closed 居住舱室内保持正压，可能吸入货物蒸汽的空调吸入口应关闭 46. Measures have been taken to ensure sufficient
26、mechanical ventilation in the pump room. 已采取措施保证泵房足够的机械通风 R 47. There is provision for an emergency escape. 预留有应急逃生通道. 548. The maximum wind and swell criteria for operations have been agreed. 作业的最大风力和涌浪标准已经达成协议 A Stop cargo at: . 停止作业Disconnect at: . 拆管Unberth at: . 离泊49. Security protocols have be
27、en agreed between the Ship Security Officer and the Port Facility Security Officer, if appropriate. 如果适用，船舶保安员和港口设施保安员达成保安协议。 A50. Where appropriate, procedures have been agreed for receiving nitrogen supplied from shore, either for inerting or purging ships tanks, or for line clearing into the ship
28、. 如果需要从岸方接收氮气用于惰化船舱、驱气或吹扫管线，就相关程序已达成协议 P A If the ship is fitted, or is required to be fitted, with an Inert Gas System (IGS) the following statements should be addressed. 如果船舶安装了，或被要求安装惰气系统如果船舶安装了，或被要求安装惰气系统(IGS)，下列各条应进行实际检查：，下列各条应进行实际检查：Inert Gas System 惰气系统惰气系统Ship 船舶船舶Terminal 码头码头Code 代码代码Remar
29、ks 备注备注51. The IGS is fully operational and in good working order. 惰气系统可完整运行并处于良好工作状态P 52. Deck seals, or equivalent, are in good working order. 甲板水封或类似装置处于良好工作状态R 53. Liquid levels in pressure/vacuum breakers are correct. 压力/真空破断器的液位正常R 54. The fixed and portable oxygen analysers have been calibrat
30、ed and are working properly. 固定式和便携式的氧气分析仪已校准并且能够正常工作. R 55. All the individual tank IGS valves (if fitted) are correctly set and locked. 各舱的惰气系统阀门（如果已安装）正确设置并上锁. R 56.All personnel in charge of cargo operations are aware that in the case of failure of the Inert Gas Plant, discharge operations shoul
31、d cease, and the terminal be advised. 所有负责货物作业的人员意识到，在惰气发生装置故障的情况下，卸货作业应停止并通知码头. If the ship is fitted with a Crude Oil Washing (COW) system, and intends to crude oil washing, the following statements should be addressed. 6如果船舶安装原油洗舱系统，需进行原油洗舱作业，应完成下列内容如果船舶安装原油洗舱系统，需进行原油洗舱作业，应完成下列内容Crude Oil Washing
32、 原油洗舱原油洗舱Ship 船舶船舶Terminal 码头码头Code 代码代码Remarks 备注备注57. The Pre-Arrival COW check list, as contained in the approved COW manual, has been satisfactorily completed. 包含在认可的原油洗舱手册中的抵港前检查清单，已经按要求填写完整. 58. The COW check lists for use before, during and after COW, as contained in the approved COW manual,
33、are available and being used. 包含在在认可的原油洗舱手册中, 用于原油洗舱作业前，过程中和之后的检查清单，准备就绪并在使用. R If the ship is planning to tank clean alongside, the following statements should be addressed. 如果船舶计划在靠泊期间清舱，应完成以下内容如果船舶计划在靠泊期间清舱，应完成以下内容Tank Cleaning 清舱清舱Ship 船舶船舶Terminal 码头码头Code 代码代码Remarks 备注备注59. Tank cleaning oper
34、ations are planned during the ships stay alongside the shore installation. 船舶靠岸期间计划进行清舱作业Yes /No* Yes/No* 60. If yes the procedures and approvals for tank cleaning have been agreed. 如“是”，清舱的程序和批准已达成协议 61. Permission has been granted for gas freeing operations. 已获得除气作业的许可证Yes /No* Yes/No* * Delete Ye
35、s or No as appropriate 根据适用情况删去“是”或“否”PART C BULK LIQUID CHEMICALS - VERBAL VERIFICATION C 部分 散装液体化工品 口头确认部分 散装液体化工品 口头确认Bulk Liquid Chemicals 散装液体 化工品散装液体 化工品Ship 船舶船舶Terminal 码头码头Code 代码代码Remarks 备注备注1.Material Safety Data Sheets are available giving the necessary data for the safe handling of the
36、 cargo. 提供了材料安全数据表, 并给出了货物安全操作必要的资料 2.A manufacturers inhibition certificate, where applicable, has been provided. 如果适用，已经提供了制造商的抑制剂证书 P 3.Sufficient protective clothing and equipment (including self-contained breathing apparatus) is ready for immediate use and is suitable for the product being hand
37、led. 足够的防护服和设备（包括自给式呼吸器）已经准备就绪,随时可用，并适合所操作的货品 4.Counter measures against accidental personal contact with the cargo have been agreed. 防止人员意外接触货品的应对措施已经同意. 5.The cargo handling rate is compatible with the automatic shut down system, if in use. 如果使用自动关闭系统，货物作业速率应与其相匹配. A 76.Cargo system gauges and ala
38、rms are correctly set and in good order. 货物系统仪表和警报正确设置并处于良好的工作状况 7.Portable vapour detection instruments are readily available for the products being handled. 适合所作业货品的便携式气体探测仪器备妥 8.Information on fire-fighting media and procedures has been exchanged. 消防器材和程序的信息已经被交换过. 9.Transfer hoses are of suitabl
39、e material, resistant to the action of the products being handled. 移货软管的材料合适，与作业的货品不发生反应。 10. Cargo handling is being performed with the permanent installed pipeline system. 货物作业使用永久安装的管线系统. P 11. Where appropriate, procedures have been agreed for receiving nitrogen supplied from shore, either for i
40、nerting or purging ships tanks, or for line clearing into the ship. 如需从岸方接收氮气用于惰化船舱、驱气或吹扫管线，就相关程序已达成协议 A P PART D BULK LIQUEFIED GASES - VERBAL VERIFICATION D 部分 散装液化气 口头确认部分 散装液化气 口头确认Bulk Liquefied Gases 散装液化气散装液化气Ship 船舶船舶Terminal 码头码头Code 代码代码Remarks 备注备注1.Material Safety Data Sheets are availab
41、le giving the necessary data for the safe handling of the cargo. 提供了材料安全数据表,并给出了货物安全操作必要的资料 2.A manufacturers inhibition certificate, where applicable, has been provided. 如果适用，提供了制造商的抑制剂证书 P 3.The water spray system is ready for immediate use. 水喷淋系统处于随时可用状态 4.There is sufficient protective equipment
42、 (including self-contained breathing apparatus) and protective clothing ready for immediate use. 充分的保护设备（包括自给式呼吸器）和防护服已经准备就绪, 随时可用. 5.Hold and inter-barrier spaces are properly inerted or filled with dry air, as required. 大舱和内屏障之间的空间按要求充惰气或干燥空气6.All remote control valves are in working order. 所有遥控阀门
43、工作状态良好. 7.The required cargo pumps and compressors are in good order, and the maximum working pressures have been agreed between ship and shore. 货泵和压缩机处于良好工作状态，船方和岸方已商定最大工作压力. A 8.Re-liquefaction or boil off control equipment is in good order. 再液化或蒸发控制设备处于良好状态 89.The gas detection equipment has been
44、 properly set for the cargo, is calibrated, has been tested and inspected and is in good order. 气体探测设备根据货品进行了适当的设置、校正、测试和检查并处于良好的状况10. Cargo system gauges and alarms are correctly set and in good order. 货物系统仪表和警报正确设置并处于良好的工作状况 11. Emergency shutdown systems have been tested and are working properly.
45、 应急切断系统已经测试，工作正常. 12. Ship and shore have informed each other of the closing rate of ESD valves, automatic valves or similar devices. 船岸双方相互告知了应急关闭装置阀门、自动阀门或类似装置的关闭速率 A Ship . Shore .13. Information has been exchanged between ship and shore on the maximum/minimum temperatures/ pressures of thecargo
46、to be handled. 船岸双方交换了作业货物最大/最小温度/压力的信息 A 14. Cargo tanks are protected against inadvertent overfilling at all times while any cargo operations are in progress. 在任何货物作业过程中，货舱随时都被保护防止意外超装. Tank No7 15. The compressor room is properly ventilated; the electrical motor room is properly pressurised and t
47、he alarm system is working. 压缩机房保持适当的通风，电机房保持合适的正压，报警系统工作正常16. Cargo tank relief valves are set correctly and actual relief valve setting are clearly and visibly displayed (Record Settings below) 货舱压力释放阀正确设置，实际设定值应清楚标示(记录设定值如下）Tank No 1 Tank No 3Tank No 4Tank No5 Tank No8 Tank No2Tank No6 Tank No9 T
48、ank No10 9DECLARATION 声明We, the undersigned, have checked the above items in Parts A and B, and where appropriate, Part C or D, in accordance with the instructions and have satisfied ourselves that the entries we have made are correct to the best of our knowledge. 我们, 下面签名者, 已经对本安全检查表内A/B部分的各个项目，如果适
49、用, 包括C或D部分的项目，根据指导进行了检查，并确信就我们所了解的情况，我们所填写的内容是正确的。We have also made arrangements to carry out repetitive checks as necessary and agreed that those items coded R in the Check List should be re-checked at intervals not exceeding _ hours. 我们对协议进行复查的项目也已作好安排，并同意在不超过 时间间隔必须对那些“代号代号”栏中标有“R”的项目进行复查。If to o
50、ur knowledge the status of any item changes, we will immediately inform the other party. 如果我们获知任何项目的状态发生变化，将立即通知另一方。For Ship 船方For Shore 岸方岸方Name姓名姓名. Rank职务职务 Signature签名签名. Date 日期日期. Time 时间时间Name 姓名姓名 Position 职务职务 Signature 签名签名. Date 日期日期 Time 时间时间 Record of repetitive checks 重复检查的记录重复检查的记录: D
