NS 043 ISSUE 1 REV 2

VESSEL SAFETY INSPECTION REPORT

Name of
Vessel:
Area Ref
No. :

Date of
Inspection:

GRAMPIAN

Week No. :

YES
1.

Is the area well illuminated?

2.

Is the area free from hazards?

3.
4.

Are all Fire Fighting/ LSA Equipment in place as per Fire

& Safety Plan?
Are all Water Tight/ Fire Doors and other closures in good
order?

5.

Is the area well ventilated, if applicable?

6.

If applicable, have all ventilation systems been cleaned

recently?

7.

Is the area adequately marked with safety signs?

8.

Are all access clear of obstructions?

9.
10.

NO

Have all outstanding repairs in the area inspected been

completed?
Have all previous deficiencies (1-8), if reported, been
closed out? If not, state below week number of
inspection reporting deficiency and the reason for noncompletion.

If answer is NO to any of the above, indicate nature of deficiency, and then if

possible give date it was rectified:

Signe
d:

Signed
:
Safety Officer

For Office Use:

Above actions
closed out:

Date
:

Safety Representative

Signe
d:
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NS 043 ISSUE 1 REV 2

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