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PT.

CIPTA SAMUDERA SHIPPING LINE


DOKUMEN PROSEDUR KEADAAN DARURAT
FORM CSSL-001
RELATED PARTIES ARE CONTACTED IN AN EMERGENCY
1. The owner of the ship
Company: Address:
Name: Phone:
Address: Office:
Home: Phone:
2. Owner Charge
Company: Address:
Name: Phone:
Address: Office:
Home: Phone:
3. A representative of the company (see list of representatives)
Company: Address:
Name: Phone:
Address: Office:
Home: Phone:
4. Authorized Officials (S.A. R, ocean freight, Administrator/head of the
Harbor)
5. Insurance companies
Company: Address:
Name: Phone:
Address: Office:
Home: Phone:
6. P & I Ctub
Company: Address:
Name: Phone:
Address: Office:
Home: Phone:
7. The Agency's Classification
Company: Address:
Name: Phone:
Address: Office:
Home: Phone:

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DOKUMEN PROSEDUR KEADAAN DARURAT

FORM CSSL-002
"Important and highly secret"
ACCIDENT REPORT OF DEATH
(The first report of the incident)
Kepada : DPA
Fax
:.......................
Tanggal : . . . . . . . . . . . . . . . . . . .
Delivery time ... ... ... ... UTC
KM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1. Voy : . . . . . . . . . . . . . . . . . . . . . . . Dari : . . . . . . . . . . . . . . . . . . . . . .
Tujuan : . . . . . . . . . . . . . . . . . . . . . . . . . . .
2. Tanggal/Waktu Kejadian : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
........................
3. Lokasi
Kejadian : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
..................
4. Type and summary of events (see the report impacts). (EXPLANATION)
5. The death/ of the missing person
Name
:. . . . . . . . . . . . . . . . . . . . . .
Jabatan
:......................
6. Tingkat
pencemaran : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
..................
7. The magnitude of the damage/loss
a) Ship Building Machine : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
..........................
b)
Load : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.....................
............................................................
.................................
c) part of the ship
Lainnya : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.......................
............................................................
................................
8. related parties reported.
a local port Administrator) (according to the procedure of handling the pollution
of the sea).
b) companies that deal with pollution (request local representatives)
9. The State of the weather and the sea.
10. Kalaik-Ocean (ship's ability to move its own machine).
11. Should help from the army.
12. The time schedule of the next talks (Say a method of communication used)

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DOKUMEN PROSEDUR KEADAAN DARURAT

JL. Tanjung Sadari No.7 60177 Surabaya, East Java, Indonesia


Tel. 031-3579683, 3579031 Fax: 031-3578662 Email: css.line@sby.dnet.net.id
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FORM CSSL-003
Strictly Confidential
TUBRUKAN
(The Second Report)
To
Date
Km.
1.

2.
3.

: DPA
:
:

Fax:
Time:
Nahkoda:

An important procedure in the Pavilion


a) Stop the engine
b) reports to nahkoda
c) Notification to the engine room
d) General alarm sounded/cue
e) Lighting the flame deck
f) raise the Cue international "Uncontrolled"
g) Cue Calls Attention to the vicinity of the ship or relationship VHF
yes/no
h) move the steering wheel to the steering wheel of the hand.
Yes/No
Date Impacts:
clock: UTC
The name and flag of the ship: flag: KM

yes/no
yes/no
yes/no
yes/no
yes/no
Yes/No

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DOKUMEN PROSEDUR KEADAAN DARURAT
4.

List of parties parties are contacted:


a local SAR):
b) company:
c) ruler of the port:
d) agent/Representative:
Yes/No
e) services Raharja:
f) PN & I Club:
g) Agency Classification:
Yes/No

Yes/No
Yes/No
Yes/No
Yes/No
Yes/No

JL. Tanjung Sadari No.7 60177 Surabaya, East Java, Indonesia


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5.
The current state of impingement
a) Bow (Repeater left/middle/right):
The ship itself:
Other boats:
b) Scene
1. Baringan distance/from object:
U/S
2. Position:
T/B
c) angle of impact:
d) Impact speed:
The Ship Itself:
Knots
Other Boats:
Knots
(Estimated)

6. The enactment of the emergency role (HR)


7. Implementation of the recording of communication link
(orders to officers radio) Yes (... ...) /Tidak
8. Role call.
1. Missing persons : Person
Name
:
Name
:
Name
:
2. Injuries
: people
Injuries
: people
Name
:
Name
:
Name
:
Minor Injuries
: People
Name
:
Name
:
Name
:
9. The following event.
1. Fire:

Yes/No

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DOKUMEN PROSEDUR KEADAAN DARURAT
2. Leaks:
Yes/No
3. Oil spill:
Yes/No
10. Building damage Ship outline
Bow, starboard (front, Center, rear), stomach left side (front, Center, rear),
The stern of the ship.
11. Damage to the machine
1. The parent Engine Damage:
Yes/No
2. Steering Engine Damage:
Yes/No
3. Damage to the leaves of the rudder:
Yes/No
4. The ability move yourself:
Yes/No
12. Urgent circumstances
1. Is it necessary to leave the ship
yes/no
2. The command to leave the ship time (HR. ....)
Yes/No

JL. Tanjung Sadari No.7 60177 Surabaya, East Java, Indonesia


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3. will help rescue required


Yes/No
4. Request by the hour
yes/no
5. ship hours Pengkandasan
yes/no
13. The State of the other ship pad first observation:
Bow:
Degrees
Distance:
Mile
The time of observation:
SMT
14. Measures to avoid impacts
1. Name of person in charge
: Nahkoda
: Pandu
2. Cue used
: communication of the VHP, Cue lights, flute
Cue the attention, danger signals)
Cue sports motion
3. Use the machine : stop the clock
Backwards:
LEGO anchor
: Hours
(dicikar)
Use the steering wheel:
15. The use of navigation equipment
(1) radar (radar used number of units)
(2) (Service range, No. 1. . . . . . . . . . .mile, no.2. . . . . . . . . . . . . . . . . . . .. . . .
mile)

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DOKUMEN PROSEDUR KEADAAN DARURAT
(3) Automatic collision avoidance system
(ARPA). . . . . . . . . . . . . . . . . . . . . . . .Yes/No
(4) (Kesalahan waktu
I.) : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .)
(5) the Engine Telegraph Logger (error time.............................).
16. Duty Officer
(1) Anjungan
: Mualim
:
( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .)
: Jr.Mudi
:
( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .)
(2) Kamar Mesin
: Masinis
:
( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .)
: Jr.Minyak :
( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .)
17. Weather and sea conditions at the time of impact
(1) the weather:
(2) the direction and speed of wind:
(3) the mileage:
(4) Current:
(5) the tides:
(6) the Phase of the Moon:

JL. Tanjung Sadari No.7 60177 Surabaya, East Java, Indonesia


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18. Show diagram of ships in the vicinity of, the conditions and then linats
voyage (on separate sheet).
19. Data data on other vessels involved impacts:
(1) the name of the Ship
:
(2) flag
:
(3) the owner of the ship
:
(4) Ship operated
by company
:
(5) the starting Harbour
:
(6) the port of destination
:
(7) the charge
:
Jasa Raharja (8)
:

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DOKUMEN PROSEDUR KEADAAN DARURAT
(9) the P & I Club
:
(10) Company Representatives
Address
:
The personnel contacted
:
20. Documents documents that must be prepared.
(1) Marine Note of Protest (LKK)
Yes/No
(2) News Events
yes/no
(3) damage report
yes/no
21. Getting started getting started for :
(1) Marine Note of Protest (LKK)
Yes/No
(2) News Events
yes/no
(3) damage report
yes/no
22. Supporting documents:
(1) Photo Photo yes/no
(2) a map of the sea used yes/no
(3) the journal deck yes/no
(4) the journal Machine yes/no
(5) the book of sports motion yes/no
(6) paper noted a switch yes/no
(7) a Radar Journals yes/no
(8) the VHF Recordings Relationship yes/no |
(9) Certificate certificate of other supporting yes/no

JL. Tanjung Sadari No.7 60177 Surabaya, East Java, Indonesia


Tel. 031-3579683, 3579031 Fax: 031-3578662 Email: css.line@sby.dnet.net.id
Things: 6/27

To
KM

: DPA
:

FORM CSSL-004
Date:
"It Is Very Important And Confidential"
WRECKED/STRANDED
(the second report)

To
: DPA
(Fax No.)
Tanggal : . . . . . . . . . . . . . . . . . . . . . .
Nomor : . . . . . . . . . . . . . . . . . . . . . .
KM : . . . . . . . . . . . . . . . . . . . . . .
Nahkoda : . . . . . . . . . . . . . . . . . . . . . .

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DOKUMEN PROSEDUR KEADAAN DARURAT
1. an important Procedure in the Pavilion.
(1) Stop the parent engine already (h) Yes/No
(2) report to nahkoda yes/no
(3) notice to the engine room yes/no
(4) Stop steering machine yes/no
(5) an alarm signal is emitted yes/no
(6) turn on the lights on deck yes/no
(7) raise the international cues to suggest AGROUND
(during the day) or turn on the light cues (night time) Yes/No
(8) Cue calls attention to the vicinity of the ship or
associated with the VHP yes/no
2. Upon the Date//Stranded (HR platform.........) LT . . . . . . . . . . . . . . . . UTC
3. The position of the Wrecked/Stranded:
(1) Baringan/distance from an object........................................
(2) the latitude/longitude (U/S)..................... (U/S) . . . . . . . . . . . . . . . . . . . . . . . . .
4. The list of officials who were contacted
(1) local SAR Already/not yet
(2) the company Already/not yet
(3) the agent/representative Already/not yet
(4) the Administrator Already/not yet
(5) the service Already/not yet Raharja
(6) the Agency Classification Already/not yet
(7) P & I Club Already/not yet
5. The circumstances at the time ran aground/Teradampar
(1) the direction of the bow (compass repeater used the left/middle/right)
(2) the speed while aground/stranded knots............................... knots

JL. Tanjung Sadari No.7 60177 Surabaya, East Java, Indonesia


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6. The enactment of the emergency role (HR............................................)


7. Implementation of the recording of communication link VHP Yes
(hour ... ... ... ... ... ... ... ... ...) Not
8. The role of the Pemangggilan
1. Name of Person missing
person
Name : ... ... ... ... ... ... ... ... ... ... ... ...
Nama : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.
Nama : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.
2. Person Injured

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DOKUMEN PROSEDUR KEADAAN DARURAT
Heavy Injury

Person Name
:....................................
Nama : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

.
Nama : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.
Minor Injuries

People Name
: ... ... ... ... ... ... ... ... ... ... ... ...
Nama : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

.
Nama : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.
9. the following Events
1. Kebakaran . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . Yes/No
2. Kebocoran . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . Yes/No
3. Tumpahan
Minyak . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes/No
10. Building damage ship outline
Bow, starboard (front, Center, rear), stomach left side (front, Center, rear),
The stern of the ship.
11. Damage to the machine
1. Kerusakan mesin
induk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes/No
2. Kerusakan Mesin Kemudi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . Yes/No
3. Kerusakan daun
kemudi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes/No
4. The ability of moving themselves ... ... ... ... ... ... ... ... ... ... ... ... ... ... ....
Yes/No
12. the urgent circumstances
1. Is it necessary to leave the ship ... ... ... ... ... ... ... ... ... ... .... Yes/No
2. The command to leave the ship time (HR..........) ... ... ... ... ... Yes/No
3. will help rescue needed......................... Yes/No
4. Request by the hour ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .... Yes/No
5. use of the machine (machine motion, though time hours ... ... ... ... ... ... ... ...
...)
Anchored Time : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . )
Rudder (Time . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......)
The Other ( . . . . . . . . . . . . . . . ). (the time of commencement of the task.
Time . . . . . . . . . )
13. The use of navigation equipment

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DOKUMEN PROSEDUR KEADAAN DARURAT

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(1) the number of Radar (radar used............................ Unit)


(2) (Service range. No. 1 . . . . . . . . . . . . . . . . mile No.
2 . . . . . . . . . . . . . . . . . . . . . . . . . . . mile)
(3) the Gyro compass (repeaters) (Wrong
point: ... ... ... ... ... ... ... ... ... ... ... ... ..)
(4) (Kesalahan waktu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
..............)
14. Duty Officer
(1) Anjungan Mualim : ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.......)
Jr.Mudi : ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . )
(2) Kamar mesin Masinis : ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
..........)
Jr.Minyak : ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . )
15. sea and Weather Conditions in wrecked/stranded
(1) Cuaca : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(2) Arah dan kecepatan angin : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.......
(3) Jarak tampak : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(4) Arus : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(5) Pasang surut : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
16. in the diagram Indicate the ship ship cruise traffic, surrounding (on a sheet
separately)
17. Documents documents that must be prepared
(1) Marine Note of Protest : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes/No
(2) Berita acara : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes/No
(3) Laporan kerusakan : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes/No
18. Getting started getting started for:
(1) Demage survey : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes/No
(2) Joint Survey : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes/No
(3) Class Survey Kapal : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes/No
(4) P & I Club : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes/No
19. Supporting documents
(1) Photo photo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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DOKUMEN PROSEDUR KEADAAN DARURAT
. . . . . . . . . . . Yes/No
(2) Peta laut . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . Yes/No
(3) Jurnal dek . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . Yes/No
(4) Jurnal mesin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . Yes/No
(5) Buku olah
gerak. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes/No
(6) Jurnal
radar . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. Yes/No
(7) Buku buku perintah . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . Yes/No
(8) Peta
cuaca. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . Yes/No
(9) Rekaman hubungan VHF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . Yes/No
(10) Certificates certificate of other
supporters ... ... ... ... ... ... ... ... ... ... ... ... ... .... Yes/No

JL. Tanjung Sadari No.7 60177 Surabaya, East Java, Indonesia


Tel. 031-3579683, 3579031 Fax: 031-3578662 Email: css.line@sby.dnet.net.id It:
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FORM CSSL-005

"It is very important and confidential"


KEBAKARAN
(the second report)

Kepada : DPA
Fax No. : . . . . . . . . . . . . . . . . . . . . . . . .
.............
Tanggal : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Nomor : . . . . . . . . . . . . . .

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DOKUMEN PROSEDUR KEADAAN DARURAT
........................
KM
:..................................
Nahkoda : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1. an important Procedure in the Pavilion.
(1) Stop mesin induk Sudah
(jam . . . . . . . . . . . . . . ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes/No
(2) Laporan kepada nahkoda . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . Yes/No
(3) notice to the engine room ... ... ... ... ... ... ... ... ... ... ... ... ... .... . Yes/No
(4) Stop mesin
kemudi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. Yes/No
(5) Sinyal alarm dibunyikan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . Yes/No
(6) Nyalakan lampu di
dek . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes/No
(7) raise the international Cues to suggest AGROUND
(during the day) or turn on the light cues (in night day) ... ... ... ... ... ... ... ....
Yes/No
(8) Cue call attention to ship around or
berhubungan dengan VHP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.........
Yes/No
2. The date of the fire (the viewing hours ... ... ... ... ... ... ...) LT UTC . . . . . . . . . . .
...
3. The position of the vessel at the time of the fire:
(1) Baringan/distance from an object...........................................
(2) the latitude/longitude:...................
(U/S) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (T/B)
4. The list of officials who were contacted
1. local SAR Already/not yet
2. Companies Already/not yet
3. Agent/Representative Already/not yet
4. The Administrator Already/not yet
5. Service Raharja Already/not yet
6. The Agency Classification Already/not yet
7. the P & I Club Already/not yet
5. The circumstances at the time the fire was known:
6. bow Direction (compass repeater used the left/middle/right)
1. Speed while aground/stranded: ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ....
knots
7. The enactment of the emergency role (HR...............................................)
8. Implementation of the record-keeping komunkasi relations VHP Yes (hour ... ...
... ... ... ... ..) Not
9. The role of calling

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DOKUMEN PROSEDUR KEADAAN DARURAT
JL. Tanjung Sadari No.7 60177 Surabaya, East Java, Indonesia
Tel. 031-3579683, 3579031 Fax: 031-3578662 Email: css.line@sby.dnet.net.id
Things: 10/27

1. Missing persons ... ....

person Name:...............................
Nama : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

.
Nama : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.
2. Person Injured
Heavy injury

person name:...............................
Nama : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

.
Nama : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.
Minor injuries

person name: ... ... ... ... ... ... ... ... ... ....
Nama : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

.
Nama : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.
10. the following Events.
1. Kebakaran . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . Yes/No
2.
Kebocoran . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . Yes/No
11. Building Damage ships in outline.
Bow, starboard (front, Center, rear), stomach left side (front, Center, rear),
The stern of the ship
12. Damage to the machine
1. Kerusakan mesin induk. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . Yes/No
2. Kerusakan mesin
kemudi. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes/No
3. Kerusakan daun kemudi. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . Yes/No
4. The ability of moving themselves ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ....
Yes/No
13. the urgent circumstances
1. Is it necessary to leave the ship ... ... ... ... ... ... ... ... ... ... ... ... ... ... Yes/No
2. The command to leave the ship time (hour) ... ... ... ... ... ... ... ... ... ... .... Yes/No
3. will help rescue needed................................. Yes/No
4. Permintaan oleh kapal
jam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes/No

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5. use of the machine (oalh motion machine time, hours)
Anchor anchored (hours:)
The rudder (h)
Wianta (). (the time of the commencement of the assignment, hours)
14. The use of navigation equipment
(1) Radar (radar used number of units)
(2) (Service range. No. 1 mile. No. 2 mile)
(3) the compass (repeaters) (point):
(4) the fault time

JL. Tanjung Sadari No.7 60177 Surabaya, East Java, Indonesia


Tel. 031-3579683, 3579031 Fax: 031-3578662 Email: css.line@sby.dnet.net.id
Things: 11/27

15. Duty Officer


1. Anjungan Mualim : ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . )
Jr.Mudi : ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . )
2. Kamar Mesin Masinis : ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
)
Jr.Minyak : ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . )
16. Sea and Weather Conditions
(1) Cuaca : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(2) Arah dan Kecepatan Angin : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.....
(3) Jarak Tampak : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(4) Arus : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(5) Pasang surut : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
17. Show you in liner around the diagram, cruise traffic (on separate sheet).
18. Documents documents that must be prepared
(1) Damage Survey : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
..........
Yes/No
(2) Joint
Survey : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes/No
(3) Class
Survey : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes/No
(4) Perbaikan Kapal : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
..........
Yes/No
(5) P & I Club : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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.....
Yes/No
19. Getting started getting started for:
(1) Damage Survey : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
..........
Yes/No
(2) Joint
Survey : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes/No
(3) Class
Survey : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes/No
(4) Perbaikan Kapal : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
..........
Yes/No
(5) P & I Club : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.....
Yes/No
20. Document supporting documents
(1) Photo photo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.............
Yes/No
(2) Peta laut . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
...............
Yes/No
(3) Jurnal dek . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
..............
Yes/No
(4) Jurnal mesin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
..............
Yes/No
(5) Buku olah
gerak. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. Yes/No
(6) Jurnal
radar . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
....
Yes/No
(7) Buku buku perintah . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
............
Yes/No
(8) Peta cuaca. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
..............
Yes/No
(9) Rekaman hubungan VHF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
...........
Yes/No
(10) Certificates certificate of other
supporters ... ... ... ... ... ... ... ... ... ... ... ... ... ... ....
Yes/No

JL. Tanjung Sadari No.7 60177 Surabaya, East Java, Indonesia


Tel. 031-3579683, 3579031 Fax: 031-3578662 Email: css.line@sby.dnet.net.id

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Things: 12/27

FORM CSSL-008
"Important and highly secret"
DAMAGE TO THE AIRCRAFT IS IMPORTANT
(THE PARENT ENGINE)
The Second Report
To
: DPA
Fax No.:......................
Tanggal
:........................................
Nomor : . . . . . . . . . . . . . . . . . . . . . .
KM
:........................................
Nahkoda : . .
....................
1. Time and date of the occurrence of the failure
hour: ... ... ... ... ... ... ... ...
date:...................
2. The place where the unknown
malfunction ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ....
3. Place the damage done
a. Baringan/distance from an object:
b. Lintang / Bujur : . . . . . . . . . . . . . . . . . . . . . . . . (U/S) (L/B) . . . . . . . . . . . . . . . . .
......................
4. Ship around the (possibility of impingement with other ship)
Yes/No
5. The dangers of navigation around the (betting, odds etc.)
Yes/No
6. Removal to driving to the manual Already not/yet
7. The goals of the international sign of "uncontrolled ship" already
not/yet
8. Tighten the observations (additional personnel, radar, VHF) already
not/yet
9. Hold a call ask for attention from the ship
around (VHF, lights) Already
not/yet
10. Weather and sea conditions
Wind Direction : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Wind speed
weather :......................
Current Direction
:..............................
Current
Velocity : . . . . . . . . . . . . . .
11. Hanyutnya ship
Arah
:..............................
Never drift: ... ... ...
... ... ... ... n. m/h
12. Anchor Preparation Alread
not/yet

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13. Determine the cause of failure Already
not/yet
14. Is it possible the crew carry out their own repairs
yes/no
15. Estimated time to complete the repairs ... ... ... ... ... ... ... ... ... ... ... ... .... Hours
16. Request the Help
Needed/not
17. Relations with related parties
a. the agent Already
not/yet
b. the Administrator Already
not/yet
c. the company Already
not/yet
18. Record keeping
a. Photo-photo
b. the book of sports motion
c. diary of deck and engine room
d. others

JL. Tanjung Sadari No.7 60177 Surabaya, East Java, Indonesia


Tel. 031-3579683, 3579031 Fax: 031-3578662 Email: css.line@sby.dnet.net.id
Terms: 13/27
FORM CSSL-009

"Important and highly secret"


DAMAGE TO THE AIRCRAFT IS IMPORTANT (STEERING ENGINES)
The Second Report

To
.....
Date

: DPA

Fax No. : . . . . . . . . . . . . . . . . . . . . . . . .

:.................................
:.............................
KM
:.................................
.............

No
Helmsman : . . . . . . . . . . . . . . . .

1. The time and date of occurrence of the


hour: ... ... ... ... ... ... ... Date : . . . . . . .
..................
2. The place where the occurrence of failure..........................................................
3. Relationship with ship ship around (the possibility of
tubrukan dengan kapal
lain). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes/No

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4. The dangers of navigation around the (betting, hurdles) ... ... ... ... ... ... ... ... ...
Yes/No
5. Removal to driving to the manual ... ... ... ... ... ... ... ... ... ... ... ....
Already/Not Yet
6. Fox machine steering from No. 1 to no. 2 or vice versa..................
Already/Not Yet
7. Used generator Transfer....................................
Already/Not Yet
8. The goals of the international sign of "Uncontrolled ship" ... ... ... ... ... ....
Already/Not Yet
9. Stand by motor
induk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Already/Not Yet
10. Tighten the observations (additional personnel, radar, VHP) ... ... ... ....
Already/Not Yet
11. Hold a call asking about ships attention
(VHP, Isyarat lampu) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . Already/Not Yet
12. Persiapan
jangkar . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Already/Not Yet
13. Determine the cause of the engine failure the steering wheel ... ... ... ... ... ....
Already/Not Yet
14. Is it possible the crew carry out repairs yourself ... ... ....
Yes/No
15. Estimated time to complete the repairs ... ... ... ... ... ... ... ... ... ....
Hours
16. Request the help needed/not ... ... ... ... ... ... ... ... ... ... ... ... ...
Need/Not
17. Relations with related parties
a. agen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . Already/Not Yet
b. the Administrator/Chief Entrepreneurs of the harbor ... ... ... ... ... ... ... ...
Already/Not Yet
c. Perusahaan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . Already/Not Yet
18. Record keeping
a. Photophoto . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Already/Not Yet
b. Buku olah
gerak . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Already/Not Yet
c. Log catatan
harian . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Already/Not Yet
d. Lainlain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Already/Not Yet

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Who is responsible
KKM
NAHKODA
JL. Tanjung Sadari No.7 60177 Surabaya, East Java, Indonesia
Tel. 031-3579683, 3579031 Fax: 031-3578662 Email: css.line@sby.dnet.net.id
Things: 14/27

FORM CSSL-007

"Important and highly secret"


DAMAGE TO CRITICAL AIRCRAFT (ELECTRIC POWER)
The Second Report

To
.....
Date

: DPA

Fax No. : . . . . . . . . . . . . . . . . . . . . . . . .

:.................................
:.............................
KM
:.................................
.............

No
Helmsman : . . . . . . . . . . . . . . . .

1. The time and date of occurrence of the hour: ... ... ... ... ... ... ... ... ....
Date : . . . . . . . . . . . . . . . . . . . . . . . . . .
2. The place where the occurrence of failure..........................................................
3. Relationship with ships about (the possibility of
impingement with other ship)
Yes/No
4. The dangers of navigation around (betting, odds)
Yes/No
5. Manual Removal to driving into
yes/no
6. The details of the designation of Compass
Gyro Compass: Magnetic Compass:
7. Perform a sign intrnasional
"Uncontrolled Ship"
Already/Not Yet
8. Tighten the observations
(additional personnel, radar, VHP)
Already/Not Yet
9. Hold a call asking for the help of the ship ship around
(VHMPI terms of lights)
Already/Not
Yet
10. An estimate of the weather and sea conditions
Wind Direction : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Wind speed
weather :......................

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Current Direction
:..............................
Current
Velocity : . . . . . . . . . . . . . .
11. Hanyutnya ship
Arah : . . . . . . . . . . . . . . . . . . . . . . . . . . . . Kecepatan
angin : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . n. m/h
12. Anchor Preparation
Already/not yet
13. Determine the cause of the failure of electric power
Already/not
yet
14. Is it possible the crew carry out
repair your own
Yes/No
15. Estimated time to complete repair Clock
16. Request the Help
Needed/not

JL. Tanjung Sadari No.7 60177 Surabaya, East Java, Indonesia


Tel. 031-3579683, 3579031 Fax: 031-3578662 Email: css.line@sby.dnet.net.id
Case: 15/27

17. Relations with related parties


a. the agent Already/not yet
b. the Administrator Already/not yet
c. the company Already/not yet
18. Record keeping
a. Photo-photo Already/not yet
b. the book of sports motion Already/not yet
c. Log diary Already/not yet
d. others Already/not yet
Responsible:

KKM

NAHKODA

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JL. Tanjung Sadari No.7 60177 Surabaya, East Java, Indonesia


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Things: 16/27

FORM CSSL-010
REPORT EXERCISES THE ROLE OF FIREFIGHTER
KM

:____________________
:_______________
Voyage number
:____________________
____________

1.

Nomor
Date of reporting

The old date and exercise date:...................... .


Start hour ... ... .... up to an hour..............

2.

The position of the fire at the time of exercise:....................


U/S . . . . . . . . . . . . . . . . . . . . . . T/B

3.

The location of the fires happened:

: ____

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4.

Total time required since the signal fires dibunykan up to readiness equipment
the firefighters arrived on the scene of the fire: minutes.

5.

The type of fire extinguisher equipment used and how do I use:

6.

The conditions of the waterproof door, fire door (fire door), how HER close and
the time required to act ... ... ... ... ... ... minutes

7.

When a fire broke out in a room, does the blower/fan have all been
extinguished................................................. Yes/No

8.

What is the quick closing valves can


difungsikan (simulasi) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes/No

9.

Pemeriksaaan
firefighting
equipment

10
.

The condition of the hose and the nozzle of the fire


Good/damaged

The condition of the fire pump/pump service


General
time start............... .waktu stop . . . . . . . . . . . . . . . . .
the condition of the pump during the run:

The condition of the fire-retardant clothes (fire man outfit)

the condition of the tool you berthing respiratory


apparatus & gas masks

The condition of various type fire extinguisher bottle


-CO2 Date examination:
Date of examination:-Foam
-ABC: inspection Date

The total number of personnel involved in the exercise:.................

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11
.

The number of personnel who are absent in connection with


guard duty ... ... ... ... ... . people

12
.

Personnel who have not followed the exercise due to a reason:


Name:
Position:
Reason:

13
.

The Other

14
.

Note the results of the exercise (filled nahkoda)

KKM:

first Officer

Helmsman

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Things: 17/27
FORM CSSL011
EXERCISE THE ROLE OF COX REPORT
(DECREASE IN THE LIFEBOAT)
KM
:____________________
_________
Voyage number: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
________

Nomor
Date of reporting

1.

The old date and exercise date:.....................


Start hour ... ... ... ... ... ... ... ... up to an hour............... .

2.

The position of the vessel at the time of exercise:...................


U/S . . . . . . . . . . . . . . . . . . . . . . . T/B

:_______
: ____ _ _ _ _

Pelabuhan : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.........
3.

Lifeboat number:
Lifeboat exercise Commander:

4.

Total time required since the signal decrease lifeboats sounded up to readiness
in the location of lifeboat: ... ... ... ... ... ... ... ... ... ... ... .... minutes.

5.

Total time required since in location s/d drop in position ... ... ... ... .... . minutes

6.

Examinatio
n of the
lifeboat
equipment

Construction condition of lifeboats and


accessories ... ... ... ... .... Good/Damaged

Lifeboat engine condition:

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Start time: ... ... ... ... ... ... timing stop: ... ... ... ... ...
C

Conditions during the attempted path: ... ... ... ... ... ... ....
There are good/leakage/damaged
The State of fuel tank: ... ... ... ... ... ... ... full/half/empty

7.

The total number of personnel involved in the


latihan : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . the people.

8.

The number of personnel who are absent in connection with tasks


Jaga . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . people

9.

Personnel who have not followed the exercises caused a pedestal an:
Name:
Position:
Reason:

10

The Other

11
.

Note the results of the exercise (filled by nahkoda):

Know

KKM

The Review By,

First Officer

Helmsman

PT.CIPTA SAMUDERA SHIPPING LINE


DOKUMEN PROSEDUR KEADAAN DARURAT

JL. Tanjung Sadari No.7 60177 Surabaya, East Java, Indonesia


Tel. 031-3579683, 3579031 Fax: 031-3578662 Email: css.line@sby.dnet.net.id
Thing: 18/27
FORM CSSL-012
EXERCISE THE ROLE OF COX REPORT
(LEAVE THE SHIP/ABANDON SHIP)
KM

:____________________
:________________
Voyage number: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
____________

Nomor
Date of reporting

1.

The old date and exercise date:.....................


Start hour ... ... ... ... ... ... ... ... up to an hour............... .

2.

The position of the vessel at the time of exercise:...................


U/S . . . . . . . . . . . . . . . . . . . . . . . T/B

: ____

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DOKUMEN PROSEDUR KEADAAN DARURAT
Pelabuhan : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.........
3.

Lifeboat number:
Lifeboat exercise Commander:

4.

Total time required since the signal decrease lifeboats sounded up to readiness
in the location of lifeboat: ... ... ... ... ... ... ... ... ... ... ... .... minutes.

5.

Total time required since in location s/d drop in position ... ... ... ... .... . minutes

6.

Examinatio
n of the
lifeboat
equipment

Construction condition of lifeboats and


accessories ... ... ... ... .... Good/Damaged

Lifeboat engine condition:


Start time: ... ... ... ... ... ... timing stop: ... ... ... ... ...

Conditions during the attempted path: ... ... ... ... ... ... ....
There are good/leakage/damaged
The State of fuel tank: ... ... ... ... ... ... ... full/half/empty

7.

The total number of personnel involved in the exercise:...................................

8.

The number of personnel absent Guard duties in connection with


the ... ... ... ... ... ... ... ... ... ... ... .... people

9.

Personnel who have not followed the exercise due to a reason:


Name:
Position:
Reason:

10

The Other

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DOKUMEN PROSEDUR KEADAAN DARURAT

AT THE SAME TIME TRY TO PLANE CARRIED ABOVE THE RADAR SWITCHED ON
LIFEBOAT
11
.

Note the results of the exercise (filled by nahkoda):

Know

KKM

The Review By,

First Officer

Helmsman

PT.CIPTA SAMUDERA SHIPPING LINE


DOKUMEN PROSEDUR KEADAAN DARURAT

JL. Tanjung Sadari No.7 60177 Surabaya, East Java, Indonesia


Tel. 031-3579683, 3579031 Fax: 031-3578662 Email: css.line@sby.dnet.net.id
Things: 19/27

CSSL FORM-015
EMERGENCY STEERING DRILLS REPORT
KM

:____________________
:________
Voyage number: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_____

Nomor
Date of reporting

: ____

The old date and exercise


1.

Tanggal : . . . . . . . . . . . . . . . . . . . . .
Start hour ... ... ... ... ... ... ... ... up to
hour . . . . . . . . . .

2.

The position of the vessel at the time of exercise:...................


U/S . . . . . . . . . . . . . . . . . . T/B
Port:

3.

The dangers of navigation around the (betting, odds)

Already/Not
Yet

4.

Moving the steering wheel from the steering position into an


emergency manual

Already/Not
Yet

5.

Tighten pengamatann (additional radar personnel, VHP)

Already/Not
Yet

6.

Communication between the Steering engine room with the


bridge (communication with the voice tube, or by phone, or the
walky talkies) has been tried and stand-by

Already/Not
Yet

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DOKUMEN PROSEDUR KEADAAN DARURAT
7.

Try the emergency steering engine with manual (without engine)The movement of the rudder position cikar I 0 -P15 , the time
required

........
seconds

The movement of the rudder position II cikar P15 -S15 , the time
required

........
seconds

The movement of the rudder position cikar III S15 -P15 , the
time required

........
seconds

The movement of the rudder position cikar IV 15 0 , the time


required

........
seconds

8.

If the whole machine can officer meng-operasikannya

Yes/No

9.

The total number of personnel involved in the exercise

........
people

10
.

The number of personnel absent guard duties in connection with


the
Personnel who have not followed the exercise due to a reason:

11
.

Name:
Position:

12
.

13
.

The Other:

Note the results of the exercise (filled by nahkoda)

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DOKUMEN PROSEDUR KEADAAN DARURAT
Know

KKM

The Review By,

First Officer

Helmsman

JL. Tanjung Sadari No.7 60177 Surabaya, East Java, Indonesia


Tel. 031-3579683, 3579031 Fax: 031-3578662 Email: css.line@sby.dnet.net.id Case:
20/27

FORM CSSL-013
REPORT POLLUTION PREVENTION ROLE OF EXERCISE
KM

:____________________
:________
Voyage number: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_____

1.

Nomor
Date of reporting

: ____

The old date and exercise POLLUTION PREVENTION & CHARGING BUNKER
the start date up to hours hours

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DOKUMEN PROSEDUR KEADAAN DARURAT
2.

The preparation of the communications section of the deck (propagator) by the


engineer I

3.

Preparation supplies bunker fuel is carried out by the engineer I


- The function of the oil gauge
Good/Damaged
- The pipes air vents
Good/Dead/Damaged
- Oil cleaning materials (chemical = neos)
There is/there isn't
- Oil absorbent material/majun
The amount of enough/less
- Sawdust
Dry/Wet
- Buckets/shovels/broom/brush rib length
Complete/Less

4.

The plan of the sort the order of execution of the bunker


- The number of bunkers and long charging ... ... ... ... ... ... .... tons
of ... ... ... ... ... ... minutes
- The pumping pressure/capacity
- The way to the cessation of the charging bunker (stop land/ship)

5.

Check the condition of the charging hose (completeness installed) check the
charging hose fastening bolts/nuts and gasket that

6.

The total number of personnel involved in the exercise: ... ... ... ... ... people

7.

The number of personnel who guard duty with respect to absent: ... ... ... ... ...
the people.

8.

Personnel who have not followed the exercise due to a reason:


Name:

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DOKUMEN PROSEDUR KEADAAN DARURAT
Position:
9.

The Other
WHILE TRYING TO START THE AIRCRAFT RADAR ON MENHIDUPKAN TURN ON

10
.

Note the results of the exercise (filled by nahkoda):

Know the review by,

KKM Propagator I Nahkoda

PT.CIPTA SAMUDERA SHIPPING LINE


DOKUMEN PROSEDUR KEADAAN DARURAT

JL. Tanjung Sadari No.7 60177 Surabaya, East Java, Indonesia


Tel. 031-3579683, 3579031 Fax: 031-3578662 Email: css.line@sby.dnet.net.id
Things: 21/27

FORM CSSL-014
PERRALATAN RESCUE DEMONSTRATION EXERCISE REPORT
KM
:____________________
Nomor
:________
Voyage number: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Date of reporting : ____
_____
INFLATABLE LIFERAFT
No
.

Dicheck/item that should be practiced

Hams diservice every 12 months

The container must be written clearly:


manufacturer, serial No., Tg. Service,
capacity/number of personnel

The condition of the fittings retro reflective


tapes

Pengikatannya conditions

Hydrostatic unit was released

The condition of the embarkation ladder

Good/Damag
ed

Description

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DOKUMEN PROSEDUR KEADAAN DARURAT
LIFE JACKETS (LIFE JACKET)
THE ENTIRE CREW DEMONSTRATED THROUGH THE WEARING OF LIFE JACKETS
DEMONSTRATION LED
BY MISSIONARIES AS A SAFETY OFFICER
1.

Each life jacket fitted with retro-reflective tapes ,


ship name and Port of registry

2.

Each life jacket equipped with whistles and lights

3.

Checking of the number and condition of extra


life jackets that are on the bridge control
room/engine room and in the warehouse

FIREPROOF CLOTHES (FIREMAN OUTFIT) and BERTHING APPARATUS


1.

Checking the condition of the fire-retardant suits,


gloves, shoes, protective head

2.

Life lines, flashlight

3.

Berthing conditions apparatus: bottle, hose,


masks, air pressure

The total number of personnel involved in the exercise:...............................


The number of personnel absent guard duties in connection with
the ... ... ... ... ... ... ... .... people
Personnel who have not followed the exercise disebebkan a reason
Name:
Position:
Reason:
Note the results of the exercise (filled by nahkoda):

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DOKUMEN PROSEDUR KEADAAN DARURAT
Knowing, Reviewed By,

KKM Propagator I Nahkoda

JL. Tanjung Sadari No.7 60177 Surabaya, East Java, Indonesia


Tel. 031-3579683, 3579031 Fax: 031-3578662 Email: css.line@sby.dnet.net.id
Things: 22/27

FORM CSSL-016
REPORTS OF
KM

PRACTICE RESCUE PEOPLE FALLEN KELAUT

:____________________
:________
Voyage number: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_____

Nomor
Date of reporting

: ____

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DOKUMEN PROSEDUR KEADAAN DARURAT
1.

The old dam date exercise Ladder: ... ... ... ... ... ... ... ... ....
Mulai jam . . . . . . . . . . . . . . . . . . . . . . . . . . . , to,

2.

The position of the vessel at the time of exercise:.................


U/S . . . . . . . . . . . . . . . . . . . . . . T/B

3.

Nahkoda toss swimsuit k to sign exercises

4.

People who deliver the shouted "PEOPLE FALL KELAUT the


right/left" and throwing a buoy helper

5.

Take care when viewing the propagator or the reports take


immediate action:
-

Cikar steering towards the people that fell kelaut


Throwing a buoy that is equipped with a self
ligniting ligh da buoyant smoke to the position of
people who fell into the sea
Tell nahkoda
Unmute the alarm alerting to the role of rescue
Tell the KKM and Drivers keep
The plot of eta buoy position dip

Yes/No

Already/Not Yet
Already/Not Yet
Already/Not Yet
Already/Not Yet
Already/Not Yet

6.

Action Nahkoda:
-

Add guard personnel for roving observation


Order the standby machine, reduce the speed to full
standby
Carry out the procedure of the Williamson Turn and
sports motion approached people who see you fall
Held communication with ships around

Already/Not Yet
Already/Not Yet

Already/Not Yet

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DOKUMEN PROSEDUR KEADAAN DARURAT
Already/Not Yet
7.

Preparation is everything to lower the lifeboat rescue

8.

Preparation of the digeladak of the vehicle:


-

Rope a lifeline and buoy helper


Set up Derek and nets-nets to lift people who fell into
the sea
Preparing rope Launcher tool

Already/Not Yet

Already/Not Yet
Already/Not Yet

Already/Not Yet
9.

Setting up the tanduan first aid supplies

Already/Not Yet

10
.

Take photo-photo

11
.

-Report to the head of representation (via radio)

Already/Not Yet

-Report to the Central Office (via radio and written reports)

Already/Not Yet

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DOKUMEN PROSEDUR KEADAAN DARURAT
JL. Tanjung Sadari No.7 60177 Surabaya, East Java, Indonesia
Tel. 031-3579683, 3579031 Fax: 031-3578662 Email: css.line@sby.dnet.net.id
Things: 23/27

13
.

The number of personnel who have not followed the exercise due to a
reason: ... ... ... ... ... people

14
.

Personnel who have not followed the exercise due to a


reason
Name:
Position:
Reason:

15
.

Wianta

16
.

Note the results of the exercise (filled by nahkoda)

Knowing, reviewed by,

KKM Propagator I Nahkoda

PT.CIPTA SAMUDERA SHIPPING LINE


DOKUMEN PROSEDUR KEADAAN DARURAT

JL. Tanjung Sadari No.7 60177 Surabaya, East Java, Indonesia


Tel. 031-3579683, 3579031 Fax: 031-3578662 Email: css.line@sby.dnet.net.id
Things: 24/27

FORM CSSL-017
CHECKLIST EMERGENCY-OPERATION OF HELICOPTERS

ACTION

PERSONN
EL

Know your needs

Nahkoda

Evaluation of risks

Nahkoda

Contact the ruler on the ground

Nahkoda

Ask for information on getting started in boats

Nahkoda

Read publishing publishing the above ship

Nahkoda

Redirect Propagator I II KKM Propagator

Nahkoda

Prepare a registration area

Propagator
I

CHECK

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DOKUMEN PROSEDUR KEADAAN DARURAT
Remove the loose gear

Propagator
I

Remove the strap temali

Propagator
I

Make sure the deck is free of gas close all the doors

Propagator
I

Prepare fire fighting equipment

Propagator
II

Trained personnel using fireproof clothes

Propagator
II

Free up the area around so as not to obstruct the view of a


pilot

Propagator
I

Mark registration area

Propagator
I

Prepare communication communication deck/platform

Propagator
II

Host communications with landline/pilot

Marconist

Provide direction to KKM

Nahkoda

Diverting the use of steering wheel on the steering wheel of


the hand

Officer of
the guard

Though the motion of the kapals according to the


instructions

Nahkoda

Turn on the lights lights correctly/figure objects

Officer of
the guard

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DOKUMEN PROSEDUR KEADAAN DARURAT
Monitor the position of the vessel

Officer of
the guard

Monitor ships around

Officer of
the guard

When the helicopter landed must not touch the wire-wire


winch

All

If the helicopter has landed don't bound

All

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DOKUMEN PROSEDUR KEADAAN DARURAT
JL. Tanjung Sadari No.7 60177 Surabaya, East Java, Indonesia
Tel. 031-3579683, 3579031 Fax: 031-3578662 Email: css.line@sby.dnet.net.id
Case: 25/27

FORM CSSL-018
CHECKLIST EMERGENCY SHEDDING POLLUTION
ACTION

Experiment with alarm


All personnel assembled

PERSONN
EL
Inventor
All

Investigate the cause and stop shedding

Officers

In emergency operation of cargo in-stop/close shellfish


crustaceans

Officers

Keep shedding don't ship out

Propagator
I

If the shedding of lower perukaan charge in the tank

Propagator
I
KKM

Evaluation of the use of the disposal pump/pump wind

Propagator
I

Use the detailed relationships for SOPEP

Nahkoda

Notify the local ruler

Nahkoda

CHECK

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DOKUMEN PROSEDUR KEADAAN DARURAT
Tell the local government

Nahkoda

Notify the company

Nahkoda

Tell your agent/representative of the P & I

Nahkoda

Never spray detergents into the sea without the permission


of the se-local rulers

Nahkoda

Provide the drum-drum/sack-bag for cleaning

Chef/KKM

JL. Tanjung Sadari No.7 60177 Surabaya, East Java, Indonesia


Tel. 031-3579683, 3579031 Fax: 031-3578662 Email: css.line@sby.dnet.net.id
Terms: 26/27
FORM CSSL-018
CHECKLIST EMERGENCY RELIEF CLOSED ROOM

ACTION
Experiment With Alarm
All personnel assembled

PERSONNEL
Inventor
All

Barred from entering the room

Inventor

Tell it to the bridge

Inventor

CHECK

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DOKUMEN PROSEDUR KEADAAN DARURAT

Tell Missionary IPenolong

Inventor

use Breathing Apparatus/Rope Helper

Two trained
Personnel

Check The Atmosphere

Propagator I

Make sure the cause

Propagator I

Provide Air to the person Injured

Team

Find the cause as soon as possible

Team

Prohibited move if a serious and ceera Atmosphere


must be sufficiently

Team

If the Atmosphere was sufficient to identify the cause

Team

Give First Aid

Nahkoda
Marconist

Use Stretcher

Chef

Place the injured on a stretcher if secure

Team

Provide continuous air/first aid

Team

Report To The Company

Nahkoda
Marconist

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DOKUMEN PROSEDUR KEADAAN DARURAT
Do The Evacuation

Nahkoda

JL. Tanjung Sadari No.7 60177 Surabaya, East Java, Indonesia


Tel. 031-3579683, 3579031 Fax: 031-3578662 Email: css.line@sby.dnet.net.id
Things: 27/27

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