Questionnaire to be completed before port state control inspection5

Port State Control office of Dunkerque / Dunkirk (France)

Email adress : psc.pchargee.csn-dunkerque@developpement-durable.gouv.fr

The vessel is liable for inspection during your next call by Port State Control Officers. Given the
exceptional circumstances due to the coronavirus pandemic, you are requested to answer the
questionnaire below and forward after completion as soon as possible before calling at the
email address above, in the perspective to carrying out this inspection in the best conditions for
the safety of crew and PSCOs, and in view of the greatest cooperation :

1- Is there a risk assessment and a prevention plan on board against the sanitary risks
due to the coronavirus ? If yes, and if in english, you are requested to forward the plan
to the email address above in attachment of the questionnaire completed.

Could you briefly describe the main provisions of the plan ?

2 - In case of a prevention plan is not formally established, what measures must the
crew members observe during the inspection with a view to preventing risks ?

5 Decree 84-810 Art. 58 : the captain of any ship obstructing the performance of a safety control is liable for penalties
prescribed for fines of 5th class

Note technique reprise inspections régulières PSC du 18/06/2020 9/10

 3 - The PSCOs will observe the following measures during the inspection :

What would it be expected from PSCOs as additional preventive measures to be

observed during the inspection ?

4 - Is the vessel provided with any invalid statutory/class certificates because of

surveys not carried out due to the coronavirus pandemic ?
(please mention certificate(s) concerned)

5 - If YES, is there a flag state plan that covers how the ship will be brought back into
the regular survey or audit cycle ? What is the maximum deadline ? (please provide
copy of flag state statement)

6 - Are there any crew members who were unable to benefit from their repatriation at
the end of the boarding period due to coronavirus pandemic ?

7 - Are there any crew members with no longer valid STCW certificates ?

8 - Is there any safety/pollution prevention equipment that has not been subject to
mandatory periodic service due to coronavirus pandemic?

9 - Is there equipment essential to the safety of the ship and of the crew that no longer
works and cannot be repaired by a lack of spare parts due to coronavirus pandemic ?

10 - Provide the list of the last 10 port calls.

[11 - Are there suspected covid-19 case on board ?]
[12 - How many crew members have boarded in the last 15 days ?]

Note technique reprise inspections régulières PSC du 18/06/2020 10/10