FORM 12-009

INTERNAL AUDIT OBSERVATIONS

Name Office/Vessel: Date of Audit:

Name of Dept Head/ Audit Reference
Master: Number: (Month/year/Initial of Office/ Dept/ Vsl)

A. Details of Observations/Findings – must have a reference to the established company systems, requirements and
standards.
ISM Code /Company Manuals/Others
Description of observed deviation and objective evidence(s)
(Specify Name of Manual & section/procedure Number)

B. Confirmed and agreed by:

Dept Head/ Master Date

(Name & Signature)
C. Lead Auditor of the
Date
Audit Team (Name & Signature)

Distribution: (During Internal Audit) April 17, 2013

1st / Original – DPA/Office
2nd / Duplicate – Auditee’s File

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