TM

Condition Survey
Report Form

HANSEATIC UNDERWRITERSTM V2.0 EN WWW.HANSEATIC-UNDERWRITERS.COM

 TM
Instructions for Condition Surveys
Dear Surveyor,
Please complete the enclosed form with the infor-
mation available on site, but remember always it is
only a guide to assist with the reporting. Typing is
optional. Please note that only ONE copy of the
report is required, which should be forwarded as
soon as possible.
We would expect a survey to be completed within
maximum one day, however, if it is required that a
surveyor should attend longer, then Hanseatic
P&I's Managers should be contacted immediately.
When reporting on the various items a tick in the
respective boxes is often sufficient. Details of e.g.
any machinery or manufacturer's serial number etc.
are usually not required.
If an item is not on board, or an operation is not
carried out, it does not mean that it is necessarily a
defect. The surveyor should use his knowledge and
experience to determine if a real "defect" exists and
consequently if a recommendation is required.
Ultrasonic Tightness test of hatch covers and pres-
sure test of double bottom tanks: these are essen-
tial at all surveys unless specifically instructed.
Hatch covers should be visually inspected and
ultrasonically tested. Ballast tanks should be
pressed up and the holds visually inspected for
leaks. Hold bilges suction tests should be carried
out but environmental rules always to be consid-
ered. Such tests are considered necessary, but if it
is not possible to carry them out, surveyors should
report this and the detailed circumstances in the
usual way.
The surveyor should test items wherever appropri-
ate whilst conducting the survey, such tests of
course only being carried out with the prior
knowledge and co-operation of the ship's staff. If
particular areas appear to be well maintained and
operational then it will be beneficial, due to possible
time constraints, to limit testing to the more im-
portant items or those, whose condition gives
cause for concern.
The last page includes a "summary" section. This
should be a brief summary of the vessel after the
survey. The last page of the form should clearly
state any deficiencies found, including anything
related to crew or management. It is important that
ZELLER ASSOCIATES MANAGEMENT SERVICES GMBH
KREUZFAHRTCENTER MANAGING DIRECTORS:
VAN-DER-SMISSEN-STR. 1 DR. HARALD ZELLER
22767 HAMBURG CAPT. BERT WARDETZKI
GERMANY TOBIAS BRAUN
Hanseatic UnderwritersTM is a trademark of Zeller Associates Management Services. In combination with the abovementioned insurance products and servic es, Zeller Associates Management
Services GmbH acts as agent of the participating insurance companies according to the applicable insurance contract act.
the nature and extent of the defect is clearly stated
so that it is apparent to the owner and to Hanseatic
P&I.
The last page(s) of the form, with the list of defects
and recommendations, must be signed for receipt
by the Master or any other manager's or owner's
representative and the original returned to Hanse-
atic P&I's Managers. If a signature is refused or is
unobtainable this should be stated with the reason.
A copy of the signed page(s) should be left with the
person signing with the request that it is passed to
the ship's managers or operators.
The surveyor should explain that the recommenda-
tions made would be forwarded to Hanseatic P&I
who will subsequently inform the Assured as ap-
propriate.
Hanseatic P&I usually requires a few photographs
to indicate the type and layout and condition of the
vessel, and then photographs of defects but only
where these usefully supplement the report. A large
number of photographs showing satisfactory items
are not required. Photocopies of plans or diagrams
to supplement the report, preferably A4 size, are
helpful, especially a general arrangement plan. If
information is required from the vessel or own-
ers/managers once the surveyor has departed the
vessel, then the vessel's owner/manager should be
requested to forward these directly to Hanseatic
Underwriters.
Preliminary Report: The preliminary report consist
of Summary section, condition rating scale, the
hatch covers ultrasonic tightness test report if ap-
plicable and the defect report. This report also con-
sist of details any tests/inspections that could not
be conducted at the time of survey. The preliminary
report to be submitted to the Club within 48 hours
of completion of survey.
Final Report: Final report to be within one week of
completion of survey or earlier where possible.
The rating section on the last page is used to assist
Hanseatic P&I to make an assessment for insur-
ance purposes. Considerable objectivity is required
from the surveyor. To ensure a common basis in
completing this section, the following brief guide
should be followed (only whole numbers should be
used!)
PAGE 2 OF 23
TRADE REGISTER: INSURANCE AGENT REGISTER NO.: D-WDHA-L8LHU-86
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PHONE +49 40 3890739 0
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 Condition Survey Report Form
TM

For all sections please use the following numbering:

0 1 2 3 4 5 6 7 8 9
Dangerous Very poor Poor Satisfactory Good Excellent

In using the above number code the following factors should be among those taken into account
for each section:

Management / Administration Cargoworthiness

• Motivation of Officers • Condition of Holds and Hatch Coaming
• Certification to ISM Code, ISO, EN • Condition and Sealing Arrangements
• or other approved standards • of Hatch Covers
• Procedures and Company Instructions • Bilges
• Manuals and Records • Hatch covers ultrasonic test
• Certification & Documentation • Ventilation Arrangements
• Maintenance
• Cleanliness
• Previous Cargo Damage Claims

Non Cargo Tanks Crew Safety

• Crew Inspections • Accidents in the Past
• Class Inspections • Safety Awareness and Attitude
• Maintenance • Safety Posters and Books
• Coating / Anodes • Safety Policy
• Corrosion • Protective Clothing worn
• Watertightness • Protective Clothing supplied

LSA & FFA Navigation

• Crew ability to use Equipment • Language
• Condition of Equipment • Passage Planning
• Maintenance Records • Bridge Equipment
• Regular Inspection and Servicing • Publications and Charts including correc-
tions
• Procedure and Logbooks
• Operating and Maintenance Instructions
• Master / Pilot Information Exchange

Manning / Competence Machinery

• Language used Spare Gear and Tools
• Attitude of Crew Maintenance and records
• Competence Cleanliness and Tidiness
• Safe Manning Leaks
• Work being Carried out Lighting / Emergency lighting
• Certificates of Competency and
endorsements
• MLC Certificate & Manual

Hull Pollution Prevention

• Equipment • Crew Attitude
• Paint coatings • Procedures
• Corrosion • Bunkering
• Accommodation space • Oil and garbage disposal
• Tidiness • Shipboard Oil Pollution Emergency Plan
• Maintenance • Ballast Management
• Damage • Garbage management

For your perusal please find enclosed our Survey Report Form

HANSEATIC UNDERWRITERSTM ZELLER ASSOCIATES MANAGEMENT SERVICES GMBH

PAGE 3 OF 23
 Contents:

Cover Page
A – Documentation and Certificates
B – Safety Equipment
C – Manning and Qualifications
D – Management
E – Bridge, Navigation and Communication Equipment
F – Accommodation
G – Machinery Installation
H – Condition of Ship’s Hull, Structure and Fittings
I – Cargo worthiness Items
J – Pollution
K – Additional items for
└ Container Vessels
└ Reefer Vessels
└ Ro-Ro Vessels
└ Tankers
└ Tug Boats
Summary
List of Deficiencies
– Cover Page –

Date and Place of Survey

Survey Company
Surveyor's Name

Vessel Name
Operators
Type of Vessel
Year & Country of Construction
Trading Area Gross
Tonnage Summer
Deadweight LOA /
Breadth / Depth
Classification
Flag
Call Sign
Owners
IMO number
Our Ref
A – Documentation and Certificates

Date and Place of Issue Expiry Date

1. Certificate of Registry

2. Certificate of Class

3. Safety Management
Certificate

4. Document of Compliance

5. International Ship Security

Certificate
6. Safety Construction
Certificate

7. Safety Equipment Certificate

8. Safety Radio Certificate

9. International Loadline
Certificate

10. I.O.P.P.C.

11. I.A.P.P.C

12. M.L.C.C

13. Safe Manning Certificate

14. C.L.C

15. Firefighting Appliance

Certificate(s)

16. Liferaft Certificate(s)

17. Hull & Mach. Special Survey /

Intermediate Survey

18. Hull & Mach Annual Survey

19. Dry-Dock Survey

20. Last Flag State Control

21. Last Port State Control

22. Cargo Gear Annual & Quad.

Survey
B – Safety Equipment

Lifesaving Appliances

No. Fitted: Material:

1. Lifeboats No. Persons: Engine:

Starboard / Port Oars:

2. Life rafts (numbers & capacity)

3. Are lifeboat hulls free from damage or

corrosion?

4. Are lifeboat equipments in satisfactory

condition?

5. Are davits and wire falls in satisfactory

condition? (Last annual & quad. insp.)

6. Are lifeboat embarkation ladders + at-

tachments sound?

7. Are lifeboats in place complete with effi-

cient self-igniting lights, smoke signals,
lifelines, etc.?

8. Are E.P.I.R.B, line throwing apparatus,

sarts and pyrotechnic devices all valid
and properly stowed?
B – Safety Equipment (contd.)

Fire fighting Installation

1. Is the fire main on deck free from

corrosion?

2. Are hydrants in good condition?

3. Are fire hose boxes on deck in good

condition and all contents complete?

4. Is the fire hose international shore con-

nection accessible?

5. Are portable fire extinguishers in place

and properly serviced?

6. Is the emergency fire pump tested regu-

larly? (To be tested if considered nec-
cessary)

7. Is there a properly kept Fire Store with

properly maintained firemen’s outfits,
breathing apparatuses etc.?

8. Are the engine room fire fighting equip-

ments properly maintained (incl. gas
flooding installation and remote stops)?

Holds:

E/R:
9. State the type of fixed system in...
Accommodation:

Paint locker:
C – Manning and Qualifications

What are the Safe Manning Certificate Requirements?

List Officers’ Certificates and Nationalities

Note: State at least Name – Competency – Validity of Competency – Nationality

Master

Chief Officer

2nd Officer

3rd Officer

Radio Officer

Chief Engineer

2nd Engineer

3rd Engineer

Total Number of Officers + Crew

(Please attach crew list and safe
manning certificate)

Total Number of Officers + Crew

required on safe manning certificate

Are endorsements of Flag State

available?

Trade Limitation if any

Are resting hours maintained

& recorded?
D – Management

Internal audits :

1. Are followings carried out at

Safety meetings:
regular intervals?

Master’s review :

• Company Manuals
• Company Orders
• Training Manual
• Safety Manual
• Cargo Securing Manual
2. Are the following manuals
onboard? • Emergency Towing Manual
• Ballast management Manual
• Energy Efficiency Manual
• Recovery person from water
Manual
• MLC Manual?

3. Is a sounding book kept?

• Tank entry procedures?

• Bunker loading
4. Are written instructions
procedures?
provided and recorded for:
• Hot work procedures?
• Near miss?
• fire?
5. Is a written contingency plan
• collision?
provided for dealing with major
incidents such as ... • grounding?
• pollution?

• Non conformance &

6. Are the records of followings
corrective actions
appropriate?
• Accidents

7. Can the officers and crew

converse in a common Which language?
language?

8. How frequently is the crew

exercised at emergency
stations?

boat drill
9. State the dates of the last ...
fire drill

e.g.
• Safety Footwear?
10. Does the crew wear
• Safety Gloves?
appropriate protective
equipment? • Safety Goggles?
• Ear Defenders?
• Face Masks?
E – Bridge, Navigation and Communication

1. Can the master confirm that all

equipment is working efficiently?

2. Are all the equipments of the

GMDSS reported working
efficiently?

3. Date of the latest Notice to

Mariners or Navigational
Warnings on board

4. Are paper and/or electronic

charts (ECDIS) of the vessel’s
trading area(s) corrected
up-to-date?

5. Are passage planning

appropriate and records kept?

• Radio Signals?
6. Are the following publications on • Light Lists?
board up-to-date? • Pilot Books?
• Bridge Procedures?

7. Is the compass deviation card Date of last adjustment:

posted?

8. Are muster lists and fire safety

plans posted?

9. Are muster lists and fire safety

plans displayed in a language
understood by the crew?

10. Is an approved trim and State issuing authority

stability booklet available? and date:

11. Are calculations made on a

regular basis and recorded?

12. Is bridge navigational watch

alarm system (BNWAS) in
apparent working order?

13. Is vessel fitted with VDR and is

it in apparent working order?
F – Accommodation

1. Are the accommodation

spaces generally clean, tidy
and free from obvious
fire/ safety hazards?

2. Are galleys, pantries and

stores clean and free from
obvious hazards?

3. Are “locked-in” alarms work- ing

efficiently and freezer room
doors fitted with means of
opening devices from the
inside?

4. Are MLC requirements being

met and certified?

5. Are medical store / hospital

clean, tidy and the medicines
available, not expired?
G – Machinery Installation

Note: It is not possible for a Surveyor to assess fully the condition of the main and auxiliary machinery within the time scale allowed
therefore Surveyors should make a general examination of the engine room, workshops and steerin g com- partment.

• illuminated?
1. Are machinery spaces well... • ventilated?
• painted?

2. Is there evidence of exhaust gas leak-

age by soot deposits on lagging of
uptakes?

3. Are ladders, gratings, floor plates and

machinery guards adequate and securely
fitted?

4. Is there evidence of significant leakage • stern glands?

at... • pump glands?
• pipe flanges/valves?

• diesel engines?
5. Is there excessive leakage of fuel and/or • boilers?
lube oil at or around... • purifiers?
• transfer pumps?

6. Are machinery bilges clean and dry?

7. Does bilge alarm work?

8. Are pumps and machinery marked

(colour coding)?

9. Are instructions for changing to

emergency steering posted?

10. Is the steering gear in good condition

and the steering gear room tidy, well
illuminated and clean?

11. Are there adequate machinery mainte-

nance handbooks onboard in a language
understood by the engineers?

12. Are comprehensive maintenance records

kept?

13. Are E/R cratings in place, secured, clean

and in safe condition?

14. Is emergency lighting working

efficiently?

15. Are self closing devices in E/R fully oper-

ational?
H – Condition of Ship's Hull, Structure and Fittings

• well painted?
1. Is external shell painting ... • free from heavy corrosion?
• free from heavy indentation?

• well painted?
2. Are weatherdecks ...
• free from heavy corrosion?

• superstructures?
• mast houses?
3. Are the following vessel parts
• bulwarks?
well maintained:
• manholes?
• watertight doors

4. Are external doors, hatches, ports

etc. well maintained regarding
seals and fastenings?

• ladders / stairways?
5. Are the following in safe • accommodation ladders?
condition: • pilot ladders?
• handrails?

6. Are ventilation openings, air

pipes and their closing appli-
ances in good condition?

• windlasses and winches?

7. Are the following in safe and • cranes and derricks?
efficient condition: • wire ropes and chains?
• safety guards of deck machinery?

8. Are the filling connections and air

pipes of fuel/ diesel oil tanks
structurally sound and fitted with
oil tight coamings?

9. Are light fittings on deck and in

the forecastle safe and effi- cient?

e.g.:
• Cement boxes to pipelines?
10. Is there any evidence of • Small doubler plate to hull?
temporary repairs visible? • Deck?
• Hatches?
• Hatch Covers?

11. If access possible, are ballast

tanks apparently free from sig-
nificant wastages, pitting etc..?
I – Cargoworthiness Items

Sketch the general arrangement of the deck layout showing cargo holds and/or tanks including permanent ballast tanks.

Number of holds/hatches:

Note: Surveyors should inspect all accessible cargo holds and hatchways and carry out ultrasonic water tightness test on hatch
covers and attach to the report!

• Hatch cover panels?

• Rubber packing?
1. Are the following items visually in
• Rubber packing channels?
satisfactory condition (please take
• Cross joints and wedges?
photos) and
Ultrasonic water tightness test car- • Quick acting cleats?
ried out with satisfactory result? • Compression bars?
• Coaming tops, drains and
non-return valves?
2. Is there any distortion of heavy
corrosion of hatch coamings and
brackets?

3. Are tarpaulins, sealing tape or high

expansive foam in use on hatch
covers and/or hatchways?

4. Is there any evidence of previous

leakage by rust stains inside hatch
coamings?

5. Are access hatches, seals and fas-

tenings in a satisfactory condition?

6. Are hold ventilation arrangements

efficient?

7. Are ventilation watertight closures

efficient?
8. Are hold ladders, safety rails etc.
safe and efficient?

9. Are air and sounding pipes in

satisfactory condition?

10. Are air pipes / sounding pipes

watertight closures efficient?

11. Are bilge wells clean & dry?

12. Does bilge alarm work?

13. Is suction test carried out with

satisfactory result? (Beware
environmental rules)

14. Does bilge non-return valve working

properly to prevent back flow

15. Is there any oil/water residues on

tank tops?

16. Are longitudinal/transverse

bulkheads structurally intact?

• shell?
17. Is corrosion evident at side • frames?
• bracket?

18. Is plating of upper/lower Hopper

Tanks intact?

19. Are brackets to tank top wasted or

damaged?

20. State last cargo carried and/or now

loading / discharging.

21. Is a loading computer or stress finder

fitted? State calculation method.

22. Are calculations made on a regular

basis and recorded? State last date.

23. Type of hatch covers and operating

mechanism
J – Pollution Prevention

1. Is the oil record book properly

maintained?

2. Are materials carried on board to

deal with minor spills?

3. Are NOX records kept?

4. Are appropriate procedures in

place for switch over to low sulphur
fuel when trading relevant areas?

5. Is garbage management in place

and records up to date?

6. Are OWS and alarm in full working

order?

7. Is vessel free from valve or pipeline

leakage liable to cause pollution?

8. Is there an approved ballast man-

agement plan and records up to
date?

9. Is vessel equipped with ballast

water treatment plant?
Additional Items for Container Vessels

1. Are tank tops clean and dry in con-

tainer holds?

2. Are container cell guides well main-

tained?

3. Does hold bilge alarms work?

4. Are container lashings and attach-

ments sufficient and well main-
tained?

5. Are gratings, platforms and handrails

around hatch covers in satisfactory
condition?

6. Is there an approved container secur-

ing manual? State approved auth.

Additional items for Reefer Vessels

1. Are cargo spaces, insulation and

thermal seals of hatch covers in sat-
isfactory condition?

2. Are fans, ducting, coolings and air

distribution arrangements in satisfac-
tory condition?

A sample copy of temperature

3. Is temperature monitoring equipment in log printout from the last
full working order? cargo voyage should be
provided, if possible.

4. Does the vessel carry a dedicated How many years experience

refrigeration engineer? has this engineer?

5. Refrigeration annual survey date?

6. Refrigeration special/intermediate
survey date?
Additional Items for Ro-Ro Vessels

• Hoisting cables
• Securing chains
1. Is/are the stern and/or side door(s) in • Locking devices
good condition and the following items • Hydraulic cylinders
in order and well maintained? • Landing flaps
• Rubber gaskets
• -Safety rails

2. State type & maker of bow access

arrangement if installed

3. If bow access arrangement exists:

Is/are the bow door in good condition
and are rubber packings, locking de-
vices, hydraulic cylinders etc. in or- der
and well maintained?
4. State date when rubber packings at
stern and/or bow access doors were
last exchanged

5. Are the internal ramps in good condi-

tion and fitted with anti-slip material?

6. Are the vehicle deck bilges or bilge

wells clean and is the bilge pump in
operation?

7. Are lashing/securing points available

(state type) and in good condition?

8. Are the vehicle decks well illuminat-

ed?

9. Is the ventilation system for the vehi- cle

decks in operation, working effi- ciently
and properly maintained?

10. State type of available cargo lashing

equipment:

11. Is the lashing equipment in satisfac-

tory condition?

12. Number of passengers allowed to

carry and the certificate available?
Additional Items for Tankers (including Gas and Chemical Carriers)

1. Is there evidence on deck of cargo

leakage from hatches, pipe system or
valves?

2. Is there any loose oil in manifold spill

tanks?

3. Is pipe system on deck free from heavy

corrosion and test dates marked (incl.
cargo, I.G., P.V., V.R.S., C.O.W.,
steam, hydraulic lines etc.)? State last
pressure test date

4. Are the gangway gratings, platforms,

stairs, ladders and handrails safe?

5. Are tank access hatches, ullage ports,

washing hatches and their co- vers and
fastenings well maintained?
6. Are the Inert Gas, tank gauging and
gas detection systems fully opera-
tional?

7. Is the Crude Oil Washing System

fully operational?

8. If a cargo control room is fitted: Is all

control and monitoring equipment,
including ODME fully operational?

9. Type of tank coating?

10. Are portable gas detection instru-

ments available and calibrat-
ed/certified?

11. State last date of CDI & SIRE inspec-

tions

Pump Room

1. Is there any evidence of cargo leak- age

from pumps, piping, valves etc.?

2. Are bilges clear of loose oil?

3. Does bilge alarm work?

4. Is lighting adequate and working

efficiently?

5. Are vent fans, trunking and fire

dampers in satisfactory condition?
6. Are ladders, gratings and handrails
safe?

7. Is the oil discharge monitoring and

alarm system fully operational?

8. State last cargo carried and/or now

loading/discharging

Additional items for Tug Boats

1. Are procedures available for

towing operations?

2. Are towing equipment, winches,

wires, connecting links, shack- les,
thimbles etc.. satisfactory and
certified?
3. Are towing control check lists and
towing plan records main- tained
(if applicable)?
– Summary –
Condition Rating Scale:

0 1 2 3 4 5 6 7 8 9
Dangerous Very poor Poor Satisfactory Good Excellent

Management / Administration Navigation

Cargoworthiness Manning / Competence

Non Cargo Tanks Machinery

Crew Safety Pollution Prevention

LSA & FFA Hull

Additional Comments:

Name of Master: Owners Representative:

 Condition Survey Report Form
TM
- LIST OF DEFICIENCIES -

– LIST OF DEFICIENCIES –

Please note: After this page was filled out please have it signed by an authorized person on behalf of the vessel and send it
as a scanned file back to Hanseatic Underwriters. When this page was filled out in handwriting only, please re-
type all information in another copy of this form electronically and send it back additionally. Thank you!

Name of vessel: Port: Date:

Section
No. Deficiency (just add more rows if needed)
& Item No.

1.

2.

3.

4.

5.

Surveyor: For receipt on behalf of vessel:

Name: Name:

Company: Position:

Signature: Signature:

HANSEATIC UNDERWRITERSTM ZELLER ASSOCIATES MANAGEMENT SERVICES GMBH PAGE 1 OF 1