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INSPECTION/AUDIT CLOSED-OUT FORM

Ships Name MT. GAS CAMELOT


(Nama Kapal)
Ship Owner/Operator PT. SUASA BENUA SUKSES
(Pemilik/Pengelola Kapal)
Date | Port of Inspection 30 October 2021 Pulau Sambu
(Tanggal | Pelabuhan Inspeksi)

VIQ / SSSCL Ref. Observation


(Temuan)

110 Fire plan endors by Administration / Flag State not available onboard

Root Cause
(Akar Masalah) In progress arrange Endorsment of Fire Plan

Corrective Action Submit the Fire Plan to administration for approval. Terlampir “Surat Pernyataan”
(Tindakan Perbaikan)
Preventive Action Master will make sure all drawing approved by Administration.
(Tindakan Pencegahan)
Close-Out evidence might be; documents, procedures, photos, certificate, service report, delivery order, etc.)
(Bukti tindak lanjut dapat berupa; dokumen, prosedur, poto, sertifikat, laporan kerja, bukti pengiriman, dll.)

Page 1 of 3
INSPECTION/AUDIT CLOSED-OUT FORM
Ships Name MT. GAS CAMELOT
(Nama Kapal)
Ship Owner/Operator PT. SUASA BENUA SUKSES
(Pemilik/Pengelola Kapal)
Date | Port of Inspection 30 October 2021 Pulau Sambu
(Tanggal | Pelabuhan Inspeksi)

Page 2 of 3
INSPECTION/AUDIT CLOSED-OUT FORM
Ships Name MT. GAS CAMELOT
(Nama Kapal)
Ship Owner/Operator PT. SUASA BENUA SUKSES
(Pemilik/Pengelola Kapal)
Date | Port of Inspection 30 October 2021 Pulau Sambu
(Tanggal | Pelabuhan Inspeksi)

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