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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)

27 Ship's SMS on behalf shipoperator PT. Suasa Benua Sukses not available onboard

Root Cause
(Akar Masalah) SMS Manual not on board

Corrective Action Send soft copies of SMS Manual and printed on board
(Tindakan Perbaikan)
Preventive Action Master will regularly check for all manuals on board
(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 5
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 5
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 3 of 5
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 4 of 5
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 5 of 5

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