INSPECTION/AUDIT CLOSED-OUT FORM

Ships Name KANAYA PRIMA 99

(Nama Kapal)
Ship Owner/Operator PT. KANAYA
(Pemilik/Pengelola Kapal)
Date | Port of
Inspection 12 APRIL 2023 at 12:00 LT
(Tanggal | Pelabuhan
Inspeksi)

Observation
VIQ / SSSCL Ref.
(Temuan)

10.30 The engine room bilge high level alarm system was malfunction.

Root Cause During the date of inspection, found the engine room bilge alarm was
(Akar Masalah) malfunction.

Corrective
Action Engineer has been fixed the engine room bilge high level alarm system.
(Tindakan Perbaikan)
Preventive
Action All the compartments related to the ship / safety should be properly maintain.
(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.)

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 INSPECTION/AUDIT CLOSED-OUT FORM
Ships Name KANAYA PRIMA 99
(Nama Kapal)
Ship Owner/Operator PT. KANAYA
(Pemilik/Pengelola Kapal)
Date | Port of
Inspection 12 APRIL 2023 at 12:00 LT
(Tanggal | Pelabuhan
Inspeksi)

BEFORE

Page 2 of 3
 INSPECTION/AUDIT CLOSED-OUT FORM
Ships Name KANAYA PRIMA 99
(Nama Kapal)
Ship Owner/Operator PT. KANAYA
(Pemilik/Pengelola Kapal)
Date | Port of
Inspection 12 APRIL 2023 at 12:00 LT
(Tanggal | Pelabuhan
Inspeksi)

AFTER

Page 3 of 3