Ship Registration

COOK ISLANDS Survey Form

BARGE INSPECTION REPORT 42A
v.3

To meet the regulations of the

Cook Islands Ship Registration Act, 2007

1. GENERAL INFORMATION / BARGE DETAILS

1.1 Name of Barge      
1.2 Type of Barge Unmanned Manned
1.3 Year Built      
1.4 GT / NT / BHP                  
1.5 Official No. / Call Sign            
1.6 IMO No. / Year of Registration in CI            
1.7 Ship’s Classification Society      
1.8 Inspection Port / Date(s)n            
1.9 Type of Inspection Initial Annual Other
1.10 Other Reason of inspection      
1.11 Date / Place previous inspection            
1.12 Has modifications been made to the barge or equipment which would affect the certification? Yes No
(any modifications must be reported in the Surveyor’s Notes section)

2. CERTIFICATION / DOCUMENTATION
2.1 Certificates – Permanent Date Issued Remarks
2.1.1 Tonnage (ITC69)            
2.1.2 Cargo Gear (if applicable)            

2.2 Certificates – Other Expiry Date Last Survey Issued By

2.2.1 Certificate of Registry       ---- MCI
2.2.2 Barge Safety Certificate       ---- MCI
2.2.3 Radio Licence (if applicable)                  
2.2.4 Radio Equipment Certificate (if applicable)                  
2.2.5 Load Line (if applicable)                  

2.3 Equipment - Manuals Approved Date Approved By

2.3.1 Barge Safety Equipment Record (if applicable)            
2.3.2 Deck Loading/Lashing plan (if applicable)            

3. GENERAL CONDITION ON DECK / HOLD / HOPPER / SUPERSTRUCTURE

If the Inspector's general impressions and his visual observations on board confirm a good standard of maintenance,
his/her inspection should be of a general nature. If, however, the Inspector has any reason to consider that the ship or its
equipment does not correspond to the requirements of the relevant Conventions, the Inspector should proceed to a more
detailed inspection.
Condition: Acceptable Poor Deficiencies noted
3.1 Weather decks
3.2 Guard rails & bulwarks
3.3 Freeing ports
3.4 Air Pipes marked and ‘hats’ ok (if applicable)
3.5 Manhole hatches & closing devices
3.6 Fittings for timber deck cargoes
3.7 Fittings for deck containers

Page 1 of 2
3.8 Anchors & winches (if applicable)
3.9 Mooring winches (if applicable)
3.10 Mooring bits & fairleads
3.11 Mooring ropes
3.12 Deck cranes / Derricks (if applicable)
3.13 As far as visible, the ship's side shell plates are without damage and
excessive wastage
3.14 Hatch cover arrangements, including gaskets and closing appliances,
appear watertight and in good condition (if applicable)
3.15 The structure of cargo hopper with regard to bulkheads, frames, brackets,
tank tops etc. Appear to be without damages and excessive wastage. (if
applicable)
3.16 Draft marks and Plimsoll marks painted in contrasting colour
3.17 Submersion marks are permanent and in accordance with the Load Line
Cert.
3.18 Tanks inspected (list tanks under notes or separately)
3.19 Navigation lights including towing lights
3.20 Power supply for navigation & towing lights
3.21 Emergency towing wire & pick-up arrangement

4. SURVEYOR’S NOTES
Ref. Remarks / Deficiencies
          
 
          
 
          
 
          
 
          
 
          
 

5. Certificate

1. It is recommended that:

A full term Vessel Safety Certificate be issued valid until      

be issued by a Deputy Registrar of Ships/ the Registrar of Ships

That the certificate [Certificate ID number] was endorsed on [Date]

No Full Term Certificate is to be issued before any conditions stipulated are completed

Signature of authorised Cook Islands Surveyor Date      

Name of Surveyor      

Page 2 of 2