Questionnaire for the Inspection Campaign

2023-1 CIC Form

Vessel Name:
IMO Number:
Port:
Date:

Number Questions Yes No

Minimum Safe Manning Certificate
For a vessel with 10 or more crew: does the vessel have the
following notation on its MSMC?

Ships with a manning of 10 or more crew shall be provided with a

ship’s cook trained and certified in accordance with STCW
1
Regulation VI/I and Regulation 3.2 of MLC, 2016

If no, please record a recommendation with the following text:

Vessel is required to apply for amended MSMC that includes a
provision for a ship’s cook no later than 31 December 2023.

Ballast Water Management Certificate

Does the vessel have a D-2 compliant Ballast Water Management
Certificate? Please record a prior to departure deficiency if the
vessel does not.
2
If the vessel has an extension for the installation of the ballast
water treatment or has not reached its required implementation
date, do not record any findings.

3 Maritime Labor Convention

3a Do all seafarers have valid SEAs?
Are Rest hours correct and satisfactory according to the Logs?
Please check records for the last month for at least 3 seafarers:
one Deck or Engineering officer and 2 ratings.
3b
Note: Drills on board are considered working hours. It is a
deficiency if rest hours are being logged for a crewmember that
participated in a drill at the same time.

3c Have proper stores and provisions been provided for the voyage?
4 Planned Maintenance
Have the vent for the ballast and other tanks been maintained after
4a
survey?
 Have the Safety Management System procedures for enclosed space
4b
entry permits been properly used onboard?
Dispensations
Is the vessel meeting all the conditions/requirements of any valid
dispensation onboard?
5
If the vessel is not following requirements of the dispensation, then
record as a deficiency.

Inspector Name: ______________________ Inspector Signature: ________________________

Please provide a copy of this check list with your Inspection report to the Administration.

Please record any non-compliant issue discovered from this CIC as a deficiency on the
Inspection form RLM-252 with the exception of item 1.