VDR and SVDR PRE-SURVEY FORM

VESSEL DETAILS
Vessel Name JAG SPARROW
IMO Number 9297412
Hull Number HHI 1612
Vessel Flag LIBERIA
Vessel Class Society LLOYDS

VDR / SVDR DETAILS

VDR/SVDR Manufacturer JRC
VDR/SVDR Model JCY-1700
VDR/SVDR Serial Number MB41196
VDR/SVDR Software Version
VDR/SVDR Date of Installation
Capsule type Fixe d Ca ps ule Floa t Fre e Ca ps ule

Manufacturer / Model of Capsule (FRM/HSM) JRC / HVR03-004-02

Serial Number of Capsule (FRM/HSM) 000716147

VDR / SVDR CONDITION

Indicate any present or recent alarms displayed
by the VDR/SVDR
Note any change of the bridge navigational NEGATIVE
equipment since the last survey ie… GPS, Gyro…
Expiration date of the VDR/SVDR internal back APRIL 2025
up batteries
Expiration date of the acoustic beacon OCT 2023
Expiration date of the Float Free Capsule battery
Expiration date of the Float Free Capsule HRU

REPORT OF ANY DEFICIENCIES

CONTACT DETAILS
Provide a postal address where the Certificate of
Compliance can be sent if the APT is successful.

Important Notes:
1) Please make sure all navigational equipment is switched on 12 hours (old VDR/SVDR) / 48
hours (new VDR/SVDR) prior to the scheduled time for the APT.
Rev 01 - Jan 2018
 VDR and SVDR PRE-SURVEY FORM
2) Please forward last APT test report with this completed VDR pre-survey form.

Rev 01 - Jan 2018