Doc. no.

FORM_OF-SCTOF-HR-PAI-005-E
FORM
E&C Offshore Rev. 01 Date 11/03/2019

Page 1 of 3
MLC 2006 ONBOARD COMPLAINT REPORT
Ref. Doc. STD-COR-HR-039-E
Complaint Reference: Vessel Code – YY – NN (To be filled by the Onboard Seafarer Representative)

Vessel Name: Vessel Location:

Complaint Ref. Seafarer Accompanied
Person (if any)
Seafarer Name: Seafarer Representative (DECK/ENGINE)
Name:
Seafarer Position: Issue Date: DD-MMM-YYYY
Seafarer Complaint Occurrence
Nationality: Date/Duration
Seafarer Company Details:
Representative
Name:
Master Name: DPA Details:

SRPSP: Human Resources

Manager Contact Details: Email :
Tel. : +
Mob. : +
Fax : +
Section (A) : Complaint Description Attachments:

Seafarer Name Date Complaint Introduced to: Signature

DD-MMM-YYYY Seafarer Representative. Seafarer Signature
Name
Section (B) : Attempt (1) Resolution Actions
“Actions have been taken with consultation of the Seafarer Representative/Department head”
Resolution Actions Seafarer Remarks
Acceptance
 

 

 

 

 

This document is the property of Saipem SpA. All rights reserved.

 Doc. no. FORM_OF-SCTOF-HR-PAI-005-E
FORM
E&C Offshore Rev. 01 Date 11/03/2019

Page 2 of 3
MLC 2006 ONBOARD COMPLAINT REPORT
Ref. Doc. STD-COR-HR-039-E
Complaint Reference: Vessel Code – YY – NN (To be filled by the Onboard Seafarer Representative)

Close out Description: Attachments:

Accepted By: Closed By:

Name Seafarer Seafarer Representative
Date Date of Acceptance/refusal Date of Close Out
Signature Seafarer Seafarer Representative
Section (C) : Attempt (2) Resolution Actions
“Actions have been taken by the master as a second attempt to solve the complaint”

Resolution Actions Seafarer Remarks

Acceptance
 

 

 

 

 

Close out Description: Attachments:

Accepted By: Closed By:

Name Seafarer Master
Date Date of Acceptance/refusal Date of Close Out
Signature Seafarer Master
Section (D) : Attempt (3) Resolution Actions
“Actions have been taken by the company as attempt (3) to solve the complaint”
Resolution Actions Seafarer Remarks
Acceptance
 

 

 

 

 

This document is the property of Saipem SpA. All rights reserved.

 Doc. no. FORM_OF-SCTOF-HR-PAI-005-E
FORM
E&C Offshore Rev. 01 Date 11/03/2019

Page 3 of 3
MLC 2006 ONBOARD COMPLAINT REPORT
Ref. Doc. STD-COR-HR-039-E
Complaint Reference: Vessel Code – YY – NN (To be filled by the Onboard Seafarer Representative)

Close out Description: Attachments:

Accepted By: Closed By:

Name Seafarer Company Representative
Date Date of Acceptance/refusal Date of Close Out
Signature Seafarer Company Representative Signature
Section (E) : Attempt (4) Resolution Actions
“Actions have been taken by External Entity as attempt (4) to solve the complaint”

Resolution Actions Seafarer Remarks

Acceptance
 

 

 

 

 

Close out Description: Attachments:

Accepted By: Closed By:

Name Seafarer External Entity Name
Date Date of Acceptance/refusal Date of Close Out
Signature Seafarer External Entity Signature

This document is the property of Saipem SpA. All rights reserved.