Document No D-04

PT. HABCO TRANS MARITIMA Tbk Issued Date 01-01-2023

DECK FORM & CHECKLIST Issued Status 1
Revision 0

BALLAST TANK INSPECTION REPORT

Vessel’s Name: Date: Tank ID:

Reason for inspection: Routine Maintenance or Inspection by 3rd Party Survey (Class, P&I, Suspected Damage
ship’s staff PSC, etc.)
Any outstanding recommendations / deficiencies or Class Conditions:

CHECK POINTS RESULT REMARKS DATE WORK DONE

1. INTERNAL STRUCTURE
 Condition of the following items for corrosion wastage
Bulkheads, platings, web frames of longitudinals on
top, at side and on sloping plate, brackets, stiffeners,
etc.
 Check condition of coating entirely
2. LADDERS
 Integrity of ladders, local cracks, deformation wastage
of steps.
3. AIR VENT PIPING
 Condition of piping for corrosion, wastage, leakages.
4. SOUNDING PIPES
 Condition of piping for corrosion, wastage, leakages.
5. VALVES & REACH RODS
 Check operation of valves.
 Condition of reach rods with universal/joints and
supporting.
6. PIPING ARRANGEMENTS
 Condition of pipes for corrosion, wastage, leakages.
 Check condition of bell mouths.
 Check pipe supports & “U” bolts.
7. SAFETY DEVICE
 Inspection for wire mesh
 Closing device of vent head
 C/W rubber gasket
1. RESULT: Give assessment of condition of the specific section/area in the following 3 categories.
2. REMARK: Specify any additional explanatory comments related to the mentioned item (if Grade is Poor)
Notes:

3. WORK DONE: Specify work carried out on the items mentioned.

4. Complete an ENCLOSED SPACE ENTRY CHECKLIST as may be necessary and keep in file.
RESULT: This column shall indicate an assessment of condition REMARK: Reference for any WORK DONE: This column is to be used for
as follows: comments. recording work carried out using the following
GOOD = Condition only with minor problems codes:
FAIR = Condition with local problems or general condition worst DATE: Use format 01 INSPECTED BY CLASS SURVEYOR
than good but better than poor. MONTH/YEAR, eg. 01/06 for 02 PARTLY RENEWED (GIVE DETAILS)
POOR = Condition with major problems in specific areas or work done. 03 RENEWED
general condition below acceptable levels. 04 CLEANED/GREASED
05 DESCALED
GENERAL REMARKS

Name of person inspected tank: Chief Officer: Master:

D-04 Ballast Tank Inspection Report Revision No. 1 Page 1 of 2

 Document No D-04
PT. HABCO TRANS MARITIMA Tbk Issued Date 01-01-2023
DECK FORM & CHECKLIST Issued Status 1
Revision 0

D-04 Ballast Tank Inspection Report Revision No. 1 Page 2 of 2