Page 409 - International safety guide for oil tankers and terminals

SAFETY MANAGEMENT

DECLARATION

We, the undersigned, have checked the above items in Parts A and B, and where appropriate
Part C or D, in accordance with the instructions, and have satisfied ourselves that the entries we
have made are correct to the best of our knowledge.
งานห้องสมุด ศูนย์ฝกพาณิชย์นาวี
We have also made arrangements to carry out repetitive checks as necessary and agreed that
those items with code ‘R’ in the Check-List should be re-checked at intervals not exceeding
_____ hours.

If to our knowledge the status of any item changes, we will immediately inform the other party.

For Ship For Shore

Name
Name Date:่อการศึกษาเท่านั้น---
Rank Position or Title

Signature Signature

Date Date
ึ
Time Time

Record of repetitive checks:
---ใช้เพื

Time:

Initials for Ship:

Initials for Shore:

© ICS/OCIMF/IAPH 2006 375