1、船/岸安全檢查表SHIP/SHORESAFETYCHECKLISTShipsName船名Berth泊位DateofArrival抵達日期Port港口TimeofArrival抵達時間填表須知INSTRUCTIONSFORCOMPLETION:為保證安全作業，下列所有問題的答復均是肯定的，可在相應的方格內清楚地打上（）標號。如果 不能給予肯定回答，應說明理由，而且船舶和碼頭之間均達成關于應采取的適當預防措施的協議。如果認為有的問題不適用，應在備注欄里加以說明。Thesafetyofoperationsrequiresthatallquestionsshouldbeansweredaffirmat

2、ivelybyclearlyt icking(V)intheappropriatebox.Ifanaffirmativeanswerisnotavailable,thereasonshouldbeg ivenandagreementreacheduponappropriateprecautionstobetakenbetweentheshipandthetermin al.Whereanyquestionisconsideredtobenotapplicable,thenanotetothateffectshouldbeinsert edintheremarkscolumn.“船舶”和“碼頭”

3、欄目下的方格，表示由負責方實施檢查。Aboxinthecolumnshipandterminalindicatesthatthepartyconcernedshouldcarryoutch ecks.在“代碼”欄目里的A，P或R字母，分別表示如下的意義:ThepresenceofthelettersA, PorRinthecolumnCodeindicatesthefollowing:A-(協議)表示該檢查項應通過協議或程序來處理，并在檢查表中的“備注”欄中明確或者通過 其它一些雙方可接受的表格來交流這些協議和程序。A - (Agreement).Thisindicatesthattheref

4、erencedconsiderationshouldbeaddressedbyanagreemen torprocedurethatshouldbeidentifiedintheRemarkscolumnoftheCheckList,orcommunicatedinsome othermutuallyacceptableform.P(批準)在否定回答的情況下，未經主管當局的書面許可，不可進行作業。P -(Permission).InthecaseofanegativeanswertothestatementscodedP,nooperationsaretobeconductedwithoutt

5、hewrittenpermissionfromtheappropriateauthority R（復查）表示在不超出聲明同意的時間間隔須重復檢查的項目。R - (Re-check).Thisindicatesitemstobere-checkedatappropriateintervals,asagreedbetweenbothpartiesandsta tedinthedeclaration.僅在所有方檢查和接受他們分配的職責和責任后方可簽署共同聲明Thejointdeclarationshouldnotbesigneduntilallpartieshavecheckedandaccepte

6、dtheirassignedresponsibilitiesandaccountabilities.PARTA- BULKLIQUIDGENERAL-PHYSICALCHECKSA部分一散裝普通液貨一現場核實BulkLiquid - General 散裝液體一普通Ship 船舶Terminal碼頭Code代碼Remarks 備注1. Thereissafeaccessbetweentheshipandsho re.船岸之間有安全通道.R2. Theshipissecurelymoored.船舶已安全系泊.R3. Theagreedship/shorecommunicationsyste mis

7、operative.商定的船/岸通信系統可用.ARSystem系統Backupsystem備用系統.4. Emergencytowing-offpennantsarecorrectlyriggedandpositioned.應急拖纜已帶好并處于正確位置.R5. Theshipsfirehosesandfire-fightingequipmentarepositionedandreadyforimmedi ateuse.船方消防水帶和消防設備配置在位并立即可R用.6. Theterminalsfire-fightingequipmentispositionedandreadyforimmedia

8、teuse.岸方消防設備配置在位并立即可用.R7. Theshipscargoandbunkerhoses,pipelinesandmanifoldsareingoodcondition,properlyriggedandappropriatefortheservice intended.船方的貨物、燃油軟管,管線和集管處于良好 狀態，適當固定并適用于預計的貨物作業.8. Theterminalscargoandbunkerhoses/armsareingoodcondition,properlyriggedandappropriatefortheserviceintended.岸方的貨物、燃

9、油軟管/裝卸臂處于良好狀 態，適當固定并適用于預計的貨物作業.9. Thecargotransfersystemissufficientlyisolatedanddrainedtoallowsaferemovalofblankflangespriortoconnection.接管前，貨物轉移系統有效隔離并放殘以能 夠安全地拆除盲板.10. Scuppersandsaveallsonboardareeffectivelypluggedanddriptraysareinpositi onandempty.R船上的排水孔和積油槽有效塞堵，空的集液盤放置到位。BulkLiquid - General

10、散裝液體一普通Ship 船舶Terminal碼頭Code代碼Remarks 備注ll.Temporarilyremovedscupperplugswillbeconstantlymonitored.臨時移開流水孔塞需保持監控。R12.Shorespillcontainmentandsumpsarecorrectlymanaged.岸方的溢油圍堰和積油槽正確管理R13. Theshipsunusedcargoandbunkerconnectionsareproperlysecuredwithblankflange sfullybolted.船方不用的貨物、燃油管接頭已裝妥盲板并 上緊全部螺栓.1

11、4. Theterminalsunusedcargoandbunkerconnectionsareproperlysecuredwithblankfl angesfullybolted.岸方不用的貨物、燃油管接頭已裝妥盲板并 上緊全部螺栓.15.Allcargo,ballastandbunkertanklidsarec losed.所有貨艙、壓載艙和燃油艙艙蓋都保持關 閉。16.Seaandoverboarddischargevalves,whennotinuse,areclosedandvisiblysecured.海底閥和舷外排出閥在不使用時已關閉和確實關妥.17.Allexternald

12、oors,portsandwindowsinthea ccommodation,storesandmachineryspacesa reclosed.Engineroomventsmaybeopen.居住艙室、儲物間和機器處所的所有外部門，開 口和窗戶已關閉.機艙的通風可以打開.R18. Theshipsemergencyfirecontrolplansarelocatedexternally.船舶緊急消防控制圖放置在外部.Location 位置Iftheshipisfitted,orisrequiredtobefitted,withanInertGasSystem(IGS)thefollow

13、ingpointsshouldbephysicallychecked:如船舶安裝有，或要求安裝惰氣系統GS),下列各條應進行現場核查：InertGasSystem惰氣系統Ship 船舶Terminal碼頭Code代碼Remarks 備注19.FixedIGSpressureandoxygencontentrecordersareworking.固定式的惰氣系統壓力和氧含量記錄器正常工作R20.Allcargotankatmospheresareatpositivepressurewithoxygencontentof8%orlessbyv olume.所有貨艙均為正壓，氧氣含量8%(體積)n

14、A nF 6 二 7TT TT T7T T CT T T TAL TT7T A T IA T IT T ZPRPARTB-BULKLIQUIDGENERAL-VERBALVERIFICATIONB部分一散裝普通液貨一口頭確認BulkLiquid - General 散裝液體一普通Ship 船舶Terminal碼頭Code代碼Remarks 備注21.Theshipisreadytomoveunderitsownpower.船舶能夠隨時靠自航移位.PR22.Thereisaneffectivedeckwatchinattendanceonboardandadequatesupervisionof

15、oper ationsontheshipandintheterminal.船上安排了有效的甲板值班，碼頭和船上有足 夠的監督人員.R23.Therearesufficientpersonnelonboardandashoretodealwithanemergency.船上和岸上有足夠人員應付緊急情況.R24.Theproceduresforcargo,bunkerandballasthandlinghavebeenagreed貨物、燃油和壓載的裝卸程序已議定.AR25.Theemergencysignalandshutdownproceduretobeusedbytheshipandshore

16、havebeenexplainedandunderstood解釋并理解船岸之間使用的應急信號和應急關閉程序A26.MaterialSafetyDataSheets(MSDS)forthecargotransferhavebeenexchangedwherereq uested.PR作業貨物的物質安全數據單已按要求進行交換27.Thehazardsassociatedwithtoxicsubstancesinthecargobeinghandledhavebeenident ifiedandunderstood.作業貨物中所含有毒物質的相關危害已辨 識并清楚。HSContent2 硫化氫含量：B

17、enzeneContent本含量：.28.AnInternationalShoreFireConnectionhasbeenprovided.已提供國際通岸接頭29.Theagreedtankventingsystemwillbeused.將使用協議的貨艙透氣系統ARMethod方 法BulkLiquid - General 散裝液體一普通Ship 船舶Terminal碼頭Code代碼Remarks 備注30.Therequirementsforclosedoperationshavebeenagreed.封閉作業要求已達成協議R31.TheoperationoftheP/Vsystemhas

18、beenverified.壓力/真空系統的操作已核驗32.Whereavapourreturnlineisconnected,operatingparametershavebeenagreed.如果接氣相回流管，操作參數已達成協議AR33.Independenthighlevelalarms,iffitted,areoperationalandhavebeentested.如果安裝了獨立的高液位報警，應處于工作狀態并經測試AR34.Adequateelectricalinsulatingmeansareinplaceintheship/shoreconnection.船/岸接管處有足夠的電氣絕

19、緣方式AR35.Shorelinesarefittedwithanon-returnvalveorprocedurestoavoidbackfillinghavebeendiscussed.岸線裝有止回閥，或已討論如何避免“倒灌”的程序PR36.Smokingroomshavebeenidentifiedandsmokingrequirementsarebeingobserved.指定吸煙室，遵守吸煙規則.ARNominatedsmokingrooms指定的吸煙室：37.Nakedlightregulationsarebeingobserved .遵守明火規則AR38.Ship/shorete

20、lephones,mobilephonesandpagerrequirementsarebeingobserved.遵守船/岸電話、手機和傳呼機使用規則AR39.Handtorches(flashlights)areofanapprovedtype.手電筒（閃光燈）為認可型40.FixedVHF/UHFtransceiversandAISequipmentareonthecorrectpowermodeorswitchedo ff.固定式高頻/甚高頻電話和自動識別系統設 備處于正確的發射功率模式或關閉.41.PortableVHF/UHFtransceiversareofanapp roved

21、type.便攜式高頻/甚高頻無線電收發機為認可 型.BulkLiquid - General 散裝液體一普通Ship 船舶Terminal碼頭Code代碼Remarks 備注42. Theshipsmainradiotransmitteraerials areearthedandradarsareswitchedoff.船舶主無線電發射天線接地，雷達處關閉狀 態43.Electriccablestoportableelectricalequipmentwithinthehazardousareaaredisconnectedfrompower.在危險區域內便攜式電氣設備的電纜斷開電源44.Wi

22、ndowtypeairconditioningunitsaredisconnected.窗式空調電源斷開45.Positivepressureisbeingmaintainedinsidetheaccommodation,andairconditioningintakes,whichmaypermittheentryofcargovapours,areclosed居住艙室內保持正壓，可能吸入貨物蒸汽的空調吸入口應關閉46.Measureshavebeentakentoensuresufficientmechanicalventilationinthepumproom.已采取措施保證泵房足夠的機

23、械通風R47.Thereisprovisionforanemergencyescape.預留有應急逃生通道.48.Themaximumwindandswellcriteriaforoperationshavebeenagreed.作業的最大風力和涌浪標準已經達成協議AStopcargoat:停止作業Disconnectat:拆管Unberthat:離泊49.SecurityprotocolshavebeenagreedbetweentheShipSecurityOfficerandthePortFacilitySecurityOfficer,ifappropriate.如果 適用，船舶保安員和

24、港口設施保安員達成保安協議。A50.Whereappropriate,procedureshavebeenagreedforreceivingnitrogensuppliedfromshore,eitherforinertingorpurgingshipstanks,orforlineclearingintotheship.AP如果需要從岸方接收氮氣用于惰化船艙、驅氣或吹掃管線，就相關程序已達成協議Iftheshipisfitted,orisrequiredtobefitted,withanInertGasSystem(IGS)thefollowingstatementssh ouldbead

25、dressed.如果船舶安裝了，或被要求安裝惰氣系統IGS),下列各條應進行實際檢查:InertGasSystem惰氣系統Ship船舶Terminal碼頭Code代碼Remarks 備注51.TheIGSisfullyoperationalandingoodwork ingorder.惰氣系統可完整運行并處于良好工作狀態P52.Deckseals,orequivalent,areingoodworkingorder.甲板水封或類似裝置處于良好工作狀態R53.Liquidlevelsinpressure/vacuumbreakersarecorrect.壓力/真空破斷器的液位正常R54.Thef

26、ixedandportableoxygenanalysershavebeencalibratedandareworkingproperly.固定式和便攜式的氧氣分析儀已校準并且能夠正常 工作.R55.AlltheindividualtankIGSvalves(iffitted)arecorrectlysetandlocked.各艙的惰氣系統閥門(如果已安裝)正確設置并上鎖.R56.AllpersonnelinchargeofcargooperationsareawarethatinthecaseoffailureoftheInertGasPlant,dischargeoperationssho

27、uldcease,andtheterminalbeadvised.所有負責貨物作業的人員意識到，在惰氣發 生裝置故障的情況下，卸貨作業應停止并通 知碼頭.IftheshipisfittedwithaCrudeOilWashing(COW)system,andintendstocrudeoilwashing,thefollowings tatementsshouldbeaddressed.如果船舶安裝原油洗艙系統,需進行原油洗艙作業，應完成下列內容CrudeOilWashing 原油洗艙Ship 船舶Terminal碼頭Code代碼Remarks 備注57.ThePre-ArrivalCOWch

28、ecklist,ascontainedintheapprovedCOWmanual,hasbeensatisf actorilycompleted.包含在認可的原油洗艙手冊中的抵港前檢 查清單，已經按要求填寫完整.58.TheCOWchecklistsforusebefore,duringandafterCOW,ascontainedintheapprovedCOWmanual,areavailableandbeingused.包含在在認可的原油洗艙手冊中，用于原油洗艙作業前，過程中和之后的檢查清單，準 備就緒并在使用.RIftheshipisplanningtotankcleanalongs

29、ide,thefollowingstatementsshouldbeaddressed.如果船舶計劃在靠泊期間清艙，應完成以下內容TankCleaning 清艙Ship船舶Terminal碼頭Code代碼Remarks 備注59.Tankcleaningoperationsareplannedduringtheshipsstayalongsidetheshoreinsta llation.Yes/No*Yes/No*船舶靠岸期間計劃進行清艙作業60. Ifyestheproceduresandapprovalsfortankcleaninghavebeenagreed.如“是”，清艙的程序和批

30、準已達成協議61.Permissionhasbeengrantedforgasfreeingoperations.已獲得除氣作業的許可證Yes/No*Yes/No*DeleteYesorNoasappropriat根據適用情況刪去是”或否PARTC-BULKLIQUIDCHEMICALS-VERBALVERIFICATIONC部分一散裝液體化工品一口頭確認BulkLiquid - Chemicals 散裝液體一化工品Ship 船舶Terminal碼頭Code代碼Remarks 備注1. MaterialSafetyDataSheetsareavailablegivingthenecessary

31、dataforthesafehandlingofthecargo.提供了材料安全數據表,并給出了貨物安全操作必要的 資料2. Amanufacturersinhibitioncertificate,whereapplicable,hasbeenprovided.如果適用，已經提供了制造商的抑制劑證書P3. Sufficientprotectiveclothingandequipment(includingself-containedbreathingapparatus)isreadyforimmediateuseandissuitabl efortheproductbeinghandled.足

32、夠的防護服和設備(包括自給式呼吸器)已 經準備就緒，隨時可用，并適合所操作的貨品4. Countermeasuresagainstaccidentalpersonalcontactwiththecargohavebeenagreed.防止人員意外接觸貨品的應對措施已經同意.5. Thecargohandlingrateiscompatiblewiththeautomaticshutdownsystem,ifinuse.如果使用自動關閉系統，貨物作業速率應與其相匹配.A6. Cargosystemgaugesandalarmsarecorrectlysetandingoodorder.貨物系統儀

33、表和警報正確設置并處于良好的工作狀況7. Portablevapourdetectioninstrumentsarereadilyavailablefortheproductsbeinghandled.適合所作業貨品的便攜式氣體探測儀器備妥8. Informationonfire-fightingmediaandprocedureshasbeenexchanged.消防器材和程序的信息已經被交換過.9. Transferhosesareofsuitablematerial,resistanttotheactionoftheproductsbeinghandl ed.移貨軟管的材料合適，與作業的

34、貨品不發生反 應。10.Cargohandlingisbeingperformedwiththepermanentinstalledpipelinesystem.貨物作業使用永久安裝的管線系統.P11. Whereappropriate,procedureshavebeenagreedforrec eivingnitrogensuppliedfromshore,eitherforinerti ngorpurgingship stanks,orforlineclearingintoth eship.如需從岸方接收氮氣用于惰化船艙、驅氣或吹掃管線，就相關程序已達成協議A PPARTD-BULKLI

35、QUEFIEDGASES-VERBALVERIFICATIOND部分一散裝液化氣一口頭確認BulkLiquefiedGases散裝液化氣Ship 船舶Terminal碼頭Code代碼Remarks 備注1. MaterialSafetyDataSheetsareavailablegivingthenecessarydataforthesafehandli ngofthecargo.提供了材料安全數據表,并給出了貨物安全操作必要的資料2. Amanufacturersinhibitioncertificate,whereapplicable,hasbeenprovided.如果適用，提供了制造商

36、的抑制劑證書P3. Thewaterspraysystemisreadyforimmediat euse.水噴淋系統處于隨時可用狀態4. Thereissufficientprotectiveequipment(includingself-containedbreathingapparatus)andprotectiveclothingreadyforimmedi ateuse.充分的保護設備(包括自給式呼吸器)和防 護服已經準備就緒，隨時可用.5. Holdandinter-barrierspacesareproperlyinertedorfilledwithdryair,asrequire

37、d.大艙和內屏障之間的空間按要求充惰氣或干燥空氣6. Allremotecontrolvalvesareinworkingord er.所有遙控閥門工作狀態良好.7. Therequiredcargopumpsandcompressorsareingoodorder,andthemaximumworkingpressureshavebeenagreedbetweenshipandshor e.貨泵和壓縮機處于良好工作狀態，船方和岸 方已商定最大工作壓力.A8. Re-liquefactionorboiloffcontrolequipmentisingoodorder.再液化或蒸發控制設備處于良

38、好狀態9. Thegasdetectionequipmenthasbeenproperlysetforthecargo,iscalibrated,hasbeentestedandinspectedandisingoodorder.氣體探測設備根據貨品進行了適當的設置、校正、測試和檢查并處于良好的狀況10.Cargosystemgaugesandalarmsarecorrectlysetandingoodorder.貨物系統儀表和警報正確設置并處于良好的工作狀況11.Emergencyshutdownsystemshavebeentestedandareworkingproperly.應急切斷系統已經測試，工作正常.12.ShipandshorehaveinformedeachotheroftheclosingrateofESDvalves,automaticvalvAShipesorsimilardevices.船岸雙方相互告知了應急關閉裝置閥門、自動閥門或類似裝置的關閉速率Shore.13.Informationhasbeenexchangedbetweenshipandshoreonthemaximum/minimumtemperatures/pressuresofthecargotobehandled.船岸雙方交換了作業貨