LF D 004a Laporan Inspeksi Kapal Vessel Inspection Report 2nd

Form Code LF – D 004 A
VESSEL INSPECTION REPORT Revision 01/2012

Laporan Inspeksi Kapal
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VESSEL INSPECTION REPORT – LAPORAN INSPEKSI KAPAL

VESSEL - KAPAL:TB. SADP XXX DATE – TANGGAL: 14 Juli 2015
Table 1. Certificates & Documentation
Tabel 1. Sertifikat & Dokumentasi
No. Item Check points N Remarks
Titik Pemeriksaan Keterangan
1. Certificates Are all certificates on board? 2
Sertifikat Apakah semua sertifikat di atas kapal?
Are all statutory certificates including Station & Harbour Craft
License displayed?
Apakah semua sertifikat yang menurut hukum termasuk
Lisensi Kapal Stasiun & Pelabuhan ditampilkan?
2. Trim & Stability Booklet Are approved copies on board? 2 Trim dan Damage stability booklet – NA
Buku Trim & Stabilitas Apakah salinan yang disetujui ada di atas kapal?
Damage Stability Booklet
Buku Stabilitas
Kerusakan
Tank Calibration Tables
Tabel Kalibrasi Tangki
SOPEP
3. Class Reports & Records Available on board and up-dated? NA
Laporan & Catatan Kelas Tersedia di atas kapal dan terkini?
4. LSA, FFA, Equipment Life rafts, Extinguishers, CO2/Halon, Foam Analysis, Hoses, 2 Foam analysis tidak terinstall di kapal
Certs. Oxygen & Gas Meters
Sertifikat Peralatan LSA, Rakit Penolong, Pemadam, CO2/Halon, Analisis Busa, Selang,
FFA Oksigen & Meteran Gas
LF – D 004 A/ Dec 2012 Written By : SK Approved By : VP / DPA Retention period: 1 year


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5. SMS, DOC, Policy Available on board and displayed? 2

SMS, DOC, Kebijakan Tersedia di atas kapal dan ditampilkan?
6. Circulars Shipping & Company Circulars filed and up-to-date? 2
Surat Edaran Surat Edaran Pelayaran & Perusahaan disimpan dan terkini?
7. Publications Publications as per Library list on board and latest? 2
Publikasi Publikasi sesuai daftar Perpustakaan di atas kapal dan
terbaru?
8. Crew List Latest Crew List on board? 1
Daftar Awak Kapal Daftar Awak Kapal Terbaru di atas kapal?
9. Officers & Crew’s Originals or copies on board? 1
Documents/Certificates Asli atau salinan di atas kapal?
Dokumen/Sertifikat
Perwira & Awak Kapal
10. Safety Management Are all Procedures complied with and records kept and up- 1
Records dated?
Arsip Manajemen Apakah semua Prosedur dipatuhi dan catatan disimpan dan
Keselamatan diperbaharui?
Note - Catatan:
1) Notations N: 1 = Good 2 = Satisfactory 3 = Poor (If poor = 3 is reported, please remark).
1) Notasi N: 1 = Baik 2 = Memuaskan 3 = Buruk (Jika buruk = 3 dilaporkan, silahkan beri keterangan).
2) If items not found on board or not fitted, insert NA
2) Jika item tidak ditemukan di atas kapal atau tidak terpasang, masukkan NA


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Table 2. Loadline Requirements
Tabel 2. Persyaratan Garis Muat
1. Hull Is the Hull free of any damage? 2

Lambung kapal Apakah Lambung Kapal bebas dari kerusakan?
2. Scuppers/Freeing Ports Are the drainage free from obstructions? 2
Pipa drainase/Lubang Apakah drainase bebas dari penghalang?
untuk mengosongkan
3. Draft & Loadline Marks Well painted and visible. 1
Draf & Tanda Garis Muat Dicat dengan baik dan terlihat.
4. Ventilators The condition to be checked, e.g. corrosion, wastage. 2
Ventilator Kondisi yang akan diperiksa, misalnya korosi, limbah.
Are closing appliances operating satisfactorily?
Apakah peralatan untuk menutup beroperasi secara memuaskan?
Are spark arrestors clean and free from foreign materials?
Apakah penahan percikan bersih dan bebas dari benda asing?
5. Air Pipes The condition to be checked, e.g. corrosion, wastage. 2
Pipa Udara Kondisi yang akan diperiksa, misalnya korosi, limbah.
The air pipe heads, wire nets, operation of closing floats to be checked.
Kepala pipa udara, jaring kawat, operasi dari pelampung penutup
diperiksa.
6. Cargo Tank Lids, Sighting The condition to be checked, e.g. corrosion, wastage. NA
/ Ullage/Sample Ports Kondisi yang akan diperiksa, misalnya korosi, limbah.


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and Sounding Pipes The water tightness including packing, hinge handles and closing
Penutup Tangki Muatan, appliances to be checked.
Lubang Intip / ”Ullage” / Kekedapan air termasuk paking, pegangan engsel dan peralatan
Sampel dan Pipa penutupan untuk diperiksa.
Pengukuran Are spark arrestors sufficient and in position, clean and free from foreign
materials?
Apakah penahan percikan cukup dan dalam posisi, bersih dan bebas dari
benda asing?
Are sounding pipes marked with reference heights and are the reference
heights clearly visible?
Apakah pipa pengukuran ditandai dengan ketinggian referensi dan apakah
ketinggian referensi jelas terlihat?
7. Watertight Doors, Hatch The condition to be checked, e.g. corrosion, wastage. 2
Entrance , Chain Lockers, Kondisi yang akan diperiksa, misalnya korosi, limbah.
Tank Top Lids, Skylights, The water tightness including packing, hinge handles and closing
Portholes, Deadlights, appliances to be checked.
Windows, etc. Kekedapan air termasuk paking, pegangan engsel dan peralatan
Pintu Kedap Air, Pintu penutupan untuk diperiksa.
Masuk ke Palka, Loker
Rantai, Tutup Tangki,
Kaca Atap, Lubang Intip,
Kaca Atap Yang Tidak
Boleh Dibuka, Jendela,
dll
8. Catwalks, Hand Rails and The condition to be checked, e.g. corrosion, wastage, missing, damages. 2
Bulwarks Kondisi yang akan diperiksa, misalnya korosi, limbah, hilang, rusak.
Titian, Rel Tangan dan

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Benteng
Note - Catatan:


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Table 3. Navigational Equipment
Tabel 3. Peralatan Navigasional
1. Magnetic Compass - The operating conditions to be checked, bubbles, compass 3 - Standard compass - NA
Standard and Steering illumination, date of last calibration and error observations. - steering compass – NA
Kompas Magnetik – Kondisi operasi diperiksa, gelembung, pencahayaan kompas,
Standar dan Kemudi tanggal kalibrasi terakhir dan pengamatan kesalahan.
2. Gyro Compass, Radars , The operating and performance condition to be checked. 3 Gyro compass, Repeater, Azimuth circle – NA
Repeaters and Azimuth Errors, synchronization of repeaters, & date of last calibration.
circles Kondisi operasi dan kinerja diperiksa. Kesalahan, sinkronisasi
Kompas Gyro, Radar, repeater, & tanggal kalibrasi terakhir.
Repeater dan lingkaran
Azimuth
3. GPS, SatNav, The operating condition to be checked. 1 Install Ctrack
Kondisi operasi diperiksa.
4. Sextants, Nautical Tables To be available on board. 3 Sextants, Nautical table - NA
and Almanac Tersedia di kapal.
“Sextants”, Tabel Nautika
dan Almanak
5. Speed and Distance Log The operating condition to be checked. NA
Catatan Kecepatan dan Kondisi operasi diperiksa.
Jarak


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6. Echo Sounder The operating condition to be checked including illumination. 2

Penduga gema Kondisi operasi diperiksa termasuk pencahayaan.
7. Bridge Control & Engine The operating condition to be checked including illumination. NA
Telegraph Kondisi operasi diperiksa termasuk pencahayaan.
Kontrol Anjungan &
Telegrap Mesin
8. Propeller Revolution and The operating condition to be checked including illumination. 2
Rudder Angle Indicators. Kondisi operasi diperiksa termasuk pencahayaan.
Revolusi Baling-Baling
dan Indikator Sudut
Kemudi.
9. Heading information in To be available in the steering gear room. 2
Steering Gear Room Tersedia di kamar perangkat kemudi.
Informasi arah di dalam
Kamar Perangkat Kemudi
10. Navigation Lights and The operating including alarm and display panel condition to be 2 Kurang lengkap isyarat-isyarat benda
Day and Night Signals checked. Availability of day signals on board including flags
Lampu Navigasi dan and shapes.
Sinyal Siang dan Malam Operasi termasuk kondisi alarm dan panel pertunjukan
diperiksa. Ketersediaan sinyal siang hari di kapal termasuk
beragam bendera dan bentuk.
11. Nautical Charts and Are Charts and Nautical Publications for the trading area 2 - Last BPI Ed 21/2015
Publications available, up-to-date and corrected? Latest NTM on board.
Peta Bahari dan Publikasi Apakah Peta dan Publikasi Bahari untuk daerah perdagangan
tersedia, terkini dan dikoreksi? BPI terbaru di atas kapal.
12. Bridge Panel & Console Are all well illuminated during operation & Dimmers working? 2


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Panel & Konsol Anjungan Apakah semua diterangi dengan baik selama operasi & Lampu
Dim berfungsi?
Note - Catatan:


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Table 4. General Safety
Tabel 4. Keselamatan Umum
1. FFA and LSA Plans Up-to-date plans to be available. 2
Rencana FFA dan LSA Rencana terkini tersedia.
Fire Control Plans to be available, one each outside near
entrance door of accommodation on both port & stbd side.
Rencana Pengendalian Kebakaran tersedia, masing-masing di
luar dekat pintu masuk akomodasi di kedua sisi kiri & kanan.
2. Muster List - Fire, Boat Oil Up-to-date list to be available. 2
and Emergency Stations Daftar terkini tersedia.
Daftar Kumpul - Api, To be exhibited in accommodation spaces, W/H and E/R.
Minyak Kapal dan Untuk diperlihatkan di ruang akomodasi, W/H dan E/R.
Stasiun Darurat
3. Training Manual To be available on board. NA
Manual Pelatihan Tersedia di atas kapal.
4. LSA Instructions and To be available on board. 2
Maintenance Checklist Tersedia di atas kapal.
Instruksi LSA dan Daftar Regular maintenance to be recorded.
Periksa Pemeliharaan Pemeliharaan rutin dicatat.
5. Operating Instructions IMO Symbol Posters provided on or in the vicinity of survival 2
Instruksi operasi crafts illustrating procedures and warnings for launching.
Poster Simbol IMO yang disediakan pada atau di sekitar


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perahu untuk kelangsungan hidup menggambarkan prosedur

dan peringatan untuk peluncuran.
6. Drills - Boat, Fire, Oil Spill Drills must be carried out at least once a month and report of 3
and Emergency drills carried out logged.
Latihan - Perahu, Api, Latihan harus dilakukan setidaknya sekali sebulan dan laporan
Tumpahan Minyak dan latihan yang dilakukan itu dicatat.
Darurat
7. Communication System The operating conditions to be checked. 2

Internal & External, Internal & External P.A. System. Telephones-W/H, E/R,
Telephones, Portable STG/RM, RAD/RM. Portable - I.S. Walkie Talkies.
Sistem Komunikasi Kondisi operasi diperiksa.
Internal & Eksternal, Sistem P.A. Internal & Eksternal. Telepon-W/H, E/R, STG/RM,
Telepon, Portabel RAD/RM. I.S. “Walkie Talkies” Portabel.
8. Main & Emergency, Auto The condition & operations of motors, actuators, connecting 2
Pilot System linkages of main & emergency steering & Auto Pilot System
Sistem Auto Pilot Utama change over to be checked. Instructions for change-over to be
& Darurat exhibited.
Kondisi & operasi motor, aktuator, penghubung kemudi utama
& darurat & peralihan Sistem Auto Pilot diperiksa. Petunjuk
untuk peralihan diperlihatkan.
9. Emergency Source and The operating condition & effectiveness of battery & lighting to 2
Lighting be checked.
Sumber darurat dan Kondisi operasi & efektivitas baterai & penerangan diperiksa.
Penerangan
10. Pilot Ladders, Rescue The condition to be checked, e.g. no damage, missing steps, NA
Harness, Stretcher and deterioration, corrosion.


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Escape ways Kondisi yang akan diperiksa, misalnya tidak ada kerusakan,
Tangga Pandu, Baju anak tangga yang hilang, kerusakan, korosi.
Rantai Penyelamatan,
Tandu dan arah
Melarikan Diri
11. Portable Gas & Oxygen Operation condition & records to be checked 2
Meters, I.S. Torchlights Kondisi operasi & catatan diperiksa
Gas Portabel & Meteran
Oksigen, Lampu Senter
I.S.
Note - Catatan:


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Table 5. Life-Saving Appliances

Tabel 5. Peralatan Untuk Menyelamatkan Jiwa

1. Lifeboats The condition of hull including attachments to shell (lifelines, NA
Sekoci bilge keel lines, etc) to be checked, e.g. corrosion, missing,
holes. The condition of rudder, propeller, FO & buoyancy tanks
to be checked.
Kondisi lambung termasuk alat pelengkap untuk kerangka (tali
untuk menyelamatkan jiwa, garis lunas lambung kapal, dll)
diperiksa, misalnya korosi, hilang, lubang. Kondisi kemudi,
baling-baling, tangki FO & apung diperiksa.
2. Lifeboat Equipment Inventory, availability and conditions of equipment to be NA
Peralatan Sekoci checked.
Persediaan, ketersediaan dan kondisi peralatan diperiksa.
3. Engine for Lifeboats The operation and condition of engines to be checked. NA
Mesin Sekoci Operasi dan kondisi mesin diperiksa.
To check whether testing of engines weekly recorded.
Untuk memeriksa apakah pengujian mesin mingguan dicatat.
To check whether quantity of fuel oil in tanks sufficient.
Untuk memeriksa apakah kuantitas bahan bakar minyak dalam
tangki mencukupi.
4. Launching & Securing The operating condition of brakes, davits, winches, falls, gripes NA


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Arrangements and lashings to be checked, e.g. wastage, corrosion, greasing.

Pengaturan Peluncuran Kondisi operasi rem, dewi-dewi, mesin derek, turunnya,
& Pengamanan penggenggaman dan ikatan diperiksa, misalnya pembuangan,
korosi, pengolesan.
5. Boat Falls To turn end for end every 30 mths & date of last change. NA
Jatuhnya Kapal Untuk memutar ujung ke ujung setiap 30 bulan & tanggal
perubahan terakhir.
Falls to be renewed every 5 years and date of last renewal.
Jatuh diperbarui setiap 5 tahun dan tanggal pembaharuan
yang lalu.
6. Blocks, Chocks The condition and operation to be checked, e.g. corrosion, NA
Blok, Ganjalan wastage, greased and blocks turning.
Kondisi dan operasi diperiksa, misalnya korosi, pembuangan,
dilumasi dan blok berputar.
7. Embarkation Ladders The condition and length to be checked, e.g. corrosion, NA
Tangga Embarkasi wastage, length sufficient to reach at lightship draft.
Kondisi dan panjang diperiksa, misalnya korosi, pembuangan,
panjang cukup untuk mencapai pada draf suar.
8. Lifebuoys No. (as per Safety Equip Cert), arrangement, condition, 1
Pelampung markings & reflective tapes of lifebuoys to be checked.
Jumlah (sesuai dengan Sertifikat Peralatan Keselamatan),
pengaturan, kondisi, tanda & pita reflektif dari pelampung
diperiksa.
The condition of grab lines, lifelines, self-igniting lights of
lifebuoys to be checked.
Kondisi tali genggam, tali untuk menyelamatkan jiwa, lampu


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yang dapat menyala dengan sendirinya dari pelampung

diperiksa.
The condition of quick release devices on bridge & expiry dates
of smoke light signals to be checked.
Kondisi perangkat rilis cepat di anjungan & tanggal berakhirnya
sinyal cahaya asap diperiksa.
9. Life rafts Date of last service of life rafts & hydrostatic releases. 2
Rakit penolong Tanggal servis terakhir dari rakit penolong & rilis hidrostatik.
Securing and launching arrangements to be checked.
Pengaturan pengamanan dan peluncuran diperiksa.
10. Line Throwing Apparatus No. (Total 4) and expiry dates to be checked. 2
Peralatan Melempar Tali Jumlah (Total 4) dan tanggal kadaluarsa diperiksa.
Note - Catatan:


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Table 6. Life-Saving Appliances

Tabel 6. Peralatan Untuk Menyelamatkan Jiwa
11. Parachute Signals No. of signals (12) and expiry dates to be checked. 2
Sinyal Parasut Jumlah sinyal (12) dan tanggal kadaluarsa diperiksa.
12. Life-jackets No. of life-jackets to be checked (as per Safety Equip Cert). 2
Jaket Pelampung Jumlah jaket pelampung diperiksa (sesuai dengan Sertifikat
Peralatan Keselamatan).
The general condition, lights (expiry, if any), whistles, reflective
tapes, securing straps, and markings to be checked.
Kondisi umum, lampu (kadaluwarsa, jika ada), peluit, pita
reflektif, tali pengaman, dan tanda-tanda diperiksa.
13. Immersion Suits & TPA No. and condition and storage position of suits to be checked. NA
Pakaian Kedap Air & TPA Jumlah dan kondisi dan posisi penyimpanan pakaian diperiksa.
14. Lifeboat Portable Radio The operating condition and records of testing of radio to be NA
Radio Portabel Sekoci checked.
Kondisi operasi dan catatan pengujian radio diperiksa.
15. EPIRB The operating conditions, and expiry dates of battery and 1
hydrostatic release to be checked.
Kondisi operasi, dan tanggal kadaluwarsa baterai dan
pelepasan hidrostatik diperiksa.
16. SART No. (2 units), the operating condition and expiry dates of 1
battery to be checked.


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Jumlah (2 unit), kondisi operasi dan tanggal kadaluwarsa

baterai diperiksa.
17. Two-way Radio No. of phones (3 sets) to be checked. 2
Telephone Jumlah telepon (3 set) diperiksa.
(Walkie - Talkies) Must be water-proof and I.S.
Telepon Radio 2-arah Harus kedap air dan I.S.
(“Walkie – Talkies”) The operating condition to be checked.
Note - Catatan:


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Table 7. Fire-Fighting Appliances

Tabel 7. Peralatan Pemadaman Kebakaran
1. Main Fire Lines on deck The condition to be checked, e.g. corrosion, damage, leakage. 1
Jalur Induk Kebakaran di Kondisi diperiksa, misalnya korosi, kerusakan, kebocoran.
dek
2. Hydrant Valve handles The condition to be checked e.g. corrosion, damage, leakage. 1
Pegangan Katup Hidran Kondisi diperiksa, misalnya korosi, kerusakan, kebocoran.
3. Fire Hoses & Nozzles The condition to be checked including Fire-Boxes, e.g. 1
Selang Kebakaran & corrosion, damage, leakage.
Nozel Kondisi yang akan diperiksa termasuk Kotak Kebakaran,
misalnya korosi, kerusakan, kebocoran.
No. and arrangement of hoses and nozzles (fire boxes) to be
checked according to plan.
Jumlah dan pengaturan selang dan nozel (kotak kebakaran)
diperiksa sesuai rencana.
4. F.O. tank Shut-Off valves The operating condition to be checked. 1
Katup penghentian tangki Kondisi operasi diperiksa.
F.O.
5. Emergency Stops of fans The operating condition to be checked. 2
and transfer pumps Kondisi operasi diperiksa.
Penghentian Darurat
kipas dan pompa transfer


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6. Portable Fire No. and arrangement to be checked according to plan. 1

Extinguishers Jumlah dan pengaturan diperiksa sesuai rencana.
Alat Pemadam Api The condition to be checked, e.g. corrosion, damage, leakage.
Ringan Kondisi diperiksa, misalnya korosi, kerusakan, kebocoran.
Date of last change/serviced of medium/extinguishers.
Tanggal perubahan terakhir/servis media/alat pemadam.
7. Fixed Fire Fighting Date of last serviced and test certificate issued to be available 3 Fix foam system – NA
System in E/R, P/ Rm, and checked.
Cargo Space, Accomm or Tanggal servis terakhir dan sertifikat pengujian yang diterbitkan
Deck akan tersedia dan diperiksa.
Sistem Pemadaman Api Date and cert of foam analysis report to be available.
Tetap di dalam E/R, Tanggal dan laporan sertifikasi analisis busa tersedia.
P/Rm, Ruang Muatan, The condition of pipes, cylinders and tanks to be checked.
Akomodasi atau Dek Kondisi pipa, silinder dan tangki diperiksa.
8. Foam/ Water turrets and Condition to be checked, e.g. corrosion, damage, leakage. 2 Water turrets and Monitors yang di install
Monitors Kondisi diperiksa, misalnya korosi, kerusakan, kebocoran.
Busa/Menara air dan
Pengamatan
9. Main Fire Pumps and The operating condition including sufficient delivery pressure to 1
Emergency Fire Pumps be checked.
Pompa Kebakaran Kondisi operasi termasuk tekanan pengiriman yang cukup
Utama dan Pompa diperiksa.
Kebakaran Darurat The condition of the pump, prime mover to be checked, e.g.
corrosion, damage, leakage.
Kondisi pompa, penggerak utama diperiksa, misalnya korosi,
kerusakan, kebocoran.
10. Fire dampers & doors The operating condition to be checked. 2


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Peredam api & pintu Kondisi operasi diperiksa

The condition including handles to be checked, e.g. corrosion,
damage.
Kondisi termasuk pegangan diperiksa, misalnya korosi,
kerusakan.
Note - Catatan:


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Table 8. Fire-Fighting Appliances

Tabel 8. Peralatan Pemadaman Kebakaran
11. Spark/Flame Arrestors For all ventilators, skylights, air intakes, etc., condition to be 2
Pelindung Percikan/Api checked, e.g. corrosion, damage, whether choked, etc.
Untuk semua ventilator, kaca atap, jalan masuk udara, dll,
kondisi diperiksa, misalnya korosi, kerusakan, apakah
tersumbat, dll
12. Fireman Outfit No. of sets (2 for SB, 4 for ocean-going) to be checked. (One 2
Pakaian Pemadam set consists of a breathing apparatus, protective clothing,
Kebakaran boots, gloves, rigid helmet, visor, safety lamp, axe and life-line)
Jumlah set (2 untuk SB, 4 untuk pelayaran laut) diperiksa.
(Satu set terdiri dari alat bantu pernapasan, pakaian pelindung,
sepatu bot, sarung tangan, helm kaku, visor, lampu
keselamatan, kapak dan tali untuk menyelamatkan jiwa)
Spare cylinders for B.A. (200%) to be checked.
Silinder cadangan untuk B.A. (200%) diperiksa.
The condition of the cylinders, masks, harness, valves pressure
gauges, whistle, lamp, securing straps, life-lines to be checked,
e.g. shortage, empty, leakage, damage, deterioration, etc.
Kondisi silinder, masker, baju rantai, alat pengukur tekanan
katup, peluit, lampu, tali pengaman, tali untuk menyelamatkan
jiwa diperiksa, misalnya kekurangan, kosong, kebocoran,
kerusakan, dll


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The storage position according to fire plan to be checked.

Posisi penyimpanan sesuai dengan rencana kebakaran
diperiksa.
13. Fire Detection System The operating condition to be checked. 2
Sistem Deteksi Kondisi operasi diperiksa.
Kebakaran
14. Paint Locker Fire The condition of piping and valves to be checked, e.g. damage, NA
Extinguishing System corrosion, leakage, etc.
Sistem Pemadaman Kondisi pipa dan katup harus diperiksa, misalnya kerusakan,
Kebakaran Loker Cat korosi, kebocoran, dll.
Arrangement of portable extinguishers to be checked.
Susunan alat pemadam api ringan diperiksa.
15. Gas Tight Lamps Condition of all gas tight lamps in stores, etc. to be checked, NA
Lampu Kedap Gas e.g. well secured, bolts missing, covers/holders damaged, etc.
Kondisi semua lampu kedap gas di gudang, dll diperiksa,
misalnya diamankan dengan baik, baut yang hilang, penutup /
pemegang rusak, dll
16. International Shore To check well greased, packing, tools and all bolts available. 2
Connection Untuk memeriksa digemuk dengan baik, paking, alat kerja dan
Koneksi Darat semua baut tersedia.
Internasional Position/location to be placed according to plan.
Posisi/lokasi ditempatkan sesuai dengan rencana.
Note - Catatan:


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Table 9. Alarms and Signals
Tabel 9. Alarm dan Sinyal
1. Fire Alarm The operating condition to be checked. 2

Alarm Kebakaran Kondisi operasi diperiksa.
2. General Alarm The operating condition to be checked. 2
Alarm Umum Kondisi operasi diperiksa.
3. Steering Gear Alarm The operating condition to be checked. 2
Alarm Alat Kemudi Kondisi operasi diperiksa.
4. Fixed Fire Extinguishing The operating condition to be checked. 1
System Alarm Alarm Kondisi operasi diperiksa.
Sistem Pemadaman
Kebakaran Tetap
5. Fire Detecting System The operating condition to be checked. 1

Alarm Kondisi operasi diperiksa.
Alarm Sistem Deteksi
Kebakaran
6. Cargo Tank High Level The operating condition to be checked. NA
Tingkat Ketinggian Kondisi operasi diperiksa.
Tangki Muatan
7. Steering Gear Bilge High The operating condition to be checked. NA
Level Alarm Kondisi operasi diperiksa.


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Alarm Tingkat Ketinggian

Bilga Alat Kemudi
8. Engine Room Bilge High The operating condition to be checked. NA
Bilga Kamar Mesin
9. Cargo Pump Room High The operating condition to be checked. NA
Kamar Pompa Muatan
10. Engineer’s Alarm The operating condition to be checked. NA
Alarm Masinis Kondisi operasi diperiksa.
11. Ship’s Whistle, manual The operating condition to be checked. NA
Peluit kapal, manual Kondisi operasi diperiksa.
12. Ship’s Whistle, electric The operating condition to be checked. 2
Peluit kapal, elektrik Kondisi operasi diperiksa.
13. Ship’s Automatic Fog The operating condition to be checked. NA
Signal Kondisi operasi diperiksa.
Sinyal Kabut Otomatis
Kapal
14. Aldis Lamp The operating condition to be checked. NA
Lampu Aldis Kondisi operasi diperiksa.
15. Morse Light The operating condition to be checked. NA
Cahaya Morse Kondisi operasi diperiksa.
Note - Catatan:


Page 24 of 42



Page 25 of 42

Table 10. Radio Equipments
Tabel 10. Peralatan Radio
1. Main Transmitter The operating condition to be checked. NA

Pemancar utama Kondisi operasi diperiksa.
2. Reserve transmitter The operating condition to be checked. NA
Pemancar cadangan Kondisi operasi diperiksa.
3. Portable Radio Key The operating condition to be checked. NA
Kunci Radio Portabel Kondisi operasi diperiksa.
4. SSB & Telex The operating condition to be checked. 3 TELEX – NA
5. Battery & Charger The operating condition to be checked. NA
Baterai & Pengisi Daya Kondisi operasi diperiksa.
6. Auto Alarm The operating condition to be checked. NA
Alarm Otomatis Kondisi operasi diperiksa.
7. VHF The operating condition to be checked. 2
8. Portable Radio The operating condition to be checked. NA
Apparatus for Survival Kondisi operasi diperiksa.
Craft
Peralatan Radio
Portabel untuk Kapal
Kelangsungan Hidup


Page 26 of 42
9. NAVTEXT Receiver The operating condition to be checked. 3

Penerima NAVTEXT Kondisi operasi diperiksa.
10. Watch Receiver The operating condition to be checked. NA
Penerima Jam Kondisi operasi diperiksa.
11. Facsimile The operating condition to be checked. NA
Faksimili Kondisi operasi diperiksa.
12. Radio Log Book To be available on board and entries as appropriate. 3
Buku Catatan Radio Tersedia di atas kapal dan entri yang sesuai.
13. Antenna including Mast The condition to be checked, e.g. corrosion, damage. 2
Antena termasuk Tiang Kondisi diperiksa, misalnya korosi, kerusakan.
14. Radio Publications Latest Volumes of Radio Signals on board and corrected? NA
Publikasi Radio Volume terbaru Sinyal Radio di atas kapal dan dikoreksi?
15. Ship Station License Is License valid and displayed? 2

Izin Stasiun Radio Kapal Apakah Izin masih berlaku dan ditampilkan?
Laut
Note - Catatan:


Page 27 of 42

Table 11. MARPOL
Tabel 11. MARPOL
1. Oily Water Separator The operating condition & Filters to be checked. 2

(OWS) Kondisi operasi & Filter diperiksa.
Pemisah Air Berminyak Equipment and piping to be checked, e.g. corrosion.
(OWS) Peralatan dan pipa diperiksa, misalnya korosi.
Is the overboard discharge valve identified, lashed and locked?
Apakah katup pembongkaran ke laut diidentifikasi, diikatkan
dan dikunci?
2. 15 P.P.M. Alarm The operating condition to be checked. NA
Alarm 15 P.P.M. Kondisi operasi diperiksa.
3. ODME The operating condition to be checked. NA
4. Oil/Water Interface To be available on board. NA
Detectors Tersedia di atas kapal.
Detektor Antarmuka
Minyak/Air
5. Standard Marpol The condition to be checked, e.g. corrosion, damage, leakage, NA
Discharge Connection and to be fully bolted, greased and identified.
Koneksi Pembongkaran Kondisi diperiksa, misalnya korosi, kerusakan, kebocoran, dan
Standar Marpol sepenuhnya dibaut, digemuki dan diidentifikasi.
6. Piping arrangement on The condition to be checked, e.g. corrosion, damage, leakage. 2


Page 28 of 42
bilge line in E/R & P/R Kondisi diperiksa, misalnya korosi, kerusakan, kebocoran.
Pengaturan perpipaan di
jalur bilga di E/R & P/R
7. Piping arrangement on The condition to be checked, e.g. corrosion, damage, leakage. NA
Cargo Oil & Ballast Lines Kondisi diperiksa, misalnya korosi, kerusakan, kebocoran.
Pengaturan pipa di Jalur
Minyak Muatan &
“Ballast”
8. Bilge in Engine Room & Are they free from oily water / oil? 2
Pump Room Apakah mereka bebas dari air berminyak/minyak?
Bilga di dalam Kamar Is the emergency bilge suction v/v in E/R identified?
Mesin & Kamar Pompa Apakah v/v hisap bilga darurat di dalam E/R diidentifikasi?
Is the sea chest/overboard discharge valve identified, lashed
and locked?
Apakah peti kelasi/katup pembuangan ke laut diidentifikasi,
diikat dan dikunci?
9. Oil Record Books Are records for both Machinery and Cargo correct and up- 3
Buku Catatan Minyak dated and entries initialed and book signed?
Apakah catatan untuk kedua Mesin dan Muatan benar dan
diperbaharui dan catatan diparaf dan buku ditandatangani?
10. SOPEP To be available on board. 2
Tersedia di atas kapal.
11. ODME Manual To be available on board and ODME to be tested, recorded NA
Manual ODME monthly.
Tersedia di atas kapal dan ODME harus diuji, dicatat setiap
bulan.
12. Oil Spill/Pollution To check condition and availability of equipment as per 2


Page 29 of 42
Equipment standard list. Oil recovery pump & Oil Spill Drills to be tested
Peralatan Tumpahan and carried out regularly.
Minyak/Polusi Untuk memeriksa kondisi dan ketersediaan peralatan sesuai
daftar standar. Pompa perolehan kembali minyak & Latihan
Tumpahan Minyak diuji dan dilakukan secara teratur.
Note - Catatan:


Page 30 of 42
Table 12. Hull, Machinery & Cargo Gear

Tabel 12. Lambung Kapal, Mesin & Perlengkapan Muatan
1. Cargo Tanks The condition of frames, brackets, bulkheads, tank top, NA
Tangki Muatan coatings, etc., to be checked, e.g. corrosion, wastage, damage.
Kondisi kerangka, kurungan, sekat, bagian atas tangki,
pelapis, dll, diperiksa, misalnya korosi, pemborosan,
kerusakan.
LF-D 012 Tank Condition Report Form to be filled.
LF-D 012 Formulir Laporan Kondisi Tangki diisi.
2. Ballast , F.W. , and The condition of frames, brackets, bulkheads, tank top, 2
Cofferdams Tanks coatings, etc., to be checked, e.g. corrosion, wastage, damage.
Tangki-tangki “Ballast”, Kondisi kerangka, kurungan, sekat, bagian atas tangki,
F.W., dan “Cofferdams” pelapis, dll, diperiksa, misalnya korosi, pemborosan,
kerusakan.
LF-D 012 Tank Condition Report Form to be filled
LF-D 012 Formulir Laporan Kondisi Tangki diisi.
3. Piping Arrangement on The condition to be checked, e.g. wastage, damage, corrosion, 2
Deck leakage.
Pengaturan Perpipaan Kondisi diperiksa, misalnya pemborosan, kerusakan, korosi,
di Dek kebocoran.
4. Deck Electrical Cable The condition of lighting, cable pipes/ducting, cable 2
Arrangement & Lighting arrangement to be checked, e.g. corrosion, wastage, damage.


Page 31 of 42
Pengaturan Kabel Listrik Kondisi penerangan, pipa kabel/”ducting”, pengaturan kabel

Dek & Penerangan diperiksa, misalnya korosi, pemborosan, kerusakan.
5. Cargo Pumps Room The cargo pump room to be cleaned. NA
Kamar Pompa Muatan Kamar pompa muatan dibersihkan.
The operating condition to be checked, e.g. efficiency, leakage
Kondisi operasi diperiksa, misalnya efisiensi, kebocoran
6. Engine Room To be cleaned. 2
Kamar Mesin Dibersihkan
7. Main Engine The operating condition to be checked. 2
Mesin Induk Kondisi operasi diperiksa
8. Main Generators The operation condition to be checked. 2
Generator Induk Kondisi operasi diperiksa
9. Auxiliary Machinery The operating condition to be checked. 2
Mesin Bantu Kondisi operasi diperiksa
10. Piping Arrangement in The condition to be checked, e.g. corrosion, wastage, leakage. 2
Engine Room Kondisi operasi diperiksa, misalnya korosi, pemborosan,
Pengaturan Pipa di kebocoran
dalam Kamar Mesin
11. E/R Electrical Cable & The condition to be checked. 2
Lighting Arrangement Kondisi diperiksa
Kabel Listrik E/R
Pengaturan Penerangan
12. Main Switch Board The operating condition and identification & illumination to be 2
(MSB) checked. Insulating Mats to be available on the floor in front
Papan Saklar Utama and at the back of the switch board.
(MSB) Kondisi operasi dan identifikasi & pencahayaan diperiksa.
Keset isolasi harus tersedia di lantai di depan dan di belakang


Page 32 of 42
papan saklar.
13. Refrigerating The operating condition and pipings in the rooms to be 2
Compressor checked.
for Meat & Cold Room Kondisi operasi dan pipa di dalam kamar diperiksa.
Kompresor Kulkas untuk
Daging & Kamar
Pendingin
Note - Catatan:


Page 33 of 42
Table 13. Hull, Machinery & Cargo Gear

Tabel 13. Lambung Kapal, Mesin & Perlengkapan Muatan
14. Cargo Gear Appliances The condition of posts, booms and winches including loose NA
Peralatan Perlengkapan gear to be checked, e.g. corrosion, wastage, damage.
Muatan Kondisi posting, booming dan pengerek termasuk gigi longgar
untuk diperiksa, misalnya korosi, pemborosan, kerusakan.
Are running parts including sheaves, wires, etc in good
condition, moving and well lubricated & all shackles housed?
Apakah semua bagian yang bergerak termasuk katrol, kabel,
dll dalam kondisi baik, bergerak dan dilumasi dengan baik &
semua belenggu diberi rumah?
The operation & condition of the winches & hydraulic pipes to
be checked, e.g. brakes, gears, corrosion, damage, leakage.
Operasi & kondisi mesin derek & pipa hidrolik diperiksa,
misalnya rem, roda gigi, korosi, kerusakan, kebocoran.
15. Windlass, Mooring The operation & condition of the machinery & hydraulic pipes to 2
Winches & Capstans checked, e.g. efficiency, brakes, gears, corrosion, damage,
Mesin Kerek, Mesin leakage, etc.
Derek Tali Tambat & Operasi & kondisi mesin & pipa hidrolik diperiksa, misalnya
Putaran Jangkar efisiensi, rem, roda gigi, korosi, kerusakan, kebocoran dll.
16. Main Deck Is on-going maintenance being carried out? 1
Dek Utama Apakah pemeliharaan terus-menerus dilakukan?

Page 34 of 42
The condition of the deck to be checked, e.g. corrosion,

wastage, damage.
Kondisi dek diperiksa, misalnya korosi, pemborosan,
kerusakan.
17. Superstructure, Funnel & Is on-going maintenance being carried out? 2
Masts Apakah pemeliharaan terus-menerus dilakukan?
Suprastruktur, Cerobong The condition of the superstructure to be checked, e.g.
& Tiang corrosion, wastage, damage.
Kondisi suprastruktur diperiksa, misalnya korosi, pemborosan,
kerusakan.
18. Ship’s Side Is on-going maintenance being carried out? 2
Sisi Kapal Apakah pemeliharaan terus-menerus dilakukan?
The condition of the topside and bootop to be checked, e.g.
corrosion, wastage, damage.
Kondisi dek atas dan sisi kapal di atas garis air diperiksa,
misalnya korosi, pemborosan, kerusakan.
19. Anchor Chain, Chain Are all of the port & stbd anchor chains studs tight? 2
Lockers Apakah semua kancing rantai jangkar kiri & kanan ketat?
Rantai Jangkar, Loker Are there any studs missing?
Rantai Apakah ada kancing yang hilang?
Is the chain guide roller in good condition?
Apakah roller panduan rantai dalam kondisi baik?
Has the Chain Locker been checked for heavy corrosion?
Apakah Locker Rantai sudah diperiksa untuk korosi berat?
20. Mooring Ropes & Fire Are there sufficient ropes and wires on board? 2
Wires Apakah ada tali dan kabel yang cukup di atas kapal?
Tali Tambat & Kabel Api To check condition of ropes & wires e.g. wear & tear, etc.


Page 35 of 42
Untuk memeriksa kondisi tali & kabel misalnya keausan dll.

21. Housekeeping Is the housekeeping of all Deck & E/R stores in order? 1
Rumah tangga Apakah rumah tangga dari semua Dek & gudang E/R tertata
rapi?
Are all loose items in stores, E/R and on deck lashed?
Apakah semua item yang longgar di gudang, E/R dan di dek
terikat?
Note - Catatan:


Page 36 of 42

Table 14. Cargo Equipments
Tabel 14. Peralatan Muatan
1. Cargo Hose Are there sufficient hoses on board? NA

Selang Muatan Apakah ada selang yang cukup di atas kapal?
To check the condition of the hoses, e.g. wear & tear.
Untuk memeriksa kondisi selang, misalnya keausan.
Are all hoses provided with blanks c/w bolts & nuts?
Apakah semua selang yang disediakan dengan “blanks”
beserta baut & mur?
2. Manifolds, Hoses Are all unused manifolds and hoses blanked & fully bolted? NA
Pipa Bermulut Banyak, Apakah semua pipa bermulut banyak yang tidak terpakai dan
Selang selang di “blank” & sepenuhnya dibaut?
3. Reducers, Adapters, Are the required nos of reducers, adapters & elbows on board NA
Elbows & provided with bolts and nuts?
Reduksi, Adaptor, Siku Apakah jumlah reduksi, adaptor & siku yang diperlukan di atas
kapal & dilengkapi dengan baut dan mur?
4. Cargo Records & Safety Are all records maintained and up-dated? NA
Checklists Apakah semua catatan dipelihara dan diperbaharui?
Catatan Muatan &
Daftar Periksa
Keselamatan
5. ASTM Thermometers, Are sufficient on board and in good condition? NA


Page 37 of 42
Sounding Tapes & Apakah jumlahnya cukup di atas kapal dan dalam kondisi
Hydrometers baik?
Thermometer ASTM,
Pita Pengukuran &
Hydrometer
6. Water & Oil Finding Are there sufficient on board? NA
Pastes Apakah jumlahnya cukup di atas kapal?
Pasta Air & Minyak
7. Sample Bottles, Seal Are there sufficient on board? NA
Pliers, Seals, Rags Apakah jumlahnya cukup di atas kapal?
Botol Sampel, Tang
Segel, Segel, Kain
Majun
8. Sampling Equipment Do they adhere to SBP? NA
Peralatan Pengambilan Apakah mereka mematuhi SBP?
Sampel
Note - Catatan:


Page 38 of 42

Table 15. Accommodation
Tabel 15. Akomodasi
1. Sanitary facilities The condition to be checked, e.g. drainage, cleanliness. 1

Fasilitas sanitasi Kondisi yang akan diperiksa, misalnya drainase, kebersihan.
2. Air Conditioning The operating condition to be checked. 1
AC Kondisi operasi diperiksa.
3. Medical equipment To be available on board. 2
Peralatan medis Tersedia di atas kapal.
4. Toilet & Shower Room The condition to be checked, e.g. drainage, cleanliness. 1
Toilet & Kamar Mandi Kondisi yang akan diperiksa, misalnya drainase, kebersihan.
5. Piping Arrangement in The condition to be checked, e.g. corrosion, leakage. 2
accommodation spaces Kondisi yang akan diperiksa, misalnya korosi, kebocoran.
Pengaturan pipa di
ruang akomodasi
6. Air Ventilators The condition to be checked, e.g. corrosion, cleanliness. 1
Ventilator udara Kondisi yang akan diperiksa, misalnya korosi, kebersihan.
7. Galley The condition to be checked, e.g. drainage, cleanliness. 2
Dapur kapal Kondisi yang akan diperiksa, misalnya drainase, kebersihan.
8. Galley Store, Provision & The condition to be checked, e.g. drainage, cleanliness. 2
Meat Room Kondisi yang akan diperiksa, misalnya drainase, kebersihan.
Gudang dapur kapal,
Kamar Perbekalan &


Page 39 of 42
Daging
9. Crew Cabins The condition to be checked, e.g. cleanliness. 2
Kabin Awak Kapal Kondisi yang akan diperiksa, misalnya kebersihan.
10. Lighting All lighting in accommodation to be working and well lit. 2
Penerangan Semua penerangan dalam akomodasi dapat bekerja dan
menyala dengan baik.
11. Housekeeping Is the general housekeeping of the accommodation & its stores 1
Rumah Tangga in order?
Apakah rumah tangga umum dari akomodasi & gudangnya
dalam keadaan baik?
Are all loose items in stores, galley, etc., lashed?
Apakah semua item yang goyang di gudang, dapur kapal, dll,
terikat?
Note - Catatan:


Page 40 of 42
Table 16. Additional Information

Tabel 16. Informasi Tambahan
No. Item Additional comments/suggestions/improvements, etc.
Komentar/saran/perbaikan tambahan, dll
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.


Page 41 of 42
11.
Inspected / Report By: Acknowledgement / Joint Inspection By:

Diinspeksi / Dilaporkan Oleh: Diketahui / Inspeksi Gabungan Oleh:
_
Superintendent-in-charge Master Chief Engineer
Superintendent Penanggung Jawab Nakhoda KKM
Name: Name: Name:
Nama: Nama: Nama:

LF D 004a Laporan Inspeksi Kapal Vessel Inspection Report 2nd

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Form Code LF – D 004 A

VESSEL INSPECTION REPORT Revision 01/2012

VESSEL INSPECTION REPORT – LAPORAN INSPEKSI KAPAL

LF – D 004 A/ Dec 2012 Written By : SK Approved By : VP / DPA Retention period: 1 year

VESSEL INSPECTION REPORT Revision 01/2012

5. SMS, DOC, Policy Available on board and displayed? 2

LF – D 004 A/ Dec 2012 Written By : SK Approved By : VP / DPA Retention period: 1 year

VESSEL INSPECTION REPORT Revision 01/2012

VESSEL INSPECTION REPORT – LAPORAN INSPEKSI KAPAL

1. Hull Is the Hull free of any damage? 2

LF – D 004 A/ Dec 2012 Written By : SK Approved By : VP / DPA Retention period: 1 year

VESSEL INSPECTION REPORT Revision 01/2012

VESSEL INSPECTION REPORT Revision 01/2012

LF – D 004 A/ Dec 2012 Written By : SK Approved By : VP / DPA Retention period: 1 year

VESSEL INSPECTION REPORT Revision 01/2012

VESSEL INSPECTION REPORT – LAPORAN INSPEKSI KAPAL

LF – D 004 A/ Dec 2012 Written By : SK Approved By : VP / DPA Retention period: 1 year

VESSEL INSPECTION REPORT Revision 01/2012

6. Echo Sounder The operating condition to be checked including illumination. 2

LF – D 004 A/ Dec 2012 Written By : SK Approved By : VP / DPA Retention period: 1 year

VESSEL INSPECTION REPORT Revision 01/2012

LF – D 004 A/ Dec 2012 Written By : SK Approved By : VP / DPA Retention period: 1 year

VESSEL INSPECTION REPORT Revision 01/2012

VESSEL INSPECTION REPORT – LAPORAN INSPEKSI KAPAL

LF – D 004 A/ Dec 2012 Written By : SK Approved By : VP / DPA Retention period: 1 year

VESSEL INSPECTION REPORT Revision 01/2012

perahu untuk kelangsungan hidup menggambarkan prosedur

7. Communication System The operating conditions to be checked. 2

LF – D 004 A/ Dec 2012 Written By : SK Approved By : VP / DPA Retention period: 1 year

VESSEL INSPECTION REPORT Revision 01/2012

LF – D 004 A/ Dec 2012 Written By : SK Approved By : VP / DPA Retention period: 1 year

VESSEL INSPECTION REPORT Revision 01/2012

VESSEL INSPECTION REPORT – LAPORAN INSPEKSI KAPAL

Table 5. Life-Saving Appliances

No. Item Check points N Remarks

LF – D 004 A/ Dec 2012 Written By : SK Approved By : VP / DPA Retention period: 1 year

VESSEL INSPECTION REPORT Revision 01/2012

Arrangements and lashings to be checked, e.g. wastage, corrosion, greasing.

LF – D 004 A/ Dec 2012 Written By : SK Approved By : VP / DPA Retention period: 1 year

VESSEL INSPECTION REPORT Revision 01/2012

yang dapat menyala dengan sendirinya dari pelampung

LF – D 004 A/ Dec 2012 Written By : SK Approved By : VP / DPA Retention period: 1 year

VESSEL INSPECTION REPORT Revision 01/2012

VESSEL INSPECTION REPORT – LAPORAN INSPEKSI KAPAL

Table 6. Life-Saving Appliances

LF – D 004 A/ Dec 2012 Written By : SK Approved By : VP / DPA Retention period: 1 year

VESSEL INSPECTION REPORT Revision 01/2012

Jumlah (2 unit), kondisi operasi dan tanggal kadaluwarsa

LF – D 004 A/ Dec 2012 Written By : SK Approved By : VP / DPA Retention period: 1 year

VESSEL INSPECTION REPORT Revision 01/2012

VESSEL INSPECTION REPORT – LAPORAN INSPEKSI KAPAL

Table 7. Fire-Fighting Appliances

LF – D 004 A/ Dec 2012 Written By : SK Approved By : VP / DPA Retention period: 1 year

VESSEL INSPECTION REPORT Revision 01/2012

6. Portable Fire No. and arrangement to be checked according to plan. 1

LF – D 004 A/ Dec 2012 Written By : SK Approved By : VP / DPA Retention period: 1 year

VESSEL INSPECTION REPORT Revision 01/2012

Peredam api & pintu Kondisi operasi diperiksa

LF – D 004 A/ Dec 2012 Written By : SK Approved By : VP / DPA Retention period: 1 year

VESSEL INSPECTION REPORT Revision 01/2012

VESSEL INSPECTION REPORT – LAPORAN INSPEKSI KAPAL

Table 8. Fire-Fighting Appliances

LF – D 004 A/ Dec 2012 Written By : SK Approved By : VP / DPA Retention period: 1 year