船岸安全检查表（重要）.docx

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1、船/岸安全检查表SHIP/SHORE SAFETY CHECK LISTShip、Name 船名Berth 泊位Port港口 Date of Arrival 抵达日期Timeof Arrival 抵达时间填表须知INSTRUCTIONS FOR COMPLETION:为保证安全作业，下列所有问题的答复均是肯定的，可在相应的方格内清楚地打上(J)标号。如果不能给予 肯定回答，应说明理由，而且船舶和码头之间均达成关于应采取的适当预防措施的协议。如果认为有的问题 不适用，应在备注栏里加以说明。The safety of operations requires that all questions s

2、hould be answered affirmatively by clearly ticking ( V) in the appropriate box. If an affirmative answer is not available, the reason should be given and agreement reached upon appropriate precautions to be taken between the ship and the terminal. Where any question is considered to be not applicabl

3、e, then a note to that effect should be inserted in the remarks column.“船舶”和“码头”栏目中出现这种方格，表示由应该方实施检查。A box in the column ship and terminar indicates that the party concerned should carry out checks.在“代码”栏目里的A, P或R,分别表示如下的意义：The presence of the letters A, P or R in the column Code5 indicates the foll

4、owing:A -(协议)表示该检查项应通过协议或程序来处理，并在检查表中的“备注”栏中明确或者通过其它一些 双方可接受的表格来交流这些协议和程序。A 一(Agreement) This indicates that the referenced consideration should be addressed by an agreement or procedure that should be identified in the Remarks column of the Check List, or communicated in some other mutually accepta

5、ble form.P-(批准)在否定回答的情况下，未经主管当局的书面许可，不可进行作业。P -(Permission5). In the case of a negative answer to the statements coded P5, no operations are to be conducted without the written permission from the appropriate authority.R(复查)表示在不超出声明同意的时间间隔须重复检查的项目。R-(Re-check) This indicates items to be re-checked a

6、t appropriate intervals, as agreed between both parties and stated in the declaration.仅在所有方检查和接受他们分配的职责和责任后方可签署共同声明The joint declaration should not be signed until all parties have checked and accepted their assigned responsibilities and accountabilities.PART C - BULK LIQUID CHEMICALS - VERBAL VERIF

7、ICATIONC部分一散装液体化工品一 口头确认Bulk Liquid 一 Chemicals散装液体一化工品Ship船舶Terminal码头Code代码Remarks备注1. Material Safety Data Sheets are available giving the necessary data for the safe handling of the cargo.有MSDS提供货物安全操作必要的资料2. A manufacturer inhibition certificate, where applicable, has been provided.如适用，提供制造商的抑制

8、剂证书P3. Counter measures against accidental personal contact with the cargo have been agreed.就人员意外接触货品的应对措施达成一致意见4. Sufficient protective clothing and equipment (including self-contained breathing apparatus) is ready for immediate use and is suitable for the product being handled.足够的防护服和设备(包括自给式呼吸器)随

9、时可 用，并适合所操作的货品5. The cargo handling rate is compatible with the automatic shut down system, if in use.如使用，货物作业速率与自动关闭系统相符合A6. Cargo system gauges and alarms are correctly set and in good order.货物系统仪表和警报正确设置并处于良好的工作状 况7. Portable vapour detection instruments are readily available for the products bei

10、ng handled.适合所作业货品的便携式蒸气探测仪器备妥8. Information on fire-fighting media and procedures has been exchanged.交换消防介质的信息和程序9. Transfer hoses are of suitable material, resistant to the action of the products being handled.移货软管的材料合适，与作业的货品不发生反应。10. Cargo handling is being performed with the permanent installed

11、 pipeline system.货物作业使用永久性管系P1 L Where appropriate, procedures have been agreed for receiving nitrogen supplied from shore, either for inerting or purging ships tanks, or for line clearing into the ship.如需从岸方接受氮气用于惰化船舱、驱气或吹扫管 线，就相关程序已达成协议APPART 廿-BULK LIQUEFIED GASES VERBAL VERIFICATIOND部分一散装液化气一 口头

12、确认Bulk Liquefied Gases散装液化气Ship船舶Terminal码头Code代码Remarks备注1. Material Safety Data Sheets are available giving the necessary data for the safe handling of the cargo.有MSDS提供货物安全操作必要的资料2. A manufacturer inhibition certificate, where applicable, has been provided.如适用，提供制造商的抑制剂证书P3. The water spray syste

13、m is ready for immediate use. 水喷淋系统处随时可用状态4. There is sufficient protective equipment (including self- contained breathing apparatus) and protective clothing ready for immediate use.足够的防护服和设备(包括自给式呼吸器)随时可 用，并适合所操作的货品5. Hold and inter-barrier spaces are properly inerted or filled with dry air, as req

14、uired.货舱和内屏蔽之间的空间按要求充惰和干燥空气6. All remote control valves are in working order. 所有遥控阀门处良好工作状态7. The required cargo pumps and compressors are in good order, and the maximum working pressures have been agreed between ship and shore.货泵和压缩机处良好工作状态，船方和岸方就最大 工作压力达成一致意见A8. Re-liquefaction or boil off control

15、 equipment is in good order.再液化或蒸发控制设备处于良好状态9. The gas detection equipment has been properly set for the cargo, is calibrated and is in good order.气体探测设备根据货品适当的设置，校验和处于良 好的10. Cargo system gauges and alarms are correctly set and in good order.货物系统仪表和警报正确设置并处于良好的工作状 况11. Emergency shutdown systems ha

16、ve been tested and are working properly.应急切断系统已经过测试，处工作状态12. Ship and shore have informed each other of the closing rate of ESD valves, automatic valves or similar devices. 船/岸方互相告知应急关闭装置阀门、自动阀门或类 似装置的关闭速率AShip Shore 13. Information has been exchanged between ship and shore on the maximuiTi/minimum

17、temperatures/ pressures of the cargo to be handled.船/岸双方交换作业货物最大/最小温度/压力的信息A14. Cargo tanks are protected against inadvertent overfilling at all times while any cargo operations are in progress.在货物作业过程中，货舱应对任何时候意外超装的 保护15. The compressor room is properly ventilated; the electrical motor room is prop

18、erly pressurised and the alarm system is working.压缩机房保持适合的通风，电机房保持合适的正 压，报警系统工作正常16. Cargo tank relief valves are set correctly and actual relief valve setting are clearly and visibly displayed (Record Settings below)货舱压力释放阀正确设置，实际设定值应清楚标示 (记录设定值如下)Tank No 1Tank No 2Tank No 3Tank No 5Tank No 6Tank N

19、o 7Tank No 8Tank No 9Tank No 10Tank No 4DECLARATION声明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.我们（以下签名

20、者）已经对本安全检查表内A/B部分，如适用，和C或D部分的各个项目，根据指导进行了检 查，并确信就我们的知识而言，我们所填写的内容是正确的。We have also made arrangements to carry out repetitive checks as necessary and agreed that those items coded R in the Check List should be re-checked at intervals not exceeding hours.我们对协议进行复查的项目已作好安排，并同意在不超过 时间间隔必须对那些“代号”栏中标有的项目进

21、行复查。If to our knowledge the status of any item changes, we will immediately inform the other party.当获知任何项目状态发生变化，将立即通知另一方。For Ship 船方For Shore 岸方Name姓名Rank职务Signature 签名Date日期Time时间Name姓名Position 职务Signature 签名Date日期Time时间.Record of repetitive checks 重复性检查的记录:Date日期:Time时间:Initials for Ship: 船方确认Ini

22、tials for Shore:岸方确认Date日期：Time时间：Initials for Ship: 船方确认Initials for Shore:岸方确认In addition to the check list above, the following provisions have been produced to secure a safe operation. These items derive from experiences, and have been proved effective. The master and all under his command must

23、adhere strictly to these requirements throughout the vessels stay alongside. The terminal representative must endure that shore personnel do likewise.在上述检查项目基础上，制定下列条款以确保安全作业。这些要求均来自作业实践，并已被证明有效。在整 个船舶停靠期间，船长及其下属船员应当严格遵守规定，终端站代表应当确保船上人员也能同样遵守规定。(1) PRE-DISCAHRGING AGREEMENT作业前协议Ship船舶Terminal码头1. Wh

24、en berth in emergency, ships side have responsibility to remove loading arm.紧急离泊时，船方代为拆臂；2. Inert gas is not permitted in line clearing operation.扫舱时禁止向岸方管线吹扫惰气；3. If the vessel is off the fender, both ship and shore need to pay close attention ,ship staffs adjustment of mooring lines need to receiv

25、e the shore side permission.船体离开护舷，船岸密切关注，禁止船方未经允许调整缆绳；4. Agree in writing on the transfer procedures, including maximum unloading rate and pressure.就卸货程序达成协议，包括允许最大流量、压力；5. Agree in writing on the action to be taken in the event of emergency during cargo handing operation.就卸货期间发生紧急情况采取的应急措施达成协议；6.

26、The vessel is fitted with a pressure relief system, surge tankers or similar devices to absorb the effect of surge sufficiently quickly.使用压力释放装置、平衡柜或类似的装置以便充分和快速地缓和憋压的影响。Chief officer:签名（船方）Loading master:签名（岸方）(2) AGREED DISCARGING PLAN卸货协议Item类别Ship船方Shore岸方Cargo to be unloaded 作业货名Quantity planne

27、d 装卸船计划量（t）Quantity permitted 装卸船限载量(t)Wind speed of operation stopping 停工作业(m/s)Wind speed of loading arm removing 拆装卸臂(m/s)Wind speed of unberthing 靠泊离泊(m/s)Initial unloading rate 初始量(t/h)Maximum unloading rate 最大量(t/h)Maximum manifold pressure 最大压力(MPa)Ship/shore communication 船岸联系Emergency stop

28、procedure 紧急停卸程序STOP STOP STOP By VHF radioSTOP STOP STOP By VHF radioRemaks:备注Chief officer:签名（船方）Loading master:签名（岸方）PART A - BULK LIQUID GENERAL PHYSICAL CHECKSA部分一散装普通液货一现场核实Bulk Liquid - General散装液体一普通Ship船舶Terminal码头Code 代码Remarks备注Main point要点1. There is safe access between the ship and shor

29、e.船岸之间是否有安全通道R远离汇管、安全网、 救生圈、照明良好2. The ship is securely moored.船舶是否已安全系泊？R船舶系牢、同方向缆 绳使用同种材料3. The agreed ship/shore communication system is operative.商定的船/岸通信系统是否可用?ARSystem 系 统Back up system 备用系 统连续看守、随身携 带、记录通讯号码及 频道4. Emergency towing-off pennants are correctly rigged and positioned.应急拖缆是否放置正确位置？

30、R布置在船首和船尾的 向海舷侧5. The ships fire hoses and fire-fighting equipment is positioned and ready for immediate use.船方消防水带和消防设备是否配置在 位并立即可用？R数量足够、保持压 力、正确配置、可随 时使用6. The terminars fire-fighting equipment is positioned and ready for immediate use.岸方消防设备是否配置在位并立即可 用？R数量足够、保持压 力、正确配置、可随 时使用7. The ships cargo

31、and bunker hoses, pipelines and manifolds are in good condition, properly rigged and appropriate for the service intended.船方的货物、燃油软管/装卸臂是否处 于良好状态，装配是否合乎要求并适用 于预计的货物作业？全部螺丝上紧、安装 牢固可靠、温度压力 要求、标志清楚8. The terminars cargo and bunker hoses/arms are in good condition, properly rigged and appropriate for th

32、e service intended.岸方的货物、燃油软管/装卸臂是否处 于良好状态，装配是否合乎要求并适 用于预计的货物作业？全部螺丝上紧、安装 牢固可靠、温度压力 要求、标志清楚9. The cargo transfer system is sufficiently isolated and drained to allow safe removal of blank flanges prior to connection.接管前，货物转移系统是否有效隔离 并放残以能够安全地拆除盲板明确确认、方法得 当、避免污染和人身 伤害Bulk Liquid - General散装液体一普通Ship船

33、舶Terminal码头Code 代码Remarks备注Main point要点10. Scuppers and save alls, on board are effectively plugged and drip trays are in position and empty.船上的排水可有效塞堵，空的集液盘 放置到位。R严密堵塞，积水定期 排干、有固定式接油 盘11. Temporarily removed scupper plugs will be constantly monitored.临时移开下水孔需保持监控。密切监测、避免溢流 污染、及时密封12. Shore spill co

34、ntainment and sumps are correctly managed.岸方的溢油围堰和积油槽正确管理R码头围堰、接油盘13. The ships unused cargo and bunker connections are properly secured with blank flanges fully bolted.船方不用的货物、燃油管接头是否已 装妥盲板并上紧全部螺栓？14. The terminals unused cargo and bunker connections are properly secured with blank flanges fully bo

35、lted.岸方不用的货物、燃油管接头是否已 装妥盲板并上紧全部螺栓？15. All cargo, ballast and bunker tank lids are closed.所有货舱、压载舱和燃油舱舱盖都保 持关闭。1、各舱盖应有明显 标识；2、舱盖、观察孔 盖、测量孔盖密封胶 圈弹性良好无裂纹； 3、货舱盖必须关 闭，空距测量和取样 孔仅能短时间打开16. Sea and overboard discharge valves, when not in use, are closed and visibly secured.海底阀和舷外排出阀在不使用时是否 已关闭和确实关妥？货汕管道与压载

36、管系 是否联通，阀门遥控 设备明显识别17. All external doors, ports and windows in the accommodation, stores and machinery spaces are closed. Engine room vents may be open.居住舱室、储物间和机器处所的所有外 部门窗是否关闭？机舱的通风可 以打 开R标识字样明显、不得 上锁18. The ships emergency fire control plans are located externally.船舶紧急消防控制图是否放置在外 部？Location 位置摆放

37、位置显著、附船 员名单If the ship is fitted, or is required to be fitted, with an Inert Gas System (IGS) the following points should be physically checked:如船舶安装有，或要求安装惰气系统(IGS),下列各条应进行现场核查：Inert Gas System 惰气系统Ship船舶Terminal码头Code 代码Remarks 备注Main point要点19. Fixed IGS pressure and oxygen content recorders are

38、working.固定式的IGS压力和氧含量记录器正 常工作R接通电源，经过校准并且保 持有效运转20. All cargo tank atmospheres are at positive pressure with oxygen content of 8% or less by volume.所有货舱均为正压，体积氧含量W8%PR惰化油舱保持正压力、含氧 达标PART B - BULK LIQUID GENERAL - VERBAL VERIFICATIONB部分一散装普通液货一 口头确认Bulk Liquid - General散装液体一普通Ship船舶Terminal码头Code 代码R

39、emarks备注Main point要点21. The ship is ready to move under its own power.船舶能否随时靠自航移位？PR接到临时通知能依靠本船 的动力进行移船22. There is an effective deck watch in attendance on board and adequate supervision of operations on the ship and in the terminal.船上是否安排了有效的甲板值 班？码头和船上是否有足够的监 督人员？R不间断监督，保持有效沟 通、穿戴适当的防护服装 和防护设23.

40、There are sufficient personnel on board and ashore to deal with an emergency.船上和岸上是否有足够人员应付 紧急情况？R准备随时应急Bulk Liquid - General 散装液体一普通Ship船舶Terminal码头Code代码Remarks备注Main point要点24. The procedures for cargo, bunker and ballast handling have been agreed 货物、燃油和压载的装卸程序是否 已议定？AR作业划F议定并正式记录25. The emergenc

41、y signal and shutdown procedure to be used by the ship and shore have been explained and understood解释并理解船岸之间使用的应急 信号和应急关闭程序A说明停止作业的情况、考 虑可能的危险26. Material safety data sheets (MSDS) for the cargo transfer have been exchanged where requested.作业货物的物质安全数据单已按 要求进行交换如化学名称、俗称、UN号 码以及以体积百分比或ppm （视情况而定）形式表示

42、的有毒成分的最大浓度27. The hazards associated with toxic substances in the cargo being handled have been identified and understood.作业货物中所含有毒物质的相关 危害已辨识并清楚。H2S Content 二氧化硫含 量：Benzene Content 苯含量：.28. An International Shore Fire Connection has been provided. 已提供国际通岸接头该接头应当符合标准要 求，如在作业开始之前没 有实际连接，则在紧急情 况发生之时即可

43、供使用29. The agreed tank venting system will be used.将使用协议的货舱透气系统ARMethod 方法1、船岸双方协议的最大装 船速度不能超过船舶呼吸 透气系统通过能力；2、呼吸阀和旁通阀阀体良 好无裂纹，法兰连接密封 良好，呼吸阀手动检查活 络，旁通阀作业前关闭； 3、加以防护的空距测孔、 固定式透气系统、其它油 气系统通到岸上30. The requirements for closed operations have been agreed. 就封舱作业的要求达成协议R封闭监测、封闭量仓31. The operation of the P/V

44、 system has been verified.压力/真空系统的操作已核验排气阀正常运作32. Where a vapour return line is connected, operating parameters have been agreed.如接气相回流管，操作参数已达 成协议AR最高、最低工作压力Bulk Liquid - General散装液体一普通Ship船舶Terminal码头Code代码Remarks备注Main point要点33. Independent high level alarms, if fitted, are operational and have

45、been tested.如安装独立的高液位报警，处于 工作状态并经测试货舱局报、高高报、污水 舱高报、火灾报警器、可 燃气体报警器（用配备样 气进行实测）处于投用状 态34. Adequate electrical insulating means are in place in the ship/shore connection.船/岸接管处有足够的电气绝缘方 式安装绝缘法兰或非导电软 管35. Ship lines are fitted with a return valve or procedures to avoid pressure surge have been discussed. 船上是否