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| 第六版 船岸安全检查表和供油安全检查表（中英对照） |
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ISGOTT Checks pre-arrival Ship/Shore Safety Checklist ISGOTT船岸安全检查表之抵港
前检查Date and time日期/时间:___________________________________________
___________________________________________Port and berth港口及泊位: _
_________________________________________________________________
___________________ Tanker船舶: __________________________________
_______________________________________________________________ T
erminal码头: ______________________________________________________
_________________________________________ Product to be transfe
rred将装卸的货物名称: ___________________________________________________
________Part 1A. Tanker: checks pre-arrival表1A 船舶自检：抵港前检查Item项目Ch
eck检查Status状态Remarks备注1Pre-arrival information is exchanged抵港前信息已
交换? Yes2International shore fire connection is available国际通岸接头可用?
Yes3Transfer hoses are of suitable construction装卸货软管适合使用(如不适用须备注
)? Yes4Terminal information booklet reviewed 码头信息资料文本已评估? Yes5Pre
-berthing information is exchanged靠泊前信息已交换? Yes6Pressure/vacuum
valves and/or high velocity vents are operational 压力/真空阀和/或高速透气阀工
作正常? Yes7Fixed and portable oxygen analysers are operational固定式和便
携式氧份仪可用 ? YesPart 1B. Tanker: checks pre-arrival if using an iner
t gas system表1B 船舶自检：如使用惰性气体系统（IGS）的抵港前检查Item项目Check检查Status状态Re
marks备注8Inert gas system pressure and oxygen recorders are operat
ional惰性气体系统（IGS）压力及氧含量记录仪可用? Yes9Inert gas system and associated
equipment are operational 惰性气体系统（IGS）及其关联设备可用? Yes10Cargo tank at
mospheres’ oxygen content is less than 8%货舱氧含量低于8%（体积比）? Yes11Car
go tank atmospheres are at positive pressure 货舱气体压力处于正压状态? YesPar
t 2. Terminal: checks pre-arrival表2 终端自检：抵港前检查（码头使用表格）Item项目Check
检查Status状态Remarks备注12Pre-arrival information is exchanged抵港前信息已交换
? Yes13International shore fire connection is available国际消防通岸接头可
用? Yes14Transfer equipment is of suitable construction货物装卸设备适合本次作
业? Yes15Terminal information booklet transmitted to tanker 码头终端信息
手册已发送至来船? Yes16Pre-berthing information is exchanged靠泊前信息已交换 ? Ye
sISGOTT Checks after mooring Ship/Shore Safety ChecklistISGOTT船岸安
全检查表之系泊后检查Part 3. Tanker: checks after mooring表3 船舶自检：系泊后检查Item项目
Check检查Status状态Remarks备注17Fendering is effective靠垫有效? Yes18Moorin
g arrangement is effective 系泊布置有效? Yes19Access to and from the ta
nker is safe登离船舶通道安全 ? Yes20Scuppers and savealls are plugged甲板排水
孔（口）和集油槽（器）已封堵? Yes21Cargo system sea connections and overboard d
ischarges are secured 货物系统舷外连接及排舷外管道已隔断并安全有效? Yes22Very high freq
uency and ultra high frequency transceivers are set to low power
mode (4.11.6,4.13.2.2)VHF/UHF无线收发装备应处于低功率模式? Yes23External openin
gs in superstructures are controlled 上层建筑外部开口受控? Yes24Pumproom ve
ntilation is effective泵舱通风有效? Yes25Medium frequency/high frequenc
y radio antennae are isolated中高频电台天线已断开接地(如装有中高频电台) ? Yes26Accomm
odation spaces are at positive pressure 生活区内空间处于正压状态? Yes27Fire c
ontrol plans are readily available防火控制图随时可取用? YesPart 4. Terminal
: checks after mooring表4 终端自检：系泊后检查（码头使用表格）Item项目Check检查Status状态
Remarks备注28Fendering is effective碰垫有效? Yes29Tanker is moored acco
rding to the terminal mooring plan船舶已按码头终端系泊方案靠泊 ? Yes30Access to
and from the terminal is safe 登离码头终端通道安全? Yes31Spill containment
and sumps are secure溢油油槽和污水收集桶（池）已经备妥? YesISGOTT Checks pre-tran
sfer Ship/Shore Safety ChecklistISGOTT船岸安全检查表之货物装卸前检查Date and tim
e日期/时间: _________________________________________________________
__________________Port and berth港口/泊位: __________________________
_________________________________________________Tanker船舶: _____
_________________________________________________________________
_______________Terminal码头: ____________________________________
______________________________________________ Product to be tran
sferred将装卸的货物名称: _______________________________________________
___________Part 5A. Tanker and terminal: pre-transfer conference表
5A 船舶和码头终端合检：货物装卸前检查Item项目Check检查Tanker status船舶状况Terminal status
码头终端状况Remarks备注32Tanker is ready to move at agreed notice period船
舶已准备好在约定通知时间内离泊? Yes? Yes33Effective tanker and terminal communic
ations are established船舶与码头建立有效沟通联系? Yes? Yes34Transfer equipment
is in safe condition(isolated, drained and de-pressurised) (18.4
.1)装卸货设备处于安全状况(已隔离 、放残及泄压)? Yes? Yes35Operation supervision and w
atchkeeping is adequate 有合适的作业监控和值班安排? Yes? Yes36There are suffic
ient personnel to deal with an emergency有足够的人员处理紧急情况? Yes? Yes37S
moking restrictions and designated smoking areas are established已
确立烟火限制并指定吸烟场所? Yes? Yes38Naked light restrictions are established
已确立限制使用明火? Yes? Yes39Control of electrical and electronic devices
is agreed电气和电子设备的使用控制达成一致? Yes? Yes40Means of emergency escape f
rom both tanker and terminal are established 船舶和码头间紧急撤离的途径已建立? Ye
s? Yes41Firefighting equipment is ready for use 消防设备准备就绪随时可用? Yes
? Yes42Oil spill clean-up material is available 溢油清除材料就位? Yes? Ye
s43Manifolds are properly connected 所有管汇均已正确连接? Yes? Yes44Samplin
g and gauging protocols are agreed 取样及计量操作协议达成一致? Yes? Yes45Proce
dures for cargo, bunkers and ballast handling operations are agre
ed (21.4, 21.5,21.6)货物 、燃油加装和压载操作程序达成一致 ? Yes? Yes46Cargo transfe
r management controls are agreed货物装卸货管理控制达成一致? Yes? Yes47Cargo ta
nk cleaning requirements, including crude oil washing, are agreed
货舱洗舱要求包括原油洗舱达成一致(如装有原油洗舱系统 ,进行原油洗舱时)? Yes? YesPart 5A. Tanker and
terminal： pre-transfer conference (cont.)表5A 船舶和码头终端合检：货物装卸前检查（续
上页）Item项目Check检查Tanker status船舶状况Terminal status码头终端状况Remarks备注48
Cargo tank gas freeing arrangements agreed货舱 除气操作达成一致? Yes? Yes49
Cargo and bunker slop handling requirements agreed货物 、燃油 、污油操作达成一
致? Yes? Yes50Routine for regular checks on cargo transferred are
agreed装卸货期间定期常规检查达成一致? Yes? Yes51Emergency signals and shutdown p
rocedures are agreed 应急信号及应急停止程序达成一致? Yes? Yes52Safety data sheet
s are available 化学品安全数据说明书可供使用? Yes? Yes53Hazardous properties of
the products to be transferred are discussed输送货品的危险特性信息已识别交换? Ye
s? Yes54Electrical insulation of the tanker/terminal interface is
effective油船/码头界面的绝缘隔绝有效? Yes? Yes55Tank venting system and close
d operation procedures are agreed油舱透气系统及关闭操作程序达成一致 ? Yes? Yes56Va
pour return line operational parameters are agreed蒸气回收管线的操作程序已达成一
致? Yes? Yes57Measures to avoid back-filling are agreed避免回流的措施已采取?
Yes? Yes58Status of unused cargo and bunker connections is satis
factory不在使用的货物和燃料的管线连接启闭正常? Yes? Yes59Portable very high frequenc
y and ultra high frequency radios are intrinsically safe 便携式 VHP/
UHF无线电对讲机防爆安全型? Yes? Yes60Procedures for receiving nitrogen from
terminal to cargo tank are agreed 从码头接收氮气惰化货舱的操作程序已商定(如使用码头惰化作业时)
? Yes? YesAdditional for chemical tankersChecks pre-transfer化学品
船的附加项目 装卸前检查Part 5B. Tanker and t
erminal: bulk liquid chemicals. Checks pre-transfer表5B 船舶和码头终端合检：
散装化学品，货物装卸前检查Item项目Check检查Tanker status船舶状况Terminal status码头终端状况R
emarks备注61Inhibition certificate received (if required) from manu
facturer已收到制造商提供的抑制剂证书(如需要)? Yes? Yes62Appropriate personal prote
ctive equipment identified and available识别并提供适当的个人防护装备（PPE） ? Yes
? Yes63Countermeasures against personal contact with cargo are ag
reed防止人员接触货物的措施达成一致? Yes? Yes64Cargo handling rate and relationsh
ip with valve closure times and automatic shutdown systems is agr
eed货物装卸速率与阀门关闭时间已商定或与自动关闭系统(如装有)的启闭动作已一致? Yes? Yes65Cargo system
gauge operation and alarm set points are confirmed货物系统仪表正常 ,且报警点设
置确认? Yes? YesPart 5B. Tanker and terminal: bulk liquid chemicals.
Checks pre-transfer (cont.)表5B 船舶和码头终端合检：散装液体化学品，货物装卸前检查（续上页）Ite
m项目Check检查Tanker status船舶状况Terminal status码头终端状况Remarks备注66Adequa
te portable vapour detection instruments are in use有足够的便携式气体 检测设备
供使用? Yes? Yes67Information on firefighting media and procedures i
s exchanged 灭火介质和灭火程序信息已交换? Yes? Yes68Transfer hoses confirmed su
itable for the product being handled装卸货软管确认适合待装卸货品? Yes? Yes69Con
firm cargo handling is only by a permanent installed pipeline sys
tem确认货物装卸仅通过永久安装的管线系统? Yes? Yes70Procedures are in place to recei
ve nitrogen from the terminal for inerting or purging(12.1.14.8)从
码头接收氮气用以惰化或驱气的程序已就绪(如使用码头惰化作业时)? Yes? YesAdditional for gas tanke
rsChecks pre-transfer 气体船附加项目 装卸前
检查Part 5C. Tanker and terminal: liquefied gas. Checks pre-transfe
r表5C 船舶和终端合检：液化气体，货物装卸前检查Item项目Check检查Tanker status船舶状况Terminal s
tatus码头终端状况Remarks备注71Inhibition certificate received (if require
d) from manufacturer已收到制造商提供的抑制剂证书（如需要）? Yes? Yes72Water spray sy
stem is operational喷淋水系统工作正常。 ? Yes? Yes73Appropriate personal pr
otective equipment is identified and available识别并提供适当的个人防护装备（PPE）
? Yes? Yes74Remote control valves are operational遥控阀工作正常? Yes? Ye
s75Cargo pumps and compressors are operational货泵及压缩机工作正常? Yes? Ye
s76Maximum working pressures are agreed between tanker and termin
al船舶和码头终端之间就最大工作压力已经议定。? Yes? Yes77Reliquefaction or boil-off con
trol equipment is operational再液化或蒸发控制设备工作正常? Yes? Yes78Gas detect
ion equipment is appropriately set for the cargo 气体检测设备已针对所载货物设置完
毕? Yes? Yes79Cargo system gauge operation and alarm set points ar
e confirmed货物液位系统运行状态和报警设置已确认 ? Yes? Yes80Emergency shutdown syst
ems are tested and operational应急切断系统已测试且工作正常? Yes? Yes81Cargo han
dling rate and relationship with valve closure times and automati
c shutdown systems is agreed货物装卸速率、阀门关闭时间和自动切断系统之间的关系已经议定。? Yes?
Yes82Maximum/minimum temperatures/pressuresof the cargo to be tra
nsferred are agreed拟装卸货物的最大/最小、温度/压力已经议定? Yes? Yes83Cargo tank re
lief valve settings are confirmed货舱释放阀设置已确认? Yes? YesPart 6. Tank
er and terminal: agreements pre-transfer表6 船舶和码头终端合检：货物装卸前的协议Part
5 item表5项目Agreement协议Details详情Tanker initials船舶确认Terminal initia
ls码头确认32Tanker manoeuvring readiness船舶可操纵备妥时间Notice period (maxim
um) for full readiness to manoeuvre从（接到）通知开始到船舶备妥依自身动力离泊所需的最长时间：P
eriod of disablement (if permitted)无法随时依自身动力离泊的时限（如允许）:33Security
protocols保安协议Security level保安等级:Local requirements地方要求:33Effecti
ve tanker/terminal communications系统有效的船舶/码头通信Primary system主系统: B
ackup system备用系统:35Operational supervision and watch-keeping操作期间的
监控和值班Tanker船舶: Terminal码头:3738Dedicated smoking areas and naked l
ights restrictions指定吸烟区和限制使用明火Tanker船舶: Terminal码头:45Maximum wind
, current and sea/swell criteria or other environmental factors最大
的风 、流 、浪/涌或其他环境因素条件限制Stop cargo transfer停止货物装卸: Disconnect拆管:Unbe
rth离泊:4546Limits for cargo, bunkers and ballast handling货物 、燃油加装及
压载装卸操作限制Maximum transfer rates最大装卸速率： Topping-off rates平舱（或称收舱）速率
：Maximum manifold pressure管汇最大压力：Cargo temperature货物温度：Other limi
tations其他限制：Part 6. Tanker and terminal: agreements pre-transfer
(cont.)表6 船舶和码头终端合检：货物装卸前的协议（续上页）Part 5 item表5项目Agreement协议Detail
s详情Tanker initials船舶Terminal initials终端4546Pressure surge control
装卸过程中的压力控制Minimum number of cargo tanks open: 最少打开的货舱数量：Tank swit
ching protocols: 换舱控制：Full load rate: 满负荷速率：Topping-off rate:平舱（或
称收舱）速率：Closing time of automatic valves:自动阀关闭所需时间：46Cargo transfe
r management procedures货物装卸管理程序Action notice periods: 需提前通知的情形和时间
：Transfer stop protocols:装卸货停止的情形和时间：50Routine for regular checks
on cargo transferred are agreed货物装卸期间需要进行定期查核船岸数据已经议定。 Routine t
ransferred quantity checks:船岸定期核对货物装卸数量：51Emergency signals商定的应急信
号Tanker 船舶：Terminal码头：55Tank venting system货油舱透气系统控制Procedure: 控制
程序55Closed operations透气系统的关闭操作Requirements: 要求56Vapour return lin
e蒸气回收管线Operational parameters 运行使用条件：Maximum flow rate最大流速：60Nitr
ogen supply from terminal来自码头的氮气(如使用码头惰化作业时)Procedures to receive
接收程序： Maximum pressure 最大压力：Flow rate流速： Part 6. Tanker and termi
nal: agreements pre-transfer (cont.)表6 船舶和码头终端合检：货物装卸前的协议（续上页）Par
t 5 item表5项目Agreement协议Details细节Tanker initials船舶Terminal initial
s码头83For gas tanker only:仅适用于气体船Cargo tank relief valve settings货
舱释放阀设置Tank 1: 1号货舱Tank 2: 2号货舱 Tank 3: 3号货舱Tank 4: 4号货舱Tank 5:5号货
舱Tank 6: 6号货舱Tank 7: 7号货舱Tank 8: 8号货舱Tank 9: 9号货舱Tank10: 10号货舱XXE
xceptions and additions免除和附加项Special issues that both parties sho
uld be aware of:双方应注意的特殊问题Date and time日期/时间: ___________________
______________________________________________________Port and be
rth港口/泊位: _______________________________________________________
__________________Tanker船舶: ____________________________________
_______________________________________________Terminal码头: ____
_________________________________________________________________
____________Product to be transferred拟装卸的货物名称: _________________
________________________________________Part 7A. General tanker:
checks pre-transfer表7船舶通用表：货物装卸前检查Item项目Check检查Status状态Remarks备注8
4Portable drip trays are correctly positioned and empty移动式积油容器（盘）
清空就位? Yes85Individual cargo tank inert gas supply valves are secu
red for cargo plan各货舱惰气阀(或透气阀)已按作业计划约定设置? Yes86Inert gas system d
elivering inert gas with oxygen content not more than 5%惰气系统输送的惰气
氧含量不超过 5%(如使用惰气系统) ? Yes87Cargo tank high level alarms are opera
tional货舱高位报警装置工作正常? Yes88All cargo, ballast and bunker tanks open
ings are secured所有货物、压载舱和燃油舱的开口都已妥善封闭 ? YesXXExceptions and addit
ions免除和附加项? YesPart 7B. Tanker: checks pre-transfer if crude oil
washing is planned表7B船舶自检：如果计划进行原油洗舱，货物装卸前检查Item项目Check检查Status状态
Remarks备注89The completed pre-arrival crude oil washing checklist,
as contained in the approved crude oil washing manual, is copied
to terminal.填写经批准的原油洗舱手册中所载的抵港前原油洗舱检查表 ,备份码头和主管机关? Yes 90Crude o
il washing checklists for use before, during and after crude oil
washing are in place ready to complete, as contained in the appro
ved crude oil washing manual.经认可的原油洗舱手册中用于原油洗舱的洗舱前 、洗舱过程中及洗舱后的检查表
备妥? YesXXExceptions and additions免除和附加项? YesISGOTT Checks after p
re-transfer conference Ship/Shore Safety Checklist ISGOTT船岸安全检查表之
船岸会议后（货物装卸前）的检查For tankers that will perform tank cleaning alongs
ide and/or gas freeing alongside用于将执行靠泊洗舱和/或靠泊除气的船舶Part 7C. Tanke
r: checks prior to tank cleaning and/or gas freeing表7C船舶自检：洗舱和/或除
气前检查Item项目Check检查Status状态Remarks备注91Permission for tank cleaning
operations is confirmed 洗舱作业的许可已获批 ? Yes92Permission for gas free
ing operations is confirmed 除气作业的许可已获批? Yes93Tank cleaning proced
ures are agreed洗舱程序已达成一致? Yes94If cargo tank entry is required, p
rocedures for entry have been agreed with the terminal如需下舱作业 ,码头已
同意下舱程序? Yes95Slop reception facilities and requirements are confi
rmed污水接受设施及要求已确认? YesDeclaration声明We the undersigned have checked
the items in the applicable parts 1 to 7 as marked and signed be
low:我们， 下面签名者，已经对以下1至7适用的表格项目标注并进行了检查和签名。Tanker船舶Terminal码头终端Part
1A.Tanker: checks pre-arrival 船舶自检：抵港前检查??Part 1B. Tanker: chec
ks pre-arrival if using an inert gas system 船舶自检：如使用惰气系统(IGS)抵港前检
查??Part 2. Terminal: checks pre-arrival 码头终端自检：抵港前检查??Part 3. Tan
ker: checks after mooring 船舶自检：系泊后检查??Part 4. Terminal: checks a
fter mooring 码头终端自检：系泊后检查??Part 5A. Tanker and terminal: pre-tran
sfer conference 船舶和码头终端：货物装卸前船岸会议??Part 5B. Tanker and terminal:
bulk liquid chemicals. Checks pre-transfer 船舶和码头终端合检：散装液体化学品，货物装
卸前检查??Part 5C. Tanker and terminal: liquefied gas. Checks pre-tra
nsfer 船舶和码头终端合检：液化气体，货物装卸前检查??Part 6. Tanker and terminal: agreem
ents pre-transfer 船舶和码头终端合检：货物装卸前船岸协议??Part 7A. General tanker:
checks pre-transfer 通用（油/化/气）：货物装卸前检查??Part 7B. Tanker: checks pr
e-transfer if crude oil washing is planned 船舶自检：如计划进行原油洗舱，货物装卸前
检查??Part 7C. Tanker: checks prior to tank cleaning and/or gas fre
eing 船舶自检：洗舱和/或除气前检查??In accordance with the guidance in chapter
25 of ISGOTT, we have satisfied ourselves that the entries we hav
e made are correct to the best of our knowledge and that the tank
er and terminal are in agreement to undertake the transfer operat
ion.We have also agreed to carry out the repetitive checks noted
in parts 9 and 10 of the ISGOTT SSSCL, which should occur at inte
rvals of not more than hours for the tanker and not more than
hours for the terminal.If, to our knowledge, the status of any i
tem changes, we will immediately inform the other party.根据ISGOTT第
25章指南，我们确信我们所填写的内容尽我们所知是正确的，而且船舶和码头终端同意进行货物装卸作业。我们也同意ISGOTT的船岸安全检
查表第9、10部分所述的重复检查项目，检查的间隔船上不应超过 ________小时，码头终端不应超过 ________小时。如果我
们获知任何项目的状态发生变化，将立即通知另一方。Tanker船舶Terminal码头终端Name姓名Name姓名Rank职务Pos
ition职位Signature签名Signature签名Date日期Date日期Time时间Time时间ISGOTT Check
s during transfer Ship/Shore Safety ChecklistISGOTT船岸安全检查表之货物装卸期间
的检查Repetitive checks重复检查Part 8. Tanker: repetitive checks during
and after transfer表8 船舶自检：货物装卸期间和完成后的重复检查Item ref参照条款Check检查Time时
间Time时间Time时间Time时间Time时间Time时间Remarks备注Interval time间隔:……………. hr
s8Inert gas system pressure and oxygen recording operational惰气系统(
IGS) 压力及氧含量记录仪正常(如安装惰 气系统) ? Yes? Yes? Yes? Yes? Yes? Yes9Inert g
as system and all associated equipment are operational惰气系统（IGS）所有
关联设备正常(如安装惰气系统或使用码头惰化作业时)? Yes? Yes? Yes? Yes? Yes? Yes11Cargo ta
nk atmospheres are at positive pressure货舱处于正压状态? Yes? Yes? Yes? Y
es? Yes? Yes18Mooring arrangement is effective系泊布置有效? Yes? Yes? Y
es? Yes? Yes? Yes19Access to and from the tanker is safe登离船舶通道安全?
Yes? Yes? Yes? Yes? Yes? Yes20Scuppers and savealls are plugged甲
板排水孔（口）及集油水槽（器）已封堵? Yes? Yes? Yes? Yes? Yes? Yes23External openin
gs in superstructures are controlled上层建筑外部开口受控? Yes? Yes? Yes? Ye
s? Yes? Yes24Pumproom ventilation is effective泵舱通风有效? Yes? Yes? Y
es? Yes? Yes? Yes32Tanker is ready to move at agreed notice perio
d船舶获得通知后能在约定的时段内离泊? Yes? Yes? Yes? Yes? Yes? Yes28Fendering is ef
fective碰垫有效? Yes? Yes? Yes? Yes? Yes? Yes33Communications are eff
ective通讯畅通? Yes? Yes? Yes? Yes? Yes? Yes35Supervision and watch k
eeping is adequate有充足的监控及值班人员? Yes? Yes? Yes? Yes? Yes? Yes36Suff
icient personnel are available to deal with an emergency有足够人员处理紧急
情况? Yes? Yes? Yes? Yes? Yes? Yes 37Smoking restrictions and desig
nated smoking areas are complied with遵守吸烟限制和指定吸烟场所规定? Yes? Yes? Y
es? Yes? Yes? Yes38Naked light restrictions are complied with遵守限制
使用明火规定? Yes? Yes? Yes? Yes? Yes? YesPart 8. Tanker: repetitive ch
ecks during and after transfer (cont.) 表8 船舶自检：货物装卸期间和完成后的重复检查（续
上页）39Control of electrical devices and equipment in hazardous zon
es is complied with遵守危险区域电气设备和装置控制规定? Yes? Yes? Yes? Yes? Yes? Ye
s40414251Emergency response preparedness is satisfactory应急准备令人满意?
Yes? Yes? Yes? Yes? Yes? Yes 54Electrical insulation of the tank
er/terminal interface is effective船舶/码头界面绝缘隔绝有效? Yes? Yes? Yes? Y
es? Yes? Yes55Tank venting system and closed operation procedures
are as agreed货舱透气系统和封闭操作程序按约定执行? Yes? Yes? Yes? Yes? Yes? Yes85I
ndividual cargo tank inert gas valves settings are as agreed各货舱惰气
阀或透气阀已按约定设置? Yes? Yes? Yes? Yes? Yes? Yes86Inert gas delivery mai
ntained at not more than 5% oxygen输送的惰气氧含量不超过(体积分数)(如使用惰气系统)5% ?
Yes? Yes? Yes? Yes? Yes? Yes87Cargo tank high level alarms are o
perational货舱高位报警功能正常? Yes? Yes? Yes? Yes? Yes? YesInitials签名Part
9. Terminal: repetitive checks during and after transfer 表9 码头终端自
检：货物装卸期间和完成后的重复检查Item ref参照条款Check检查Time 时间Time 时间Time 时间Time 时间T
ime 时间Time 时间Remarks备注Interval time间隔:………. hrs18Mooring arrangeme
nt is effective系泊布置有效? Yes? Yes? Yes? Yes? Yes? Yes19Access to an
d from the terminal is safe登离码头终端的通道安全? Yes? Yes? Yes? Yes? Yes?
Yes28Fendering is effective碰垫可用? Yes? Yes? Yes? Yes? Yes? Yes32Sp
ill containment and sumps are secure溢油容器及集油槽备妥? Yes? Yes? Yes? Ye
s? Yes? Yes33Communications are effective通信畅通? Yes? Yes? Yes? Yes
? Yes? Yes35Supervision and watchkeeping is adequate有充足的监控及值班人员?
Yes? Yes? Yes? Yes? Yes? Yes36Sufficient personnel are available
to deal with an emergency有足够人员处理紧急状况? Yes? Yes? Yes? Yes? Yes? Ye
s37Smoking restrictions and designated smoking areas are complied
with遵守吸烟限制和指定吸烟场所规定? Yes? Yes? Yes? Yes? Yes? Yes38Naked light r
estrictions are complied with遵守限制使用明火规定? Yes? Yes? Yes? Yes? Yes?
Yes39Control of electrical devices and equipment in hazardous zo
nes is complied with遵守危险区域电气设备和装置控制规定? Yes? Yes? Yes? Yes? Yes? Y
es4041 4251Emergency response preparedness is satisfactory应急准备令人满
意? Yes? Yes? Yes? Yes? Yes? Yes54Electrical insulation of the tan
ker/terminal interface is effective船舶/码头终端界面绝缘隔绝有效? Yes? Yes? Yes
? Yes? Yes? Yes55Tank venting system and closed operation procedu
res are as agreed货舱透气系统和封闭操作程序按约定执行? Yes? Yes? Yes? Yes? Yes? Yes
Initials签名ISGOTT Bunker checklist: pre-arrivalISGOTT供油安全检查表之抵达前检查
Date and time日期和时间: _____________________________________________
_____________________________________ Port and berth港口和泊位: _____
_________________________________________________________________
___________ Receiving ship受油船: __________________________________
____________________________________________________ Bunker facil
ity供油设施: _______________________________________________________
______________________________ Part A. Checks at the planning st
age for the receiving ship表A 受油船在计划阶段进行的自检Item项目Check检查Status状态Re
marks备注1Necessary permissions are granted被授予必要的作业许可□Yes2Local req
uirements are observed已获取并遵守当地要求□Yes3All personnel are aware of o
perations所有人员都熟悉加油作业程序 □Yes4Bunker plan is exchanged燃油加装计划已交换□Yes
5Mooring and fendering arrangement is agreed系泊和碰垫的布置已经议定□YesPart
B. Checks at the planning stage for the bunker facility表B 供油设施在计
划阶段的自检Item项目Check检查Status状态Remarks备注6Necessary permissions are gr
anted 被授予必要的作业许可□Yes7Local requirements are observed已获取并遵守当地要求□Ye
s8All personnel are aware of operations所有人员都熟悉加油作业□Yes9Bunker pla
n is exchanged燃油加装计划已交换□Yes10Mooring and fendering arrangement is
agreed系泊和碰垫的布置已经议定□YesISGOTT Bunker checklist: checks after moor
ing ISGOTT供油安全检查表之系泊后检查Date and time日期和时间: ______________________
_____________________________________________________________ P
ort and berth港口和泊位: _____________________________________________
______________________________________ Receiving ship受油船: ______
_________________________________________________________________
_______________ Bunker facility供油设施: _________________________
_____________________________________________________________ P
art C. Checks after mooring for the receiving ship表C 受油船系泊后的自检Ite
m项目Check检查Status状态Remarks备注11Fenders are effective碰垫有效□Yes12Moori
ng is effective 系泊有效□Yes13Access between ship and facility is saf
e 受油船与供油设施间的通道安全□YesPart D. Checks after mooring for the bunker f
acility表D 供油设施系泊后的自检Item项目Check检查Status状态Remarks备注14Fenders are
effective碰垫有效□Yes15Mooring is effective系泊有效□Yes16Access between s
hip and facility is safe受油船与供油设施间的通道安全□YesISGOTT Bunker checklist
: pre-transfer conference ISGOTT供油安全检查表之加装前会议Date and time日期和时间:
_________________________________________________________________
___________________ Port and berth港口和泊位: _______________________
_____________________________________________________________ R
eceiving ship受油船: _______________________________________________
_________________________________________ Bunker facility供油设施: __
_________________________________________________________________
___________________ Part E. Pre-transfer conference表E 驳油作业前会议Ite
m项目Check检查Receiving ship status受油船Bunker facility status 供油设施Rema
rks备注17Effective communications are established已建立有效沟通□Yes□Yes18B
unker watch is established 已设立加油值守人员□Yes□Yes19Smoking restriction
s and designated smoking areas are established已设立吸烟限制规定和指定的吸烟场所□Y
es□Yes20Naked light restrictions are established限制使用明火作业规定已设立□Yes
□Yes21Safety data sheets are available化学品安全数据说明书可供使用□Yes□Yes22Haz
ardous properties of the product to be transferred identified in
the safety data sheet are discussed拟加装的油品安全数据表中识别出的危险特性已讨论□Yes□Ye
sAS1. Agreement sheet part 1表AS1 协议表 第1部分Bunkers to be transferre
d 拟加装的燃油量 (21.4, 21.5, 21.6)Product and grade油品名称和等级Tonnes吨Volume
(in m3) at loading temperature加装温度下的体积(m3)Loading temperature加装温度
Maximum transfer rate最大转驳速率Maximum line pressure管路最大压力AS2. Agreem
ent sheet part 2表AS2 协议表 第2部分Bunker tanks to be loaded (volume in
m3) 受油舱预计加装体积（m3 ）(21.4, 21.5, 21.6)Tank number油舱号Product and gr
ade油品名称和等级Capacity of tank(volume in m3)油舱容积（m3）Volume of oil in
the tank before bunkering加装前存油量Free capacity of tank(volume in m3
)油舱可装量Volume (in m3)to be loaded拟加装量（m3）Final volume(in m3)最终体积（m
3）AS3. Agreement sheet part 3表AS2 协议表 第3部分Operational management
controls操作管理控制Item ref项目参考Agreement协议Details细节Receiving ship ini
tials受油船签名Bunker facility initials供油设施签名17Process for starting tr
ansfer加装起始程序Initial flow rate:初始速率Increase of flow to full rate:提
升至最大速率Quantity transferred check intervals:加装数量定期比对间隔18Process fo
r completing transfer结束加装程序Slowdown of flow: 降低速率：Transfer stop:结
束程序：ISGOTT Bunker checklist: pre-bunkering ISGOTT供油安全检查表之燃油加装前检查D
ate and time日期和时间: ______________________________________________
______________________________________ Port and berth港口和泊位: ___
_________________________________________________________________
_______________ Receiving ship受油船: __________________________
_____________________________________________________________ Bu
nker facility供油设施: ______________________________________________
_______________________________________Part F. Receiving ship: te
chnical checks before bunkering表F 受油船自检：加装前的技术检查Item项目Check检查Stat
us状态Remarks备注23Electrical insulation is effective电气绝缘有效□Yes24Bunk
er transfer equipment: 加装设备检查 ? is in good condition状态良好? is ap
propriate 适用? line up is checked管线布置已检查? is properly rigged软管已正
确悬挂? is secured to manifolds软管已固定于管汇? is fully bolted供受油接口上满螺栓□
Yes25Firefighting equipment is ready for use消防设备随时可用□Yes26Scupper
s and savealls are plugged排水孔及集油器已封堵□Yes27Portable drip trays are
correctly positioned and empty移动式积油盘清空就位□Yes28Unused bunker conn
ections are blanked and fully bolted未使用的燃油接口已盲封且上满螺栓 □Yes29High l
evel and overfill alarm units are operational高位、溢流（高高位）报警设备功能正常 □
Yes30Bunker operation emergency stop is operational加油操作紧急关停设备功能正常
□Yes31Bunker tank openings are closed燃油舱开口均已关闭 □Yes32Oil spill cl
ean-up material is available溢油清除材料就位□Yes33Medium frequency/high f
requency radio antennae are isolated中高频无线电电台天线已隔离□Yes34Very high
frequency and ultra high frequency transceivers are set to low po
wer modeVHF/UHF无线收发装备应处于低功率模式□YesISGOTT Bunker checklist: pre-bun
kering ISGOTT供油安全检查表之燃油加装前检查Date and time日期和时间: _________________
_________________________________________________________________
_ Port and berth港口和泊位: __________________________________________
_________________________________________ Receiving ship受油船: __
_________________________________________________________________
____________________ Bunker facility供油设施: ______________________
________________________________________________________________
Part G. Bunker facility: technical checks before bunkering表G供油设施自
检：供油前技术检查Item项目Check检查Status状态Remarks备注35Electrical insulation is
effective电气绝缘有效□Yes36Bunker transfer equipment:加装设备检查? is in go
od condition状态良好? is appropriate适用? line up is checked管线布置已检查?
is properly rigged软管已正确悬挂? is secured to manifolds软管已固定于管汇? is
fully bolted供受油接口上满螺栓□Yes 37Firefighting equipment is ready for
use消防设备随时可用□Yes38Scuppers and savealls are plugged 排水孔及集油器已封堵□Yes
39Portable drip trays are correctly positioned and empty移动式积油盘清空就
位□Yes40Unused bunker connections are blanked and fully bolted未使用的
燃油接口已盲封且上满螺栓□Yes41High level and overfill alarm units are operati
onal高位、溢流（高高位）报警设备功能正常□Yes42Bunker operation emergency stop is op
erational加油操作紧急关停设备功能正常□Yes43Bunker tank openings are closed燃油舱开口
均已关闭□Yes44Oil spill clean-up material is available溢油清除材料就位 □Yes45
Medium frequency/high frequency radio antennae are isolated 中高频无线
电电台天线已隔离□Yes46Very high frequency and ultra high frequency transc
eivers are in low power mode (4.11.6,4.13.2.2)VHF/UHF无线收发装备应处于低功率
模式□YesISGOTT Bunker checklist: repetitive checks ISGOTT供油安全检查表之重复
检查Date and time日期和时间: ___________________________________________
_________________________________________ Port and berth港口和泊位: _
_________________________________________________________________
__________________ Receiving ship受油船: ________________________
________________________________________________________________
Bunker facility供油设施: ___________________________________________
___________________________________________ Part H. Receiving s
hip: repetitive checks during bunkering表H 受油船：加油期间重复检查内容Item refC
heck检查Time时间Time时间Time时间Time时间Time时间Time时间Remarks备注Interval time间
隔：……… …. Hrs11Fendering is effective碰垫有效□Yes□Yes□Yes□Yes□Yes□Yes1
2Mooring arrangement is effective系泊布置有效□Yes□Yes□Yes□Yes□Yes□Yes13
Access between ship and bunker facility is safe船舶与供油设施间通道安全□Yes□Y
es□Yes□Yes□Yes□Yes17Communications are effective通讯有效通畅□Yes□Yes□Ye
s□Yes□Yes□Yes19Smoking restrictions and designated smoking areas
are complied with遵守吸烟限制和指定吸烟场所规定□Yes□Yes□Yes□Yes□Yes□Yes20Naked l
ight restrictions are complied with遵守限制使用明火规定□Yes□Yes□Yes□Yes□Yes
□Yes26Scuppers and savealls are plugged 排水孔及集油器已封堵□Yes□Yes□Yes□Ye
s□Yes□YesAS3Bunker tank contents are monitored燃油舱容量变化被监控□Yes□Yes□
Yes□Yes□Yes□YesInitials签名ISGOTT Bunker checklist: repetitive chec
ks ISGOTT供油安全检查表之重复检查Date and time日期和时间: ________________________
____________________________________________________________ Por
t and berth港口和泊位: _______________________________________________
_____________________________________ Receiving ship受油船: _____
_________________________________________________________________
__________________ Bunker facility供油设施: ________________________
______________________________________________________________ Pa
rt I. Bunker facility: repetitive checks during bunkering表I 供油设施：
加油期间重复检查Item refCheck检查Time时间Time时间Time时间Time时间Time时间Time时间Observ
ation观察项Interval time间隔:……… …. Hrs14Fendering is effective碰垫有效□Ye
s□Yes□Yes□Yes□Yes□Yes15Mooring arrangement is effective系泊布置有效□Yes
□Yes□Yes□Yes□Yes□Yes16Access between ship and bunker facility is
safe船舶与供油设施间通道安全□Yes□Yes□Yes□Yes□Yes□Yes17Communications are effe
ctive通讯有效通畅□Yes□Yes□Yes□Yes□Yes□Yes19Smoking restrictions and des
ignated smoking areas are complied with遵守吸烟限制和指定吸烟场所规定□Yes□Yes□Ye
s□Yes□Yes□Yes20Naked light restrictions are complied with遵守限制使用明火
规定□Yes□Yes□Yes□Yes□Yes□Yes38Scuppers and savealls are plugged 落水孔
及集油器已封堵□Yes□Yes□Yes□Yes□Yes□YesAS3Bunker tank contents are monito
red燃油舱容量变化被监控□Yes□Yes□Yes□Yes□Yes□YesInitials签名ISGOTT Bunker chec
klist: post-bunkeringISGOTT供油安全检查表之供油后检查Date and time日期和时间: _____
_________________________________________________________________
______________ Port and berth港口和泊位: ____________________________
_______________________________________________________ Receiv
ing ship受油船: ____________________________________________________
___________________________________ Bunker facility供油设施: ______
_________________________________________________________________
______________ Part J. Receiving ship: checks before disconnecti
ng表J 受油船：拆管前检查Item项目Check检查Status状态Remarks备注47Bunker hoses, fixed
pipelines and manifolds are drained加油软管，固定管路及管汇残液已排空 (12.1.14, 1
8.4, 24.2)□Yes48Remote and manually controlled valves are closed
遥控及手动控制阀均已关闭 (12.1.6.17, 12.1.14.3, 23.7.6)□YesPart K. Bunkering facility: checks before disconnecting表K 供油设施：拆管前检查Item项目Check检查Status状态Remarks备注49Bunker hoses, fixed pipelines and manifolds are drained加油软管，固定管路及管汇残液已排空(12.1.14, 18.4, 24.2)□Yes50Remote and manually controlled valves are closed遥控及手动控制阀均已关闭(12.1.6.17, 12.1.14.3, 23.7.6)□YesDeclaration声明We the undersigned have checked the items in the applicable parts A to G as marked and signed below:我们， 下面签名者，已经对以下A至G适用的表格项目标注并进行了检查和签名。 Receiving ship受油船Bunker facility供油设施Part A. Checks at the planning stage for the receiving ship 表A 受油船在计划阶段进行的检查??Part B. Checks at the planning stage for the bunker facility 表B 供油设施在计划阶段的检查??Part C. Checks after mooring for the receiving ship 表C 受油船系泊后检查??Part D. Checks after mooring for the bunker facility 表D 供油设施系泊后检查??Part E. Pre-transfer conference 表 E 加装作业前会议??Part F. Receiving ship: technical checks before bunkering 表F 受油船自检：加装前的技术检查??Part G. Bunker facility: technical checks before bunkering 表G供油设施：加装前技术检查??In accordance with the guidance noted in chapter 24 of ISGOTT, we are satisfied that the entries we have made are correct to the best of our knowledge and that the receiving ship and bunker facility are in agreement to undertake the transfer operation.根据ISGOTT第24章指南，我们确信我们所填写的内容尽我们所知是正确的，而且受油船和供油船同意进行驳油作业。We have also agreed to carry out the repetitive checks noted in parts H and I of the ISGOTT bunker checklist, which should occur at intervals of not more than hours for the receiving ship and not more than hours for the bunker facility.我们也同意ISGOTT的加油安全检查表H、I所述的重复检查项目，检查的间隔受油船不应超过________小时，供油船不应超过_______ 小时。If, to our knowledge, the status of any item changes, we will immediately inform the other party.如果我们获知任何项目的状态发生变化，将立即通知另一方。 Receiving ship受油船Bunker facility供油设施Name姓名Name姓名Rank职务Position职位Signature签名Signature签名Date日期Date日期Time时间Time时间To be completed after any transfer operation: 每次加油作业完成后应执行 Receiving ship受油船Bunker facility供油设施Part J. Receiving ship: checks before disconnecting受油船：拆管前检查??Part K. Bunkering facility: checks before disconnecting供油设施：拆管前检查?? Receiving ship受油船Bunker facility供油设施Name姓名Name姓名Rank职务Position职位Signature签名Signature签名Date日期Date日期Time时间Time时间ISGOTT Sixth Edition 2 of 27? ICS/OCIMF 2020 27 of 27? ICS/OCIMF 2020 |
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