This report may be used by surveyors to record the inspection of a vessel in accordance with the requirements of AMSA EX40. If after survey the surveyor is satisfied with the vessel and equipment, this form may be used to make a recommendation to the National Regulator advising that the vessel is fit for purpose.

Survey location	Date of survey

Vessel details

Vessel name	Displayed unique identifier	AMSA issued UVI

Hull material	Hull form (mono, cat etc.)	Maximum speed (kts)

Drive type (outboard / stern drive / screw / jet)	Engine make / model	Number of engines and power (kW)

Length (m)	Breadth (m)	Depth (m)

Service Category	Crew	Special persons

Choose an item.
Choose an item.
Choose an item.

Construction

Describe the intended purpose including any operational restrictions such as distance to home base, wave height or wind speed considered in the determination that the vessel construction is fit for purpose:

I am satisfied that the vessels design is fit for the intended purpose	☐ Yes	☐ No

I am satisfied that the vessels construction is fit for the intended purposes	☐ Yes	☐ No

Vessel construction deemed fit for purpose based on a record of at least five years’ history of safe operation	☐ Yes	☐ No

Note: Where history of safe operation is used, supporting documentation must be supplied to AMSA. Ref SAGM 7.5.2(5)

To determine the vessel fitness for purpose above I have used the following information or records:

Flotation

Note: Flotation compliance standard used in this section must also be used for Load Capacity determination.

Option 1 – Level flotation

The vessel has level flotation, complying with:

☐ ABYC H-8	☐ ISO 12217-3	☐ AS 1799.1	☐ NSCV C6B

Option 2 – Basic flotation plus a liferaft or dingy

The vessel is fitted with a life raft or dingy sufficient to support all persons on board and,	☐ Yes	☐ No

The vessel has basic flotation or (if ≥6m) meets the decked criteria, in accordance with:

☐ ABYC H-8	☐ ISO 12217-3	☐ AS 1799.1	☐ NSCV C6B

Option 3 – Basic flotation plus lifejacket plus lifebuoy or carley float

A risk assessment has been conducted for the vessel showing that it is safe to use this options	☐ Yes	☐ No

The risk assessment has been documented and the document kept up to date	☐ Yes	☐ No

The owner has confirmed that persons on board will wear life jackets at all times	☐ Yes ☐ N/A – Vessel > 7.5m

The vessel has basic flotation or (if ≥6m) meets the decked criteria, in accordance with:

☐ ABYC H-8	☐ ISO 12217-3	☐ AS 1799.1	☐ NSCV C6B

And, the vessel is fitted with:

☐ Buoyant appliances sufficient to support all persons	☐ A carley float

Option 4 - Collared vessel, RIB or inflatable

The vessel complies with ISO 6185 - Parts 1 to 4 as applicable;	☐ Yes ☐ No

Load Capacity

The maximum load capacity of the vessel is determined to be:

The vessels load capacity has been calculated in accordance with:

☐ABYC H-5	☐AS 1799.1	☐ISO 6185	☐ISO 14946

Stability

The vessel has a net reel, crane, lifting device or deck load installed.	☐Yes	☐No

I am satisfied that the vessel has stability characteristics suitable for the intended purpose	☐Yes

To determine the above I have used the following information or records (include details of any net reel, crane, lifting device or deck load installed and stability criteria applied) :

Steering system

I am satisfied that the vessels steering system is fit for the intended purpose	☐Yes	☐No

If vessel is ≥ 7.5m does it have an emergency means of steering ☐ Yes ☐ No ☐ N/A

Bilge pumping

A Bilge pump is fitted to the vessel:	☐ Yes	☐ No	☐ N/A

Fuel tanks and piping

Number of non-portable fuel tanks fitted to vessel:	Fuel tank volume:

The vessels underdeck fuel system complies with NSCV C5A	☐ Yes	☐ No	☐ N/A

Flexible fuel lines are installed to avoid chafing, allow regular inspection and are certified in accordance with:

☐ ISO 7840:2013 requirements for type A1	☐ SAE J1527 requirements for type A

Shafting

The vessels shaft installation complies with:

☐ ABYC P-6 2010	☐ NSCV C5A	☐ No shaft

Electrical

Complete AMSA 563 / 564 form as applicable to the vessel is attached to this report.	☐ Yes

The vessels electrical installation complies with NSCV C5B / AS3000.	☐ Yes	☐ N/A

The vessel has a 3 hour emergency electrical supply	☐ Yes

Field of vision and window light transmission

The vessels field of vision, windows and decks complies with AS 1779.1	☐ Yes

Watertight and weathertight integrity

The vessels hull penetrations comply with:

☐NSCV C5A	☐ISO 9093-1 part 1:Metallic

All deck openings that may be used at sea are arranged near the centreline	☐ Yes	☐ N/A

All inlets have steel valves that are accessible during normal operations	☐ Yes	☐ N/A

Penetrations below the LWL that are not sea inlets are fitted with steel non-return valves	☐ Yes	☐ N/A Discharges with diameter ≥ 50mm located less than 225mm above the LWL have a steel valve	☐ Yes	☐ No	☐ N/A

If No - a bilge alarm is fitted and there is an alternate means to stop flooding	☐ Yes	☐ N/A

Fire equipment

2 dry powder extinguishers of 4.5 kg	☐ Yes	☐ No	☐ N/A

Or

The quantity and type of fire extinguisher mentioned in AS 1799.1:2009	☐ Yes	☐ No ☐ N/A

If AS1799.1 record type and quantity fitted:

Means of smothering fire for Main Engine>120kW and contained in enclosed space	☐ Yes	☐ N/A

Record of Safety, Navigation, Communication in accordance with Exemption 40

Item	Quantity / Expiry	Item	Quantity / Expiry
Lifejackets -level 150 standard (Number)	2L of water per person
Lifebuoy or buoyant appliance with light 1 with a self-igniting light	Sound signal – a sound signal (horn). Note: if the horn is portable, a spare canister is required
3 distress signals – red star parachute rocket	/	Magnetic compass 75mm
2 distress signals - red handheld distress flare	/	GNSS receiver (e.g GPS)
1 distress signal – orange smoke handheld	/	Navigation Lights
EPIRB – registered with AMSA	Radio 1: complying with NSCV C7B
Water proof buoyant Torch	Anchor and cable
Distress signal - V sheet marine	2 Oars (for vessels <5m)
1 First aid kit	/	1 9L bucket with a lanyard if the vessel is not self-draining

All equipment complies with and is installed in accordance with NSCV F2 specifications	☐ Yes

Notes

Additional supporting documentation

The following documentation is provided to support this recommendation:

Item #	Document name

On conducting the survey(s) I make the following recommendation:

☐	Recommended - Where a surveyor recommends a survey the vessel must fully comply with the applicable legislation and standards and the vessel must not have any outstanding deficiencies.

☐	Recommend with Conditions - Where a surveyor recommends with operational or environmental conditions, the vessel must fully comply the applicable legislation and standards and the vessel must not have any outstanding deficiencies. The surveyor must provide details of the condition they think should be imposed in the comments section below.

☐	Do not Recommend - Where a surveyor does not a recommend a survey the surveyor must fully detail the deficiencies with status of ‘will not resolve’. The surveyor must provide details and supporting documentation to support the recommendation in the comments section below. See SAGM – 2.9.4

Recommended Conditions / Disputed Items / Deficiencies (will not resolve) / Item(s) not required / Comments

Surveyor’s declaration

I declare that:

I have conducted a survey(s) of the above mentioned vessel, in accordance with the applicable standards as set out in Marine Safety (Class C restricted operations) Exemption (EX40), and that to the extent evident from the inspection/s carried out, I am satisfied that the vessel meets the standards.

I understand and acknowledge that the Australian Maritime Safety Authority, as the National Regulator, may ask that I provide any information or document that the National Regulator reasonably considers necessary in relation to this recommendation

Name of Surveyor	Surveyor Number

Signature of Surveyor	Date of Completion

Recognised Organisation / Company or trading name

Where to lodge:	Lodge by email to DCVapplications@amsa.gov.au or mail to: Australian Maritime Safety Authority, Attention: Vessel Safety Unit, GPO box 2181, Canberra ACT 2601, Australia

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