This is an approved form for the purpose of S36 of the Marine Safety (Domestic Commercial Vessel) National Law Regulation 2013 and can be used to make a recommendation to the National Regulator in accordance with the requirements of the Marine Surveyors Accreditation Guidance Manual. This form may be used to provide a recommendation to the National Regulator relating to survey of a new vessel or modifications to a vessel.

A. Surveyed vessel details

Vessel name / service category	Displayed unique identifier	AMSA issued UVI

B. Indicate type of survey conducted

Phase	Type of survey	Survey Scope	Documentation checklist
Design approval	Plan approval	Accom & arrangement Watertight & Weathertight Construction Fire Safety Machinery Electrical	Plans Plan approval letter Vessel particulars report
Loadline assignment	Full Partial	Conditions of assignment
Construction	Initial hull structure	Full Partial	Structural survey report
Initial engineering	Full Partial	Engineering survey report
Initial fuel tank	Full Partial	Fuel tank report LPG Certificate of Compliance
Initial shaft	Full Partial	Shaft survey report
Initial fire systems and fitout	Full Partial	Fire system and fitout report
Initial W&W integrity	Full Partial	Watertight integrity report
Initial loadline survey	Full Partial	Loadline survey report
Initial electrical survey	Full Partial	Electrical survey report Electrical certificate of compliance
Commissioning	Initial lightship check or incline	Full Partial	Lightship inclining
Stability book approval	Full Partial	Stability book
Commissioning survey	Full Partial	Commissioning report
Periodic/renewal	In water survey	Full Partial	Survey report
Out of water survey	Full Partial	Survey report
Shaft survey	Full Partial	Shaft report
Lightship check	Full Partial	Lightship report
Loadline	Full Partial	Loadline survey report

C. Recommendation

On conducting the above survey(s) I make the following recommendation: (Place an “X” in the appropriate box)

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. See SAGM – 2.9.1 and 2.9.2

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 Recommended Conditions / Disputed Items / Deficiencies (will not resolve) / Item(s) not required / Comments section below and provide documentation to support the recommendation. See SAGM – 2.9.3

Recommend with Dispute - Where a surveyor recommends a vessel, and there is one or more deficiencies that have a status of ‘disputed’. Other than the disputed items, the remainder of the vessel must comply the applicable legislation and standards and the vessel must not have any other outstanding deficiencies. The surveyor must provide details of the disputed items in the Recommended Conditions / Disputed Items / Deficiencies (will not resolve) / Item(s) not required / Comments section below and provide documentation to support the recommendation. See SAGM – 2.9.4

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 in the Recommended Conditions / Disputed Items / Deficiencies (will not resolve) / Item(s) not required / Comments section below and provide documentation to support the recommendation. See SAGM – 2.9.5

Not Required - If a survey letter has surveys listed, and the surveyor believes that a particular survey is not required, the surveyor must include documented reasons why the survey is either not applicable to the kind of vessel, or in the particular circumstance. The surveyor should detail the reasons in the Recommended Conditions / Disputed Items / Deficiencies (will not resolve) / Item(s) not required / Comments section below and provide documentation to support the recommendation. (e.g. for alterations or modifications, the system will generate the full list of initial surveys, which may not be applicable for the kind of alteration – see MO503.
D. Recommended Conditions / Disputed Items / Deficiencies (will not resolve) / Item(s)
not required / Comments

E. Additional supporting documentation

The following additional supporting documentation is provided to support this recommendation

Item #	Document Name

Additional rows may be added by clicking the tab key at the end of the last entry.

F. Surveyor’s declaration

I declare that:

I have conducted survey(s) as indicated, of the above mentioned vessel, in accordance with the applicable standards as set out in Marine Order 503 Certificates of Survey, and that to the extent evident from the inspection/s carried out I am satisfied that the vessel meets the standards.

I consent to the Australian Maritime Safety Authority using and disclosing the information provided in this form for purposes associated with the administration of the Marine Safety (Domestic Commercial Vessel) National Law Act 2012.

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 identification number

Recognised Organisation / company or trading name

Phone	Mobile	Email

Signature of surveyor	Date

G. Where to Lodge

Lodge online via MARS (Preferred), or email to mailto:DCVapplications@amsa.gov.au , or by mail to: Australian Maritime Safety Authority, Attention: Vessel Safety Unit, GPO box 2181, Canberra ACT 2601, Australia

Privacy Statement The collection of information requested in this form is required or authorised by Schedule 1 of the Marine Safety (Domestic Commercial Vessel) National Law Act 2012 (the Act). It will be used for purposes related to the Act and may be provided to Commonwealth or State / Territory government agencies and accredited marine surveyors for the purposes of marine safety. Failure to provide the information may result in the transaction not being processed. To contact us, or for more information on how to access or correct your personal information, how to make a privacy complaint, or how your information may be used or disclosed for purposes beyond those described in this statement, visit www.amsa.gov.au/privacy/