LF-D 004A LAPORAN INSPEKSI KAPAL - Vessel Inspection Report (2nd)

VESSEL INSPECTION REPORT
Laporan Inspeksi Kapal
Form Code
LF D 004 A
Revision
01/2012
Page
1 of 42
VESSEL INSPECTION REPORT LAPORAN INSPEKSI KAPAL

VESSEL - KAPAL:TB. SADP XXX
Table 1. Certificates & Documentation
Tabel 1. Sertifikat & Dokumentasi
No.
Item
1.
Certificates
Sertifikat
2.
Trim & Stability Booklet

Buku Trim & Stabilitas
Damage Stability Booklet
Buku Stabilitas
Kerusakan
Tank Calibration Tables
Tabel Kalibrasi Tangki
SOPEP
Class Reports & Records
Laporan & Catatan Kelas
LSA, FFA, Equipment
Certs.
Sertifikat Peralatan LSA,
FFA
3.
4.
LF D 004 A/ Dec 2012
DATE TANGGAL: 14 Juli 2015
Check points
Titik Pemeriksaan
Are all certificates on board?
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?
Are approved copies on board?
Apakah salinan yang disetujui ada di atas kapal?
Available on board and up-dated?

Tersedia di atas kapal dan terkini?
Life rafts, Extinguishers, CO2/Halon, Foam Analysis, Hoses,
Oxygen & Gas Meters
Rakit Penolong, Pemadam, CO2/Halon, Analisis Busa, Selang,
Oksigen & Meteran Gas
Written By : SK
Remarks
Keterangan
Trim dan Damage stability booklet NA
NA
2
Foam analysis tidak terinstall di kapal
Approved By : VP / DPA
Retention period: 1 year

5.
6.
7.
8.
9.
10.
SMS, DOC, Policy

SMS, DOC, Kebijakan
Circulars
Surat Edaran
Publications
Publikasi
Crew List
Daftar Awak Kapal
Officers & Crews
Documents/Certificates
Dokumen/Sertifikat
Perwira & Awak Kapal
Safety Management
Records
Arsip Manajemen
Keselamatan
Available on board and displayed?

Tersedia di atas kapal dan ditampilkan?
Shipping & Company Circulars filed and up-to-date?
Surat Edaran Pelayaran & Perusahaan disimpan dan terkini?
Publications as per Library list on board and latest?
Publikasi sesuai daftar Perpustakaan di atas kapal dan
terbaru?
Latest Crew List on board?
Daftar Awak Kapal Terbaru di atas kapal?
Originals or copies on board?
Asli atau salinan di atas kapal?
Are all Procedures complied with and records kept and updated?
Apakah semua Prosedur dipatuhi dan catatan disimpan dan
diperbaharui?
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2
2
1
1
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
LF D 004 A/ Dec 2012
Written By : SK

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Revision
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Table 2. Loadline Requirements
Tabel 2. Persyaratan Garis Muat
No.
Item
1.
2.
3.
4.
Hull
Lambung kapal
Scuppers/Freeing Ports
Pipa drainase/Lubang
untuk mengosongkan
Draft & Loadline Marks
Draf & Tanda Garis Muat
Ventilators
Ventilator
5.
Air Pipes
Pipa Udara
6.
Cargo Tank Lids, Sighting

/ Ullage/Sample Ports
LF D 004 A/ Dec 2012
Check points
Titik Pemeriksaan
Is the Hull free of any damage?
Apakah Lambung Kapal bebas dari kerusakan?
Are the drainage free from obstructions?
Apakah drainase bebas dari penghalang?
N
2
2
Well painted and visible.

Dicat dengan baik dan terlihat.
The condition to be checked, e.g. corrosion, wastage.
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?
The air pipe heads, wire nets, operation of closing floats to be checked.
Kepala pipa udara, jaring kawat, operasi dari pelampung penutup
diperiksa.
Written By : SK
Remarks
Keterangan
1
2
NA

and Sounding Pipes

Penutup Tangki Muatan,
Lubang Intip / Ullage /
Sampel dan Pipa
Pengukuran
7.
Watertight Doors, Hatch

Entrance , Chain Lockers,
Tank Top Lids, Skylights,
Portholes, Deadlights,
Windows, etc.
Pintu Kedap Air, Pintu
Masuk ke Palka, Loker
Rantai, Tutup Tangki,
Kaca Atap, Lubang Intip,
Kaca Atap Yang Tidak
Boleh Dibuka, Jendela,
dll
8.
Catwalks, Hand Rails and

Bulwarks
Titian, Rel Tangan dan
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The water tightness including packing, hinge handles and closing

appliances to be checked.
Kekedapan air termasuk paking, pegangan engsel dan peralatan
penutupan untuk diperiksa.
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?
The water tightness including packing, hinge handles and closing
appliances to be checked.
Kekedapan air termasuk paking, pegangan engsel dan peralatan
penutupan untuk diperiksa.
The condition to be checked, e.g. corrosion, wastage, missing, damages.

Kondisi yang akan diperiksa, misalnya korosi, limbah, hilang, rusak.
Written By : SK

Form Code
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Revision
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Benteng
Note - Catatan:
LF D 004 A/ Dec 2012
Written By : SK

Form Code
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Revision
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Table 3. Navigational Equipment
Tabel 3. Peralatan Navigasional
No.
Item
1.
2.
3.
4.
5.
Magnetic Compass Standard and Steering

Kompas Magnetik
Standar dan Kemudi
Gyro Compass, Radars ,
Repeaters and Azimuth
circles
Kompas Gyro, Radar,
Repeater dan lingkaran
Azimuth
GPS, SatNav,
Sextants, Nautical Tables
and Almanac
Sextants, Tabel Nautika
dan Almanak
Speed and Distance Log
Catatan Kecepatan dan
Jarak
LF D 004 A/ Dec 2012
Check points
Titik Pemeriksaan
The operating conditions to be checked, bubbles, compass
illumination, date of last calibration and error observations.
Kondisi operasi diperiksa, gelembung, pencahayaan kompas,
tanggal kalibrasi terakhir dan pengamatan kesalahan.
The operating and performance condition to be checked.
Errors, synchronization of repeaters, & date of last calibration.
Kondisi operasi dan kinerja diperiksa. Kesalahan, sinkronisasi
repeater, & tanggal kalibrasi terakhir.
N
3
Remarks
Keterangan
-
Standard compass - NA
steering compass NA
Gyro compass, Repeater, Azimuth circle NA
The operating condition to be checked.

Kondisi operasi diperiksa.
To be available on board.
Tersedia di kapal.
Install Ctrack
Sextants, Nautical table - NA

NA
Written By : SK

Echo Sounder
Penduga gema
Bridge Control & Engine
Telegraph
Kontrol Anjungan &
Telegrap Mesin
Propeller Revolution and
Rudder Angle Indicators.
Revolusi Baling-Baling
dan Indikator Sudut
Kemudi.
Heading information in
Steering Gear Room
Informasi arah di dalam
Kamar Perangkat Kemudi
Navigation Lights and
Day and Night Signals
Lampu Navigasi dan
Sinyal Siang dan Malam
The operating condition to be checked including illumination.

Kondisi operasi diperiksa termasuk pencahayaan.

To be available in the steering gear room.

Tersedia di kamar perangkat kemudi.
The operating including alarm and display panel condition to be

checked. Availability of day signals on board including flags
and shapes.
Operasi termasuk kondisi alarm dan panel pertunjukan
diperiksa. Ketersediaan sinyal siang hari di kapal termasuk
beragam bendera dan bentuk.
11.
Nautical Charts and

Publications
Peta Bahari dan Publikasi
12.
Bridge Panel & Console
Are Charts and Nautical Publications for the trading area

available, up-to-date and corrected? Latest NTM on board.
Apakah Peta dan Publikasi Bahari untuk daerah perdagangan
tersedia, terkini dan dikoreksi? BPI terbaru di atas kapal.
Are all well illuminated during operation & Dimmers working?
6.
7.
8.
9.
10.
LF D 004 A/ Dec 2012
Written By : SK
Form Code
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Revision
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NA
Kurang lengkap isyarat-isyarat benda
Last BPI Ed 21/2015

Panel & Konsol Anjungan
Form Code
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Revision
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Apakah semua diterangi dengan baik selama operasi & Lampu

Dim berfungsi?
Note - Catatan:
LF D 004 A/ Dec 2012
Written By : SK

Form Code
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Revision
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Page
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Table 4. General Safety
Tabel 4. Keselamatan Umum
No.
Item
1.
FFA and LSA Plans

Rencana FFA dan LSA
2.
Muster List - Fire, Boat Oil

and Emergency Stations
Daftar Kumpul - Api,
Minyak Kapal dan
Stasiun Darurat
Training Manual
Manual Pelatihan
LSA Instructions and
Maintenance Checklist
Instruksi LSA dan Daftar
Periksa Pemeliharaan
Operating Instructions
Instruksi operasi
3.
4.
5.
LF D 004 A/ Dec 2012
Check points
Titik Pemeriksaan
Up-to-date plans to be available.
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.
Up-to-date list to be available.
Daftar terkini tersedia.
To be exhibited in accommodation spaces, W/H and E/R.
Untuk diperlihatkan di ruang akomodasi, W/H dan E/R.
Tersedia di atas kapal.
Regular maintenance to be recorded.
Pemeliharaan rutin dicatat.
IMO Symbol Posters provided on or in the vicinity of survival
crafts illustrating procedures and warnings for launching.
Poster Simbol IMO yang disediakan pada atau di sekitar
Written By : SK
Remarks
Keterangan
NA
2

6.
Drills - Boat, Fire, Oil Spill

and Emergency
Latihan - Perahu, Api,
Tumpahan Minyak dan
Darurat
7.
Communication System
Internal & External,
Telephones, Portable
Sistem Komunikasi
Internal & Eksternal,
Telepon, Portabel
Main & Emergency, Auto
Pilot System
Sistem Auto Pilot Utama
& Darurat
8.
9.
10.
Emergency Source and

Lighting
Sumber darurat dan
Penerangan
Pilot Ladders, Rescue
Harness, Stretcher and
LF D 004 A/ Dec 2012
perahu untuk kelangsungan hidup menggambarkan prosedur

dan peringatan untuk peluncuran.
Drills must be carried out at least once a month and report of
drills carried out logged.
Latihan harus dilakukan setidaknya sekali sebulan dan laporan
latihan yang dilakukan itu dicatat.
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The operating conditions to be checked.

Internal & External P.A. System. Telephones-W/H, E/R,
STG/RM, RAD/RM. Portable - I.S. Walkie Talkies.
Sistem P.A. Internal & Eksternal. Telepon-W/H, E/R, STG/RM,
RAD/RM. I.S. Walkie Talkies Portabel.
The condition & operations of motors, actuators, connecting
linkages of main & emergency steering & Auto Pilot System
change over to be checked. Instructions for change-over to be
exhibited.
Kondisi & operasi motor, aktuator, penghubung kemudi utama
& darurat & peralihan Sistem Auto Pilot diperiksa. Petunjuk
untuk peralihan diperlihatkan.
The operating condition & effectiveness of battery & lighting to
be checked.
Kondisi operasi & efektivitas baterai & penerangan diperiksa.
The condition to be checked, e.g. no damage, missing steps,

deterioration, corrosion.
NA
Written By : SK
Form Code

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Revision
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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:
LF D 004 A/ Dec 2012
Written By : SK

Form Code
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Revision
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Table 5. Life-Saving Appliances
Tabel 5. Peralatan Untuk Menyelamatkan Jiwa
No.
Item
1.
Lifeboats
Sekoci
2.
Lifeboat Equipment
Peralatan Sekoci
3.
Engine for Lifeboats

Mesin Sekoci
4.
Launching & Securing

LF D 004 A/ Dec 2012
Check points
Titik Pemeriksaan
The condition of hull including attachments to shell (lifelines,
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.
Inventory, availability and conditions of equipment to be
checked.
Persediaan, ketersediaan dan kondisi peralatan diperiksa.
The operation and condition of engines to be checked.
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.
The operating condition of brakes, davits, winches, falls, gripes
Written By : SK
Remarks
Keterangan
NA
NA
NA
NA

Arrangements
Pengaturan Peluncuran
& Pengamanan
and lashings to be checked, e.g. wastage, corrosion, greasing.

Kondisi operasi rem, dewi-dewi, mesin derek, turunnya,
penggenggaman dan ikatan diperiksa, misalnya pembuangan,
korosi, pengolesan.
5.
Boat Falls
Jatuhnya Kapal
6.
Blocks, Chocks
Blok, Ganjalan
7.
Embarkation Ladders
Tangga Embarkasi
8.
Lifebuoys
Pelampung
To turn end for end every 30 mths & date of last change.
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.
The condition and operation to be checked, e.g. corrosion,
wastage, greased and blocks turning.
Kondisi dan operasi diperiksa, misalnya korosi, pembuangan,
dilumasi dan blok berputar.
The condition and length to be checked, e.g. corrosion,
wastage, length sufficient to reach at lightship draft.
Kondisi dan panjang diperiksa, misalnya korosi, pembuangan,
panjang cukup untuk mencapai pada draf suar.
No. (as per Safety Equip Cert), arrangement, condition,
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
LF D 004 A/ Dec 2012
Written By : SK
Form Code
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Revision
01/2012
Page
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NA
NA
NA

9.
Life rafts
Rakit penolong
10.
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.
Date of last service of life rafts & hydrostatic releases.
Tanggal servis terakhir dari rakit penolong & rilis hidrostatik.
Securing and launching arrangements to be checked.
Pengaturan pengamanan dan peluncuran diperiksa.
No. (Total 4) and expiry dates to be checked.
Jumlah (Total 4) dan tanggal kadaluarsa diperiksa.
Form Code
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Revision
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Line Throwing Apparatus

2
Peralatan Melempar Tali
Note - Catatan:
LF D 004 A/ Dec 2012
Written By : SK

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Revision
01/2012
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Table 6. Life-Saving Appliances
Tabel 6. Peralatan Untuk Menyelamatkan Jiwa
No.
Item
11.
12.
13.
14.
Parachute Signals
Sinyal Parasut
Life-jackets
Jaket Pelampung
Immersion Suits & TPA

Pakaian Kedap Air & TPA
Lifeboat Portable Radio
Radio Portabel Sekoci
15.
EPIRB
16.
SART
LF D 004 A/ Dec 2012
Check points
Titik Pemeriksaan
No. of signals (12) and expiry dates to be checked.
Jumlah sinyal (12) dan tanggal kadaluarsa diperiksa.
No. of life-jackets to be checked (as per Safety Equip Cert).
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.
No. and condition and storage position of suits to be checked.
Jumlah dan kondisi dan posisi penyimpanan pakaian diperiksa.
The operating condition and records of testing of radio to be
checked.
Kondisi operasi dan catatan pengujian radio diperiksa.
The operating conditions, and expiry dates of battery and
hydrostatic release to be checked.
Kondisi operasi, dan tanggal kadaluwarsa baterai dan
pelepasan hidrostatik diperiksa.
No. (2 units), the operating condition and expiry dates of
battery to be checked.
Written By : SK
Remarks
Keterangan
2
2
NA
NA

17.
Two-way Radio
Telephone
(Walkie - Talkies)
Telepon Radio 2-arah
(Walkie Talkies)
Jumlah (2 unit), kondisi operasi dan tanggal kadaluwarsa

baterai diperiksa.
No. of phones (3 sets) to be checked.
Jumlah telepon (3 set) diperiksa.
Must be water-proof and I.S.
Harus kedap air dan I.S.
Form Code
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Revision
01/2012
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Note - Catatan:
LF D 004 A/ Dec 2012
Written By : SK

Form Code
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Revision
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Table 7. Fire-Fighting Appliances
Tabel 7. Peralatan Pemadaman Kebakaran
No.
Item
1.
2.
3.
4.
5.
Main Fire Lines on deck

Jalur Induk Kebakaran di
dek
Hydrant Valve handles
Pegangan Katup Hidran
Fire Hoses & Nozzles
Selang Kebakaran &
Nozel
F.O. tank Shut-Off valves

Katup penghentian tangki
F.O.
Emergency Stops of fans
and transfer pumps
Penghentian Darurat
kipas dan pompa transfer
LF D 004 A/ Dec 2012
Check points
Titik Pemeriksaan
The condition to be checked, e.g. corrosion, damage, leakage.
Kondisi diperiksa, misalnya korosi, kerusakan, kebocoran.
N
1
The condition to be checked e.g. corrosion, damage, leakage.

The condition to be checked including Fire-Boxes, e.g.
corrosion, damage, leakage.
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.

Written By : SK
Remarks
Keterangan

6.
Portable Fire
Extinguishers
Alat Pemadam Api
Ringan
7.
Fixed Fire Fighting

System in E/R, P/ Rm,
Cargo Space, Accomm or
Deck
Sistem Pemadaman Api
Tetap di dalam E/R,
P/Rm, Ruang Muatan,
Akomodasi atau Dek
Foam/ Water turrets and
Monitors
Busa/Menara air dan
Pengamatan
Main Fire Pumps and
Emergency Fire Pumps
Pompa Kebakaran
Utama dan Pompa
Kebakaran Darurat
8.
9.
10.
Fire dampers & doors

LF D 004 A/ Dec 2012
No. and arrangement to be checked according to plan.

Jumlah dan pengaturan diperiksa sesuai rencana.
Date of last change/serviced of medium/extinguishers.
Tanggal perubahan terakhir/servis media/alat pemadam.
Date of last serviced and test certificate issued to be available
and checked.
Tanggal servis terakhir dan sertifikat pengujian yang diterbitkan
akan tersedia dan diperiksa.
Date and cert of foam analysis report to be available.
Tanggal dan laporan sertifikasi analisis busa tersedia.
The condition of pipes, cylinders and tanks to be checked.
Kondisi pipa, silinder dan tangki diperiksa.
Condition to be checked, e.g. corrosion, damage, leakage.
The operating condition including sufficient delivery pressure to

be checked.
Kondisi operasi termasuk tekanan pengiriman yang cukup
diperiksa.
The condition of the pump, prime mover to be checked, e.g.
corrosion, damage, leakage.
Kondisi pompa, penggerak utama diperiksa, misalnya korosi,
kerusakan, kebocoran.
Written By : SK
Form Code
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Revision
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Fix foam system NA
Water turrets and Monitors yang di install

Peredam api & pintu
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Kondisi operasi diperiksa

The condition including handles to be checked, e.g. corrosion,
damage.
Kondisi termasuk pegangan diperiksa, misalnya korosi,
kerusakan.
Note - Catatan:
LF D 004 A/ Dec 2012
Written By : SK

Form Code
LF D 004 A
Revision
01/2012
Page
20 of 42

Table 8. Fire-Fighting Appliances
Tabel 8. Peralatan Pemadaman Kebakaran
No.
Item
11.
Spark/Flame Arrestors
Pelindung Percikan/Api
12.
Fireman Outfit
Pakaian Pemadam
Kebakaran
LF D 004 A/ Dec 2012
Check points
N
Titik Pemeriksaan
For all ventilators, skylights, air intakes, etc., condition to be
2
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
No. of sets (2 for SB, 4 for ocean-going) to be checked. (One
2
set consists of a breathing apparatus, protective clothing,
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
Written By : SK
Remarks
Keterangan

13.
14.
Fire Detection System

Sistem Deteksi
Kebakaran
Paint Locker Fire
Extinguishing System
Sistem Pemadaman
Kebakaran Loker Cat
15.
Gas Tight Lamps

Lampu Kedap Gas
16.
International Shore
Connection
Koneksi Darat
Internasional
The storage position according to fire plan to be checked.

Posisi penyimpanan sesuai dengan rencana kebakaran
diperiksa.
The condition of piping and valves to be checked, e.g. damage,
corrosion, leakage, etc.
Kondisi pipa dan katup harus diperiksa, misalnya kerusakan,
korosi, kebocoran, dll.
Arrangement of portable extinguishers to be checked.
Susunan alat pemadam api ringan diperiksa.
Condition of all gas tight lamps in stores, etc. to be checked,
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
To check well greased, packing, tools and all bolts available.
Untuk memeriksa digemuk dengan baik, paking, alat kerja dan
semua baut tersedia.
Position/location to be placed according to plan.
Posisi/lokasi ditempatkan sesuai dengan rencana.
Form Code
LF D 004 A
Revision
01/2012
Page
21 of 42
NA
NA
Note - Catatan:
LF D 004 A/ Dec 2012
Written By : SK

Form Code
LF D 004 A
Revision
01/2012
Page
22 of 42

Table 9. Alarms and Signals
Tabel 9. Alarm dan Sinyal
No.
Item
1.
2.
3.
4.
5.
6.
7.
Fire Alarm
Alarm Kebakaran
General Alarm
Alarm Umum
Steering Gear Alarm
Alarm Alat Kemudi
Fixed Fire Extinguishing
System Alarm
Alarm Sistem
Pemadaman Kebakaran
Tetap
Fire Detecting System
Alarm
Alarm Sistem Deteksi
Kebakaran
Cargo Tank High Level
Tingkat Ketinggian
Tangki Muatan
Steering Gear Bilge High
Level Alarm
LF D 004 A/ Dec 2012
Check points
Titik Pemeriksaan
N
2
2
2
1


NA

NA
Written By : SK
Remarks
Keterangan

Form Code
LF D 004 A
Revision
01/2012
Page
23 of 42
Alarm Tingkat Ketinggian

Bilga Alat Kemudi
NA
8.
Engine Room Bilge High
Level Alarm
Bilga Kamar Mesin
NA
9.
Cargo Pump Room High
Level Alarm
Kamar Pompa Muatan
NA
10. Engineers Alarm
Alarm Masinis
NA
11. Ships Whistle, manual
Peluit kapal, manual
2
12. Ships Whistle, electric
Peluit kapal, elektrik
NA
13. Ships Automatic Fog
Signal
Sinyal Kabut Otomatis
Kapal
NA
14. Aldis Lamp
Lampu Aldis
NA
15. Morse Light
Cahaya Morse
Note - Catatan:
LF D 004 A/ Dec 2012
Written By : SK

Form Code
LF D 004 A
Revision
01/2012
Page
24 of 42

LF D 004 A/ Dec 2012
Written By : SK

Form Code
LF D 004 A
Revision
01/2012
Page
25 of 42

Table 10. Radio Equipments
Tabel 10. Peralatan Radio
No.
Item
1.
2.
3.
4.
5.
6.
7.
8.
Main Transmitter
Pemancar utama
Reserve transmitter
Pemancar cadangan
Portable Radio Key
Kunci Radio Portabel
SSB & Telex
Battery & Charger
Baterai & Pengisi Daya
Auto Alarm
Alarm Otomatis
VHF
Portable Radio
Apparatus for Survival
Craft
Peralatan Radio
Portabel untuk Kapal
Kelangsungan Hidup
LF D 004 A/ Dec 2012
Check points
Titik Pemeriksaan
Written By : SK
Remarks
Keterangan
NA
NA
NA
3
TELEX NA
NA
NA
2
NA

9.
10.
11.
12.
13.
14.
NAVTEXT Receiver
Penerima NAVTEXT
Watch Receiver
Penerima Jam
Facsimile
Faksimili
Radio Log Book
Buku Catatan Radio
Antenna including Mast
Antena termasuk Tiang
Radio Publications
Publikasi Radio

To be available on board and entries as appropriate.
Tersedia di atas kapal dan entri yang sesuai.
The condition to be checked, e.g. corrosion, damage.
Kondisi diperiksa, misalnya korosi, kerusakan.
Latest Volumes of Radio Signals on board and corrected?
Volume terbaru Sinyal Radio di atas kapal dan dikoreksi?
Form Code
LF D 004 A
Revision
01/2012
Page
26 of 42
3
NA
NA
3
2
NA
2
Ship Station License
Is License valid and displayed?
Izin Stasiun Radio Kapal Apakah Izin masih berlaku dan ditampilkan?
Laut
Note - Catatan:
15.
LF D 004 A/ Dec 2012
Written By : SK

Form Code
LF D 004 A
Revision
01/2012
Page
27 of 42

Table 11. MARPOL
Tabel 11. MARPOL
No.
Item
1.
Oily Water Separator

(OWS)
Pemisah Air Berminyak
(OWS)
2.
15 P.P.M. Alarm
Alarm 15 P.P.M.
ODME
3.
4.
5.
6.
Oil/Water Interface
Detectors
Detektor Antarmuka
Minyak/Air
Standard Marpol
Discharge Connection
Koneksi Pembongkaran
Standar Marpol
Piping arrangement on
LF D 004 A/ Dec 2012
Check points
Titik Pemeriksaan
The operating condition & Filters to be checked.
Kondisi operasi & Filter diperiksa.
Equipment and piping to be checked, e.g. corrosion.
Peralatan dan pipa diperiksa, misalnya korosi.
Is the overboard discharge valve identified, lashed and locked?
Apakah katup pembongkaran ke laut diidentifikasi, diikatkan
dan dikunci?
The condition to be checked, e.g. corrosion, damage, leakage,
and to be fully bolted, greased and identified.
Kondisi diperiksa, misalnya korosi, kerusakan, kebocoran, dan
sepenuhnya dibaut, digemuki dan diidentifikasi.
Written By : SK
Remarks
Keterangan
NA
NA
NA
NA

7.
8.
bilge line in E/R & P/R

Pengaturan perpipaan di
jalur bilga di E/R & P/R
Piping arrangement on
Cargo Oil & Ballast Lines
Pengaturan pipa di Jalur
Minyak Muatan &
Ballast
Bilge in Engine Room &
Pump Room
Bilga di dalam Kamar
Mesin & Kamar Pompa
9.
Oil Record Books

Buku Catatan Minyak
10.
SOPEP
11.
ODME Manual
Manual ODME
12.
Oil Spill/Pollution
LF D 004 A/ Dec 2012
Form Code
LF D 004 A
Revision
01/2012
Page
28 of 42

NA
Are they free from oily water / oil?

Apakah mereka bebas dari air berminyak/minyak?
Is the emergency bilge suction v/v in E/R identified?
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?
Are records for both Machinery and Cargo correct and updated and entries initialed and book signed?
Apakah catatan untuk kedua Mesin dan Muatan benar dan
diperbaharui dan catatan diparaf dan buku ditandatangani?
To be available on board and ODME to be tested, recorded
monthly.
Tersedia di atas kapal dan ODME harus diuji, dicatat setiap
bulan.
To check condition and availability of equipment as per
Written By : SK
2
NA

Equipment
Peralatan Tumpahan
Minyak/Polusi
Form Code
LF D 004 A
Revision
01/2012
Page
29 of 42
standard list. Oil recovery pump & Oil Spill Drills to be tested
and carried out regularly.
Untuk memeriksa kondisi dan ketersediaan peralatan sesuai
daftar standar. Pompa perolehan kembali minyak & Latihan
Tumpahan Minyak diuji dan dilakukan secara teratur.
Note - Catatan:
LF D 004 A/ Dec 2012
Written By : SK

Form Code
LF D 004 A
Revision
01/2012
Page
30 of 42

Table 12. Hull, Machinery & Cargo Gear
Tabel 12. Lambung Kapal, Mesin & Perlengkapan Muatan
No.
Item
Check points
Titik Pemeriksaan
1.
Cargo Tanks
The condition of frames, brackets, bulkheads, tank top,
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,
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,
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
Arrangement & Lighting
arrangement to be checked, e.g. corrosion, wastage, damage.
LF D 004 A/ Dec 2012
Written By : SK
Remarks
Keterangan
NA

5.
6.
7.
8.
9.
10.
11.
12.
Pengaturan Kabel Listrik

Dek & Penerangan
Cargo Pumps Room
Kamar Pompa Muatan
Engine Room
Kamar Mesin
Main Engine
Mesin Induk
Main Generators
Generator Induk
Auxiliary Machinery
Mesin Bantu
Piping Arrangement in
Engine Room
Pengaturan Pipa di
dalam Kamar Mesin
E/R Electrical Cable &
Lighting Arrangement
Kabel Listrik E/R
Pengaturan Penerangan
Main Switch Board
(MSB)
Papan Saklar Utama
(MSB)
LF D 004 A/ Dec 2012
Kondisi penerangan, pipa kabel/ducting, pengaturan kabel

diperiksa, misalnya korosi, pemborosan, kerusakan.
The cargo pump room to be cleaned.
Kamar pompa muatan dibersihkan.
The operating condition to be checked, e.g. efficiency, leakage
Kondisi operasi diperiksa, misalnya efisiensi, kebocoran
To be cleaned.
Dibersihkan
The operation condition to be checked.
The condition to be checked, e.g. corrosion, wastage, leakage.
Kondisi operasi diperiksa, misalnya korosi, pemborosan,
kebocoran
LF D 004 A
Revision
01/2012
Page
31 of 42
NA
2
2
2
2
2
The condition to be checked.

Kondisi diperiksa
The operating condition and identification & illumination to be

checked. Insulating Mats to be available on the floor in front
and at the back of the switch board.
Kondisi operasi dan identifikasi & pencahayaan diperiksa.
Keset isolasi harus tersedia di lantai di depan dan di belakang
Written By : SK
Form Code

Form Code
LF D 004 A
Revision
01/2012
Page
32 of 42
papan saklar.
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:
13.
LF D 004 A/ Dec 2012
Written By : SK

Form Code
LF D 004 A
Revision
01/2012
Page
33 of 42

Table 13. Hull, Machinery & Cargo Gear
Tabel 13. Lambung Kapal, Mesin & Perlengkapan Muatan
No.
Item
Check points
N
Titik Pemeriksaan
NA
14. Cargo Gear Appliances
The condition of posts, booms and winches including loose
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.
1
16. Main Deck
Is on-going maintenance being carried out?
Dek Utama
Apakah pemeliharaan terus-menerus dilakukan?
LF D 004 A/ Dec 2012
Written By : SK
Remarks
Keterangan

17.
Superstructure, Funnel &

Masts
Suprastruktur, Cerobong
& Tiang
18.
Ships Side
Sisi Kapal
19.
Anchor Chain, Chain

Lockers
Rantai Jangkar, Loker
Rantai
20.
Mooring Ropes & Fire

Wires
Tali Tambat & Kabel Api
LF D 004 A/ Dec 2012
The condition of the deck to be checked, e.g. corrosion,

wastage, damage.
Kondisi dek diperiksa, misalnya korosi, pemborosan,
kerusakan.
The condition of the superstructure to be checked, e.g.
corrosion, wastage, damage.
Kondisi suprastruktur diperiksa, misalnya korosi, pemborosan,
kerusakan.
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.
Are all of the port & stbd anchor chains studs tight?
Apakah semua kancing rantai jangkar kiri & kanan ketat?
Are there any studs missing?
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?
Are there sufficient ropes and wires on board?
Apakah ada tali dan kabel yang cukup di atas kapal?
To check condition of ropes & wires e.g. wear & tear, etc.
Written By : SK
Form Code
LF D 004 A
Revision
01/2012
Page
34 of 42

21.
Housekeeping
Rumah tangga
Untuk memeriksa kondisi tali & kabel misalnya keausan dll.

Is the housekeeping of all Deck & E/R stores in order?
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?
Form Code
LF D 004 A
Revision
01/2012
Page
35 of 42
Note - Catatan:
LF D 004 A/ Dec 2012
Written By : SK

Form Code
LF D 004 A
Revision
01/2012
Page
36 of 42

Table 14. Cargo Equipments
Tabel 14. Peralatan Muatan
No.
Item
1.
Cargo Hose
Selang Muatan
2.
Manifolds, Hoses
Pipa Bermulut Banyak,
Selang
Reducers, Adapters,
Elbows
Reduksi, Adaptor, Siku
3.
4.
5.
Cargo Records & Safety

Checklists
Catatan Muatan &
Daftar Periksa
Keselamatan
ASTM Thermometers,
LF D 004 A/ Dec 2012
Check points
Titik Pemeriksaan
Are there sufficient hoses on board?
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?
Are all unused manifolds and hoses blanked & fully bolted?
Apakah semua pipa bermulut banyak yang tidak terpakai dan
selang di blank & sepenuhnya dibaut?
Are the required nos of reducers, adapters & elbows on board
& provided with bolts and nuts?
Apakah jumlah reduksi, adaptor & siku yang diperlukan di atas
kapal & dilengkapi dengan baut dan mur?
Are all records maintained and up-dated?
Apakah semua catatan dipelihara dan diperbaharui?
Are sufficient on board and in good condition?

Written By : SK
Remarks
Keterangan
NA
NA
NA
NA
NA

Form Code
LF D 004 A
Revision
01/2012
Page
37 of 42
Sounding Tapes &

Apakah jumlahnya cukup di atas kapal dan dalam kondisi
Hydrometers
baik?
Thermometer ASTM,
Pita Pengukuran &
Hydrometer
NA
6.
Water & Oil Finding
Are there sufficient on board?
Pastes
Apakah jumlahnya cukup di atas kapal?
Pasta Air & Minyak
NA
7.
Sample Bottles, Seal
Are there sufficient on board?
Pliers, Seals, Rags
Apakah jumlahnya cukup di atas kapal?
Botol Sampel, Tang
Segel, Segel, Kain
Majun
NA
8.
Sampling Equipment
Do they adhere to SBP?
Peralatan Pengambilan
Apakah mereka mematuhi SBP?
Sampel
Note - Catatan:
LF D 004 A/ Dec 2012
Written By : SK

Form Code
LF D 004 A
Revision
01/2012
Page
38 of 42

Table 15. Accommodation
Tabel 15. Akomodasi
No.
Item
1.
2.
3.
4.
5.
6.
7.
8.
Sanitary facilities
Fasilitas sanitasi
Air Conditioning
AC
Medical equipment
Peralatan medis
Toilet & Shower Room
Toilet & Kamar Mandi
Piping Arrangement in
accommodation spaces
Pengaturan pipa di
ruang akomodasi
Air Ventilators
Ventilator udara
Galley
Dapur kapal
Galley Store, Provision &
Meat Room
Gudang dapur kapal,
Kamar Perbekalan &
LF D 004 A/ Dec 2012
Check points
Titik Pemeriksaan
The condition to be checked, e.g. drainage, cleanliness.
Kondisi yang akan diperiksa, misalnya drainase, kebersihan.
The condition to be checked, e.g. corrosion, leakage.
Kondisi yang akan diperiksa, misalnya korosi, kebocoran.
The condition to be checked, e.g. corrosion, cleanliness.
Kondisi yang akan diperiksa, misalnya korosi, kebersihan.
Written By : SK
Remarks
Keterangan
1
1
2
1
2
1
2
2

9.
10.
11.
Daging
Crew Cabins
Kabin Awak Kapal
Lighting
Penerangan
Housekeeping
Rumah Tangga
The condition to be checked, e.g. cleanliness.

Kondisi yang akan diperiksa, misalnya kebersihan.
All lighting in accommodation to be working and well lit.
Semua penerangan dalam akomodasi dapat bekerja dan
menyala dengan baik.
Is the general housekeeping of the accommodation & its stores
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?
Form Code
LF D 004 A
Revision
01/2012
Page
39 of 42
2
2
Note - Catatan:
LF D 004 A/ Dec 2012
Written By : SK

Form Code
LF D 004 A
Revision
01/2012
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.
LF D 004 A/ Dec 2012
Written By : SK

Form Code
LF D 004 A
Revision
01/2012
Page
41 of 42
11.
Inspected / Report By:
Diinspeksi / Dilaporkan Oleh:
Acknowledgement / Joint Inspection By:

Diketahui / Inspeksi Gabungan Oleh:
___________________
Superintendent-in-charge
Superintendent Penanggung Jawab
Name:
Nama:
_________________
Master
Nakhoda
Name:
Nama:
LF D 004 A/ Dec 2012
Written By : SK
___________________
Chief Engineer
KKM
Name:
Nama:

LF-D 004A LAPORAN INSPEKSI KAPAL - Vessel Inspection Report (2nd)

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VESSEL INSPECTION REPORT

Laporan Inspeksi Kapal

VESSEL INSPECTION REPORT LAPORAN INSPEKSI KAPAL

Trim & Stability Booklet

LF D 004 A/ Dec 2012

DATE TANGGAL: 14 Juli 2015

Available on board and up-dated?

Trim dan Damage stability booklet NA

Foam analysis tidak terinstall di kapal

Retention period: 1 year

VESSEL INSPECTION REPORT

SMS, DOC, Policy

Available on board and displayed?

LF D 004 A/ Dec 2012

Retention period: 1 year

VESSEL INSPECTION REPORT

VESSEL INSPECTION REPORT LAPORAN INSPEKSI KAPAL

Cargo Tank Lids, Sighting

Well painted and visible.

Retention period: 1 year

VESSEL INSPECTION REPORT

and Sounding Pipes

Watertight Doors, Hatch

Catwalks, Hand Rails and

The water tightness including packing, hinge handles and closing

The condition to be checked, e.g. corrosion, wastage, missing, damages.

Retention period: 1 year

VESSEL INSPECTION REPORT

LF D 004 A/ Dec 2012

Retention period: 1 year

VESSEL INSPECTION REPORT

VESSEL INSPECTION REPORT LAPORAN INSPEKSI KAPAL

Magnetic Compass Standard and Steering

Gyro compass, Repeater, Azimuth circle NA

The operating condition to be checked.

Sextants, Nautical table - NA

The operating condition to be checked.

Retention period: 1 year

VESSEL INSPECTION REPORT

The operating condition to be checked including illumination.

The operating condition to be checked including illumination.

To be available in the steering gear room.

The operating including alarm and display panel condition to be

Nautical Charts and

Bridge Panel & Console

Are Charts and Nautical Publications for the trading area

LF D 004 A/ Dec 2012

Kurang lengkap isyarat-isyarat benda

Last BPI Ed 21/2015

Retention period: 1 year

VESSEL INSPECTION REPORT

Panel & Konsol Anjungan

Apakah semua diterangi dengan baik selama operasi & Lampu

LF D 004 A/ Dec 2012

Retention period: 1 year

VESSEL INSPECTION REPORT

VESSEL INSPECTION REPORT LAPORAN INSPEKSI KAPAL

FFA and LSA Plans

Muster List - Fire, Boat Oil

LF D 004 A/ Dec 2012

Retention period: 1 year

VESSEL INSPECTION REPORT

Drills - Boat, Fire, Oil Spill