Port State Controls

Vessel: IMO Number: Vessel Type:

Report Number: Call Sign: Owner:

Year of Build: Date of Inspection:

Class Society (ies):

PSC MOU (if known):

Place of Inspection (Port Code):

Type of Inspection:

Area Inspected

Detention:

Deficiencies: Number if any

record all deficiencies in the Company Deficiency Record book

Code(s) of deficiency (ies) if Yes: Codes for Actions taken by PSCO if deficiency

Response From Office

Date: From:
Origin of response: Office:

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