PSA Onboard Handover Checklist

Vessel : __________________
Date : __________________
File No.: __________________

PSA Handover
Items Yes No N/A Comments
1. Review dock safe work permit and FLRA (field
level risk assessment)

2. Nominated tanks ship & shore

3. Last message to client reported

4. Any incident, unsafe act or unsafe condition

reported

5. Any change to original nominated quantity

and/or current or expected rate(s)

6. Load/Discharge rate experienced and forecast

7. Number of parcels

8. Estimated time of completion

9. Weather experienced and forecast

10. Results of initial inspection checklist

11. 1PSA duties handed over to:

1 Name: _____________________Signed__________________
.

OCA_CAN_FRM_PSAWI_03e_I02 Effective Date: 14-April-2015 Page 1 of 1

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