BROD/OBALA SIGURNOSNA KONTROLNA LISTA

SHIP/SHORE SAFETY CHECK LIST

Ime broda: __________________________________________________

Ship's Name

Privezno mjesto _________________________ Luka: _________________________

Berth Port

Datum dolaska: _________________________ Vrijeme dolaska:

_________________________

Date of Arrival: Time of Arrival:

UPUTE ZA ISPUNJAVANJE:

INSTRUCTION FOR COMPLETION

Sigurno rukovanje zahtjeva da svi uvjeti budu potvrdni i ispunjeni oznakom ( ) u

označeni prostor.

Ako nije moguć potvrdan odgovor, treba navesti razlog, te dogovoriti odgovarajuće mjere
predostrožnosti koje treba poduzeti brod i privezno mjesto. Kada se smatra da se uvjeti ne
mogu primijeniti, treba ih navesti u rubrici Primjedbe.

The safety of operations requires that all questions should be answered affirmatively by
clearly ticking ( ) the appropriate box. If an affirmative answer is not possible, the reason
should be given and agreement reached upon appropriate precautions to be taken between
the ships and the terminal.Where any question is considered to be not applicable, then a
note to that effect should be inserted in the remarks column.

Ovaj prostor u stupcu "brod" i "privez" označava da će provjeru izvršiti označena stranka

A box in the column "ship" and "terminal" indicates that check should be carried out by
the party concerned.

Prisustvo slova A,P ili R u stupcu "Code" ima slijedeće značenje:

The presence of the letters A, P or R in the column "Code" indicater the following

A - svaki postupak i odgovor mora biti upisan u rubrici "Primjedbe" kontrolne liste i
potpisan od obje stranke
- any procedures and agreements should be in writting in the remarks column of this
check list or other mutually acceptable form. In either case, the signature of both parties
should be required.

P - u slučaju da se na pitanja označena ovim slovom ne može odgovoriti potvrdno,

rukovanje se obustavlja, dok lučke vlasti ne izdaju odobrenje.

- in the case of a negative answer the operation should not be carried out without the
permission of the Port Authority.

R - označava da se kontrola treba ponoviti u vremenskim razmacima koji su odgovorni u

deklaraciji.

- indicates items to be rechecked at intervals not exceeding that agreed in the declaration.

DIO "A" - OPĆENITO TEKUĆINE

PART "A" - BULK LIQUID GENERAL

________________________________________________________________________
__________

Općenito Brod Privez Code Primjedbe

General Ship Terminal Remarks

________________________________________________________________________
__________

1. Da li je brod sigurno privezan? R Zaustavljen rad Brzina

Is the ship securely moored? teretom u: vjetra u

Nm

Stop cargo at kts wind

Odvojen Brzina

cjevovod u: vjetra u Nm

Disconnect at kts wind

Brod odvezan u: Brzina

Unberth at vjetra u Nm
kts wind vel.

________________________________________________________________________
__________

2. Da li je ispravno postvljena užad za tegljenje u slučaju opasnosti?R

Are emergency towing wires correctly positioned?

________________________________________________________________________

3. Da li je pristup brodu siguran? R

Is there safe access between ships and shore?

________________________________________________________________________

4. Da li je brod spreman otploviti na vlastiti pogon? PR

Is the ship ready to move under its own power?

________________________________________________________________________

5. Da li je spremna brodska straža i nadzor kao i nadzor na privezu?

Is there an effective deck watch in attedance on board and adequate

supervision on the terminal and on the ship?

________________________________________________________________________

6. Da li je dogovorena komunikacija brod-kopno? AR

Is the agreed ship/shore communication system operative?

________________________________________________________________________

7. Da li su dogovoreni signali za slučaj opasnosti? A

Has the emergency signal to be used by the ship and shore been explained

and understood?

________________________________________________________________________
8. Da li je dogovoren postupak rada sa teretom, bunkerom i balastom?

AR

Have the procedures for cargo, bunker and ballast handling been agreed?

________________________________________________________________________

9. Da li su opasnosti od tereta kojim se rukuje obznanjene?

Have the hazards associated with toxic substances in the cargo being handled been

identified and understood?

________________________________________________________________________

10. Da li je dogovoren posupak za obustavu rada u slučaju opasnosti?

Has the emergency shutdown procedure been agreed?

________________________________________________________________________

11. Da li je protupožarna zaštita pravilno postavljena i spremna za upotrebu? R

Are fire hoses and fire fighting equipment on board and ashore positioned and

ready for immediate use?

_______________________________________________________________________

12. Da li su priključci na cjevovodu za teret u dobrom stanju, odgovarajuće

pričvršćeni i spremni za upotrebu?

Are cargo and bunker hoses/arms in good condition, properly rigged and appropriate

for the service intented?

________________________________________________________________________

13. Da li su izljevi zatvoreni i da li su postavljene posude za prikupljanje

prolivene tekućine na brodu i kopnu?

Are scuppers effectively plugged and drips trays in position, both on board

and ashore?

________________________________________________________________________

14. Da li su cjevovodi tereta i pogonskog goriva koji nisu u upotrebi zatvoreni

slijepim prirubnicama?

Are unused cargo and bunker connections properly secured with blank flanges

fully bolted?

________________________________________________________________________

15. Da li su svi ventili mora koji nisu u upotrebi zatvoreni i zapečaćeni?

Are sea and overboad discharge valves, when not in use, closed and visibly secured?

________________________________________________________________________

16. Da li su svi poklopci tankova i pogonskog goriva zatvoreni?

Are all cargo and bunker tank lids closed?

________________________________________________________________________

17. Da li se odzračivanje tankova vrši na propisan način?

AR

Is the agreed tank venting system being used?

________________________________________________________________________

18. Da li su ručne lampe u skladu s propisima?

Are hand torches of an approved type?

________________________________________________________________________

19. Da li su prenosne VHF/UHF radijske postaje u skladu sa propisima?

Are portable VHF/UHF transceivers of an approved type?

________________________________________________________________________

20. Da li je antena glavne radijske postaje uzemljena i radar isključen?

Are the ship's main radio transmitter aerials earthed and radar switched off?

________________________________________________________________________

21. Da li su električni kabeli od prenosnih električnih uređaja isključeni?

Are electric cables to portable electrical equipment disconnected from power?

________________________________________________________________________

22. Da li su vanjska vrata i prozori prostorija posade zatvoreni?

Are all external doors and ports in the accommodation closed?

________________________________________________________________________

23. Da li su isključeni uređaji za klimatizaciju?

Are window-type air conditioning units disconnected?

________________________________________________________________________

24. Da li su zatvoreni usisi zraka uređaja za klimatizaciju?

Are air conditioning intakes which may permit the entry of cargo

vapours closed?

________________________________________________________________________

25. Da li su zadovoljeni propisi za korištenje kuhinje?

Are the requirements for use of galley and other cooking appliances being observed?

________________________________________________________________________

26. Da li se poštuju propisi zabrane pušenja?

Are smoking regulations being observed?

________________________________________________________________________

27. Da li se poštuju propisi o zabrni rada otvorenim plamenom?

Are naked lights regulations being observed?

________________________________________________________________________

28. Da li postoji izlaz za slučaj opasnosti?

Is there provision for emergency escape?

________________________________________________________________________

29. Ima li dovoljno osoba na brodu i obali za slučaj opasnosti?

Are sufficient personnel on board and ashore to deal with an emergency?

________________________________________________________________________

30. Da li je odgovarajuće izolaciono sredstvo postavljeno na cjevovodu brod-kopno?

Are aequate insulating means in place in the ship/shore connection?

________________________________________________________________________

31. Da li je ventilacija pumpne stanice zadovoljavajuća?

Have measures been taken to ensure sufficient pumproom ventilation?

________________________________________________________________________

32. Ako je brod sposoban za zatvoreno krcanje, da li je postupak dogovoren?R

If the ship is capable of closed loading, have requirements for closed operations

been agreed?

________________________________________________________________________

33. Da li je pričvršćen odgovarajući povratni cjevovod pare?

Has an adequate vapour return line been conected?

________________________________________________________________________

34. Ako je pričvršćen povratni cjevovod pare, da li su i drugi faktori dogovoreni?

If a vapour return line is connected, have operating parameters been agreed?

________________________________________________________________________

35. Da li se požarni plan nalazi na ulazu broda?

Are ship emergency fire control plans located externally?

_______________________________________________________________________

36. Da li je sustav inertnog plina ispravan i P

funkcionalan?

Is the Inert Gas System fully operational and in

good working order?

________________________________________________________________________

37. Da li su ispravne palubne vodene brtve?

Are deck seals in good working order? R

________________________________________________________________________

38. Da li odgovara nivo tekućine u vakumsko-prekotlačnom ventilu?

Are liquid levels in p/v breakers correct?

_______________________________________________________________________

39. Da li su ugrađeni i prenosni analizatori kisika kalibrirani i

ispravni?
Have the fixed and portable oxygen analyzers been calibrated

and are they working properly?

_______________________________________________________________________

40. Da li radi ugrađeni registrator kisika i tlaka inertnog plina?

Are fixed IG pressure and oxygen recorders working?

________________________________________________________________________

41. Da li je u tankovima tereta manje od 8% kisika i nadtlak inertnog

plina? PR

Are all cargo tank atmospheres 8% or less oxygen content by volume

and with positive pressure?

________________________________________________________________________

42. Da li su ventili inertnog plina na tankovima ispravno podešeni?

Are all the individual tank IG valves (if fitted) correctly set and locked?

________________________________________________________________________

43. Da li je odgovorna osoba za rukovanje teretom upoznata da u slučaju kvara

slučaja za inertni plin treba zaustaviti rukovanje teretom i obavijestiti

AR

privezno mjesto?

Are all the persons in charge of cargo operations aware that in the case of

failure of the Inert Gas Plant, discharge operations should cease and the

terminal so advised?
________________________________________________________________________

Ako je brod opremljen sa sustavom za pranje tankova sirovom naftom treba odgovoriti na
slijedeća pitanja:

If the ship is fitted with a crude oil washing system, and itends to crude oil wash (COW)
the following questions should be answered.

________________________________________________________________________

Pranje sirovom naftom Brod Privez Code Primjedbe

Crude Oil Washing Ship Terminal Remarks

________________________________________________________________________

44. Da li je prije dolaska broda ispravno ispunjena

kontrolna lista za pranje tankova sirovom naftom?

Is the Pre-Arrival Crude Oil Washing Check List, as contained

in the approved Crude Oil Washing Manual, satisfacorily completed?

________________________________________________________________________

45. Da li postoji kontrolna lista za pranje tankova sirovom naftom

i da li se koristi?

Is the crude Oil Washing Check List for use before, during and

after Crude Oil Washing, as contained in the approved Crude Oil

Washing Manual, available and being used?

________________________________________________________________________

Ako brod planira čišćenje tankova uz obalu, treba odgovoriti na slijedeća pitanja:

If the ship is planning to tank clean alongside, the following questions should be
answered:

________________________________________________________________________
Čišćenje tankova Brod Obala Primjedbe

Tank cleaning Ship Shore Remarks

________________________________________________________________________

Da li će se čistiti tankovi za vrijeme boravka broda Da/Ne*

uz obalu?

Are tank cleaning operations planned during the ship's

stay alongside the shore installation? Yes/No*

________________________________________________________________________

Ako se vrši čišćenje tankova da li je obaviješteno Da/Ne* Da/Ne*

osoblje priveznog mjesta i lučke vlasti?

If so, have the Port Authority and terminal authority Yes/No* Yes/No*

been informed?

________________________________________________________________________

* Precrtajte Da ili Ne kako odgovara.

Delete Yes or No as appropriate.

DEKLARACIJA:

DECLARATION

Dolje potpisani zajedno smo provjerili sve stavke u sigurnosnoj kontrolnoj listi i podaci
koji su uneseni su ispravni.

We the undersigned have checked, where appropriate jointly, the items on this check list
and have satisfied ourselves that the entires we have made are correct to the best of our
knowledge.

Također smo se dogovorili da provjerimo priču prema potrebi, a stavke označene slovom
"R" u stupcu "Code" ponovno provjerimo u vremenskom razmaku (intervalu) koji ne
prelazi ...... sati.
We have also made arrangements to carry out repetitive check as necessary and agree that
those items marked with the letter "R" in the column "Code" should be re-checked at
interval not exceeding ...... hours.

______________________________________________________________________

Za brod Za kopno (privez)

For ship For shore

______________________________________________________________________

Ime: Ime:

Name Name

______________________________________________________________________

Čin: Čin:

Rank Rank

______________________________________________________________________

Potpis: Potpis:

Signature Signature

______________________________________________________________________

Datum:

Date

Vrijeme:

Time

______________________________________________________________________

Prilog 5

BROD/OBALA SIGURNOSNA KONTROLNA LISTA

SHIP/SHORE SAFETY CHECK LIST

Ime broda: ______________________________________________

Ship's Name

Privezno mjesto __________________________ Luka __________________________

Berth Port

Datum dolaska: __________________________ Vrijeme dolaska

__________________________

Date of Arrival: Time of Arrival:

UPUTE ZA ISPUNJAVANJE:

INSTRUCTION FOR COMPLETION

Sigurno rukovanje zahtjeva da svi uvjeti budu potvrdni i ispunjeni oznakom ( ) u

označeni prostor. Ako nije moguć potvrdan dogovor, treba navesti razlog, te dogovoriti
odgovarajuće mjere predostrožnosti koje treba poduzeti brod i privezno mjesto. Kada se
smatra da se uvjeti ne mogu primijeniti, treba ih navesti u rubrici Primjedbe.

The safety of operations requires that all questions should be answered affirmatively by
clearly ticking ( ) the appropriate box. If an affirmative answer is not possible, the reason
should be given and agreement reached upon appropriate precautions to be taken between
the ships and the terminal.

Where any question is considered to be not applicable, then a note to that effect should be
inserted in the remarks column.

Ovaj prostor u stupcu "brod" i "privez" označava da će provjeru izvšiti označena stranka.

A box in the column "ship" and "terminal" indicates that check should be carried out by
the party concerned.

Prisustvo slova A, P ili R u stupcu "Code" ima slijedeće značenje:

The presence of the letters A,P or R in the column "Code" indicates the following

A - svaki postupak i dogovor mora biti upisan u rubrici "Primjedbe" kontrolne liste i
potpisan od obje stranke.

- any procedures and agreements should be in writting in the remarks column of this
check list or other mutually acceptable form. In either case, the signature of both parties
should be required.
P - u slučaju da se na pitanja označena ovim slovom ne može odgovoriti potvrdno,
rukovanje se obustavlja, dok lučke vlasti ne izdaju odobrenje.

- in the case of a negative answer the operation should not be carried out without the
permission of the Port Authority.

R - označava da se kontrola treba ponoviti u vremenskim razmacima koji su dogovoreni u

deklaraciji.

- indicates items to be rechecked at intervals not exceeding that agreed in the declaration.

DIO "A" - OPĆENITO TEKUĆINE

PART "A" - BULK LIQUID GENERAL

_______________________________________________________________________

Općenito Brod Privez Code Primjedbe

General Ship Terminal Remarks

________________________________________________________________________

1. Da li je brod sigurno privezan? Zaustavljen rad Brzina

Is the ship securely moored? R teretom u: vjetra u Nm

Stop cargo at kts wind vel

Odvojen Brzina

cjevovod u: vjetra u Nm

Disconnect at kts wind vel.

Brod odvezan u: Brzina vjetra

Unberth at u Nm

kts wind vel

________________________________________________________________________

2. Da li je ispravno postavljena užad za tegljenje u R

slučaju opasnosti?
Are emergency towing wires correctly positioned?

________________________________________________________________________

3. Da li je pristup brodu siguran? R

Is there safe access between ships and shore?

________________________________________________________________________

4. Da li je brod spreman otploviti na vlastiti pogon? PR

Is the ship ready to move under its own power?

________________________________________________________________________

5. Da li je spremna brodska straža i nadzor kao i nadzor

na privezu?

Is there an effective deck watch in attendance on board and

adequate supervision on the terminal and on the ship?

________________________________________________________________________

6. Da li je dogovorena komunikacija brod - kopno? AR

Is the agreed ship/shore communicatios system operative?

________________________________________________________________________

7. Da li su dogovoreni signali za slučaj opasnosti?

Has the emergency signal to be used by the ship and shore been

explained and understood?

________________________________________________________________________

8. Da li je dogovoren posupak rada sa teretom, bunkerom

AR
i balastom?

Have the procedures for cargo, bunker and ballast handling been agreed?

________________________________________________________________________

9. Da li su opasnosti od tereta kojim se rukuje obznanjene?

Have the hazards associated with toxic substances in the cargo being

handled been identified and understood?

________________________________________________________________________

10. Da li je dogovoren postupak za obustavu rada u slučaju

opasnosti?

Has the emergency shutdown procedure been agreed?

________________________________________________________________________

11. Da li je protupožarna oprema pravilno postavljena i spremna

za upotrebu?

Are fire hoses and fire fighting equipment on board and ashore positioned

and ready for immediate use?

________________________________________________________________________

12. Da li su priključci na cjevovodu za teret u dobrom stanju, odgovarajuće

pričvršćeni i spremni za upotrebu?

Are cargo and bunker hoses/arms in good condition, properly rigged and

appropriate for the service intended?

________________________________________________________________________
13. Da li su izljevi zatvoreni i da li su postavljene posude za

prikupljanje prolivene tekućine na brodu i kopnu?

Are scuppers effectively plugged and drips trays in position, both on

board and ashore?

________________________________________________________________________

14. Da li su cjevovodi tereta i pogonskog goriva koji nisu u upotrebi

zatvoreni slijepim prirubnicima?

Are unused cargo and bunker connections properly secured with blank

flages fully bolted?

_______________________________________________________________________

15. Da li su svi ventili mora koji nisu u upotrebi zatvoreni i zapečaćeni?

Are sea and overboard discharge valves, when not in use, closed and

visibly secured?

________________________________________________________________________

16. Da li su svi poklopci tankova i pogonskog goriva zatvoreni?

Are all cargo and bunker tank lids closed?

________________________________________________________________________

17. Da li se odzračivanje tankova vrši na propisani način?

AR

Is the agreed tank venting system being used?

________________________________________________________________________

18. Da li su ručne lampe u skladu s propisima?

Are hand torches of an approved type?

________________________________________________________________________

19. Da li su prenosne VHF/UHF radijske postaje u skladu sa propisima?

Are portable VHF/UHF transceivers of an approved type?

________________________________________________________________________

20. Da li je antena glavne radijske postaje uzemljena i radar isključen?

Are the ship's main radio transmitter aerials earthed and radar switched off?

________________________________________________________________________

21. Da li su električni kabeli od prenosnih električnih uređaja isključeni?

Are electric cabels to portable electric equipment disconnected from

power?

________________________________________________________________________

22. Da li su vanjska vrata i prozori prostorija posade zatvoreni?

Are all external doors and ports in the accommodation closed?

________________________________________________________________________

23. Da li su isključeni uređaji za klimatizaciju?

Are window-type air conditioning units disconnected?

________________________________________________________________________

24. Da li su zatvoreni usisi zraka uređaja za klimatizaciju?

Are air conditioning itakes which may permit the entry of cargo vapours

closed?

________________________________________________________________________
25. Da li su zadovoljeni propisi za korištenje kuhinje?

Are the requrements for use of gallery and other cooking applicances being

observed?

________________________________________________________________________

26. Da li se poštuju propisi zabrane pušenja? R

Are smoking regulations being observed?

________________________________________________________________________

27. Da li se poštuju propisi o zabrani rada otvorenim plamenom?

Are naked lights regulations being observed?

________________________________________________________________________

28. Da li postoji izlaz za slučaj opasnosti?

Is there provision for emergency escape?

________________________________________________________________________

29. Ima li dovoljno osoba na brodu i obali za slučaj opasnosti?

Are sufficent personnel on board and ashore to deal with an emergency?

________________________________________________________________________

30. Da li je odgovarajuće izolaciono sredstvo postavljeno na cjevovodu

brod-kopno?

Are adequate insulating means in place in the ship/shore connection?

________________________________________________________________________

31. Da li je ventilacija pumpne stanice zadovoljavajuća?

R
Have measures been taken to ensure sufficient pumproom ventilation?

________________________________________________________________________

32. Ako je brod sposoban za zatvoreno krcanje, da li je postupak dogovoren?

If the ship is capable of closed loading, have requirements for closed

operations been agreed?

________________________________________________________________________

33. Da li je pričvršćen odgovarajući povratni cjevovod pare?

Has an adequate vapour return line been connected?

_______________________________________________________________________

34. Ako je pričvršćen povratni cjevovod pare, da li su i drugi

faktori dogovoreni?

If a vapour return line is connected, have operating parameters

been agreed?

_______________________________________________________________________

35. Da li se požarni plan nalazi na ulazu broda?

Are ship emergency fire control plans located externally?

_______________________________________________________________________

DIO "B" KEMIKALIJE U RAZLIVENOM STANJU

PART "B" - BULK LIQUID CHEMICALS

_______________________________________________________________________

Kemikalije u razlivenom stanju Brod Privez Code Primjedbe

Bulk Liquid Chemicals Ship Terminal Remarks

________________________________________________________________________

1. Postoje li informacije o potrebnim podacima za sigurno

rukovanje teretom uključujući sve podatke proizvođača

tereta?

Is information available giving the necessary data for the

safe handling of the cargo, and where applicable, a

manufacturer's inhibition certificate?

________________________________________________________________________

2. Da li je odgovarajuća zaštitna oprema (uključujući i dišni

aparat) spremna za upotrebu?

Is sufficient and suitable protective equipment (including

self-contained breathing apparatus) and protective clothing

ready for immediate use?

________________________________________________________________________

3. Da li su dogovorene osobne zaštitne mjere?

Have counter measures against accidental personal contact

with the cargo been agreed?

________________________________________________________________________

4. Ako je u upotrebi automatski zatvarajući sistem, da li je usklađen

sa stupnjem iskrcaja tereta?

Is the cargo handling rate compatible with the automatic shut down

system, if in use?
________________________________________________________________________

5. Da li su sustavi mjerenja i alarmiranja ispravni?

Are cargo system gauges and alarms correctly set and in good order?

________________________________________________________________________

6. Da li su spremni odgovarajući prenosni detektori plina?

Are portable vapour detection instruments readily available for the

producth to be handled?

______________________________________________________________________

7. Da li je dogovoren plan gašenja požara?

Has information on fire-fighting media

and procedures been exchanged?

_______________________________________________________________________

8. Da li su prenosive cijevi odgovarajuće teretu?

Are transfer hoses of suitable material, resistant to the

action of the cargoes?

________________________________________________________________________

9. Da li se rukovanje teretom vrši stalnim ugrađenim cjevovodom?

Is cargo hadling being performed with the permanent installed pipeline?

________________________________________________________________________

* Precrtajte Da ili Ne kako odgovara.

Delete Yes or No as appropriate.

DEKLARACIJA

DECLARATION
Dolje potpisani zajedno smo provjerili sve stavke u sigurnosnoj kontrolnoj listi i podaci
koji su uneseni su ispravni.

We the undersigned have checked, where appropriate jointly, the items on this check list
and have satisfied ourselves that the entries we have made are correct to the best of our
knowledge.

Također smo se dogovorili da ponovimo provjeru prema potrebi, a stavke označene sa

slovom "R" u stupcu "Code" ponovno provjerimo u vremenskom razmaku (intervalu)
koji ne prelazi ___ sati.

We have also made arrangements to carry out repetitive check as necessary and agreed
that those items marked with the letter "R" in the column "Code" should be re-checked at
interval not exceeding ___ hours.

________________________________________________________________________

Za brod Za kopno (privez)

For ship For shore

________________________________________________________________________

Ime: Ime:

Name Name

________________________________________________________________________

Čin: Čin:

Rank Rank

________________________________________________________________________

Potpis: Potpis:

Signature Signature

________________________________________________________________________

Datum:

Date

Vrijeme:
Time

_______________________________________________________________________

Prilog 5

BROD/OBALA SIGURNOSNA KONTROLNA LISTA

SHIP/SHORE SAFETY CHECK LIST

Ime broda: ____________________________________________________

Ship's Name

Privezno mjesto: __________________________ Luka: __________________________

Berth Port

Datum dolaska: __________________________ Vrijeme dolaska

__________________________

Date of Arrival: Time of Arrival:

UPUTE ZA ISPUNJAVANJE:

INSTRUCTION FOR COMPLETION

Sigurno rukovanje zahtijeva da svi uvjeti budu potvrdni i ispunjeni oznakom ( ) u

označeni prostor. Ako nije moguć potvrdan odgovor, treba navesti razlog, te dogovoriti
odgovarajuće mjere predostrožnosti koje treba poduzeti brod i privezno mjesto. Kada se
smatra da se uvjeti ne mogu primijeniti, treba ih navesti u rubrici Primjedbe.

The safety of operations requires that all questions should be answered affirmatively by
clearly ticking ( ) the appropriate box. If an affirmative answer is not possible, the reason
should be given and agreement reached upon appropriate precautions to be taken between
the ships and the terminal.

Where any question is considered to be not applicable, then a note to that effect should be
inserted in the remarks column.

Ovaj prostor u stupcu "brod" i "privez" označava da će provjeru izvršiti označena stranka

A box in the column "ship" and "terminal" indicates that check should be carried out by
the party concerned.

Prisustvo slova A, P ili R u stupcu "Code" ima slijedeće značenje:

The presence of the letters A, P or R in the column "Code" indicates the following

A - svaki postupak i dogovor mora biti upisan u rubrici "Primjedbe" kontrolne liste i
potpisan od obje stranka.

- any procedures and agreements should be in writing in the remarks column of this
check list or other mutually acceptalbe form. In either case, the signature of both parties
should be required.

P - u slučaju da se na pitanja označena ovim slovom ne može odgovoriti potvrdno,

rukovanje se obustavlja, dok lučke vlasti ne izdaju odobrenje.

- in the case of a negative answer the operation should not be carried out without the
permission of the Port Authority.

R - označava da se kontrola treba ponoviti u vremenskim razmacima koji su dogovoreni u

deklaraciji.

- indicates items to be rechecked at intervals not exceeding that agreed in the declaration.

DIO "A" - OPĆENITO TEKUĆINE

PART "A" - BULK LIQUID GENERAL

_______________________________________________________________________

Općenito Brod Privez Code Primjedbe

General Ship Terminal Remarks

_______________________________________________________________________

Isto kao i prethodna tabela za DIO "A" - OPĆENITO TEKUĆINE (1- 35)

DIO "C" UKAPLJENI PLINOVI

PART "C" - BULK LIQUEFIED GASES

________________________________________________________________________

Ukapljeni plinovi Brod Privez Code Primjedbe

Bulk Liquefied Gases Ship Terminal Remarks

________________________________________________________________________
1. Postoje li informacije o potrebnim podacima za

sigurno rukovanje teretom, uključujući sve podatke

proizvođača tereta?

Is information givig the necessary data of the safe handling

of the cargo including as applicable, a manufacturer's inhibition

certificate?

_______________________________________________________________________

2. Da li je vodena zavjesa spremna za upotrebu?

Is the water spray system ready for use?

_______________________________________________________________________

3. Da li je odgovarajuća zaštitna oprema (uključujući

i dišne aparate) spremna za upotrebu?

Is sufficient and suitable protective equipment (including

self-contained breathing apparatus) and protective clothing

readiy for immediate use?

_______________________________________________________________________

4. Da li su skladišta i međuprostori inertirani prema propisima?

Are hold an inter-barrier spaces properly inerted as required?

________________________________________________________________________

5. Da li su ventili na daljinsko upravljanje ispravni?

Are all remote control valves in working order?

________________________________________________________________________

6. Da li su sisaljke tereta i kompresori ispravni, da li je dogovoren

A

maksimalni tlak rada s teretom, između obale i broda?

Are the required cargo pumps and compressors in good order, and

have maximum working pressures been agreed between ship and shore?

________________________________________________________________________

7. Da li je ispravan kontrolni uređaj za ukapljivanje ili isparavanje?

Is reliquefaction or boil off control equipment in good order?

________________________________________________________________________

8. Da li je odgovarajući uređaj za detekciju propuštanja plina podešen i

ispravan?

Is the gas detection equipment properly set for the cargo, calibrated and

in good order?

________________________________________________________________________

9. Da li su sustavi mjerenja i alarmiranja ispravni?

Are cargo system gauges and alarms correctly set and in good order?

________________________________________________________________________

10. Da li je ispravan sustav za brzo zatvaranje u nuždi?

Are emergency shutdown systems working properly?

________________________________________________________________________

11. Da li su međusobno upoznati brod i privezno mjesto o sustavu

A Ship: ______

automatskog zatvaranja ventila na cjevovodu tereta? Shore: _____

Does shore know the closing rate of ship's automatic valves;

does ship have similar details of shore system?

________________________________________________________________________

12. Da li su brod i privezno mjesto međusobno razmijenili informacije A

o maksimalnom/minimalnom tlaku i temperaturi tereta kojim se rukuje?

Has information been exchanged between ship and shore on the

maximum/minimum temperatures/pressures of the cargo to be handled?

________________________________________________________________________

13. Da li postoji zaštita od nepažljivog prepunjenja tankova za vrijeme

rukovanja teretom?

Are cargo tanks protected against inadvertent overfiling at all times

while any cargo operations are in progress?

_______________________________________________________________________

14. Da li je prostorija kompresora propisno ventilirana;strojarnica

propisno zatvorena i alarmni sustav ispravan?

Is the compressor room properly ventilated; the motor room properly

pressurised and is the alarm system working?

________________________________________________________________________

15. Da li su sigurnosni ventili tankova tereta ispravno podešeni, a podešeni

tlak vidljivo ispisan?

Are cargo tank relief valves set correctly and actual relief valve settings

clearly and visibly displayed?

Tank No 1 __________________________

Tank No 2__________________________
Tank No 3__________________________

Tank No 4__________________________

Tank No 5__________________________

Tank No 6__________________________

Tank No 7__________________________

Tank No 8__________________________

Tank No 9__________________________

Tank No 10__________________________

________________________________________________________________________

DEKLARACIJA:

DECLARATION

Dolje potpisani zajedno smo provjerili sve stavke u sigurnosnoj kontrolnoj listi i podaci
koji su uneseni su ispravni.

We the undersigned have checked, where appropriate jointly, the items on this check list
and have satisfied ourselves that the entries we have made are correct to the best of our
knowledge.

Također smo se dogovorili da ponovimo provjeru prema potrebi, a stavke označene sa

slovom "R" u stupcu "Code" ponovno provjerimo u vremenskom razmaku (intervalu)
koji ne prelazi ____ sati.

We have also made arrangements to carry out repetitive check as necessary and agreed
that those items marked with the letter "R" in the column "Code" should be re-checked at
interval not exceeding __ hours.

________________________________________________________________________

Za brod Za kopno (privez)

For ship For shore

________________________________________________________________________

Ime: Ime:
Name Name

________________________________________________________________________

Čin: Čin:

Rank Rank

________________________________________________________________________

Potpis: Potpis:

Signature Signature

________________________________________________________________________

Datum:

Date

Vrijeme:

Time

________________________________________________________________________