INSPECTION CLOSED-OUT FORM
Ships Name
(Nama Kapal)
Ship Owner/Operator
(Pemilik/Pengelola Kapal)
Date | Port of Inspection
(Tanggal | Pelabuhan Inspeksi)
VIQ / SSSCL Ref.
2.10
Root Cause
(Akar Masalah)
Corrective Action
(Tindakan Perbaikan)
Preventive Action
(Tindakan Pencegahan)
Close-Out evidence might be; documents, procedures, photos, certificate, service report, delivery order, etc.)
(Bukti tindak lanjut dapat berupa; dokumen, prosedur, poto, sertifikat, laporan kerja, bukti pengiriman, dll.)
SPOB ELISABETH 03
PT. ELISABETH BERKAT ENERGI
26 JANUARI 2023 GANDUS, PANGKALAN PALEMBANG
SUMATERA SELATAN
Observation
(Temuan)
1. The completion of recording on oil record book part 1 was found not meeting with
the requirements of MEPC.1/Cicr. 736/Rev. 2;
2. Oil record Book part 2 was found not update,last record on year 2021
1. The completion of recording on oil record book part 1 was found not meeting with
the requirements of MEPC.1/Cicr. 736/Rev. 2;
2. Oil record Book part 2 was found not update,last record on year 2021
1. Provides the completion of recording on oil record book part 1
2. Provides oil record Book part 2
1. Provides the completion of recording on oil record book part 1
2. Provides oil record Book part 2
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INSPECTION CLOSED-OUT FORM
Ships Name SPOB ELISABETH 03
(Nama Kapal)
Ship Owner/Operator PT. ELISABETH BERKAT ENERGI
(Pemilik/Pengelola Kapal)
Date | Port of Inspection 26 JANUARI 2023 GANDUS, PANGKALAN PALEMBANG
(Tanggal | Pelabuhan Inspeksi) SUMATERA SELATAN

VIQ / SSSCL Ref. Observation

(Temuan)

4.12 A sample charts used for voyage was found not being corrected. Operators wasn’t
provided Indonesia Notice to Mariners to the vessel for chart correction guide

Root Cause A sample charts used for voyage was found not being corrected. Operators wasn’t
(Akar Masalah) provided Indonesia Notice to Mariners to the vessel for chart correction guide

Corrective Action Provides examples of charts used for navigation

(Tindakan Perbaikan)
Preventive Action Provides examples of charts used for navigation
(Tindakan Pencegahan)

Close-Out evidence might be; documents, procedures, photos, certificate, service report, delivery order, etc.)
(Bukti tindak lanjut dapat berupa; dokumen, prosedur, poto, sertifikat, laporan kerja, bukti pengiriman, dll.)

CHART 130 CHART 130 : BPI NO. 04 2023-02-04

NO. KOREKSI 032.B

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INSPECTION CLOSED-OUT FORM
Ships Name SPOB ELISABETH 03
(Nama Kapal)
Ship Owner/Operator PT. ELISABETH BERKAT ENERGI
(Pemilik/Pengelola Kapal)
Date | Port of Inspection 26 JANUARI 2023 GANDUS, PANGKALAN PALEMBANG
(Tanggal | Pelabuhan Inspeksi) SUMATERA SELATAN

VIQ / SSSCL Ref. Observation

(Temuan)

5.9 Ship/shore safety cheklist was found not being prefared during cargo activity

Root Cause Ship/shore safety cheklist was found not being prefared during cargo activity
(Akar Masalah)
Corrective Action Provides ship/shore cheklist
(Tindakan Perbaikan)
Preventive Action Provides ship/shore cheklist
(Tindakan Pencegahan)

Close-Out evidence might be; documents, procedures, photos, certificate, service report, delivery order, etc.)
(Bukti tindak lanjut dapat berupa; dokumen, prosedur, poto, sertifikat, laporan kerja, bukti pengiriman, dll.)

Page 3 of 10
INSPECTION CLOSED-OUT FORM
Ships Name SPOB ELISABETH 03
(Nama Kapal)
Ship Owner/Operator PT. ELISABETH BERKAT ENERGI
(Pemilik/Pengelola Kapal)
Date | Port of Inspection 26 JANUARI 2023 GANDUS, PANGKALAN PALEMBANG
(Tanggal | Pelabuhan Inspeksi) SUMATERA SELATAN

VIQ / SSSCL Ref. Observation

(Temuan)

5.13 There is no evidence that emergency drills has been conducted onboard by crews staf

Root Cause There is no evidence that emergency drills has been conducted onboard by crews staf
(Akar Masalah)
Corrective Action Provides evidence that emergency drills has been conducted onboard by crews staf
(Tindakan Perbaikan)
Preventive Action Provides evidence that emergency drills has been conducted onboard by crews staf
(Tindakan Pencegahan)

Close-Out evidence might be; documents, procedures, photos, certificate, service report, delivery order, etc.)
(Bukti tindak lanjut dapat berupa; dokumen, prosedur, poto, sertifikat, laporan kerja, bukti pengiriman, dll.)

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INSPECTION CLOSED-OUT FORM
Ships Name SPOB ELISABETH 03
(Nama Kapal)
Ship Owner/Operator PT. ELISABETH BERKAT ENERGI
(Pemilik/Pengelola Kapal)
Date | Port of Inspection 26 JANUARI 2023 GANDUS, PANGKALAN PALEMBANG
(Tanggal | Pelabuhan Inspeksi) SUMATERA SELATAN

VIQ / SSSCL Ref. Observation

(Temuan)

5.35 Operating instruction of fixed CO2 system onboard was found not cleary displayed near the
system

Root Cause Operating instruction of fixed CO2 system onboard was found not cleary displayed near the
(Akar Masalah) system

Corrective Action Provides clear Operating instruction of CO2 system

(Tindakan Perbaikan)
Preventive Action Provides clear Operating instruction of CO2 system
(Tindakan Pencegahan)

Close-Out evidence might be; documents, procedures, photos, certificate, service report, delivery order, etc.)
(Bukti tindak lanjut dapat berupa; dokumen, prosedur, poto, sertifikat, laporan kerja, bukti pengiriman, dll.)

Page 5 of 10
INSPECTION CLOSED-OUT FORM
Ships Name SPOB ELISABETH 03
(Nama Kapal)
Ship Owner/Operator PT. ELISABETH BERKAT ENERGI
(Pemilik/Pengelola Kapal)
Date | Port of Inspection 26 JANUARI 2023 GANDUS, PANGKALAN PALEMBANG
(Tanggal | Pelabuhan Inspeksi) SUMATERA SELATAN

VIQ / SSSCL Ref. Observation

(Temuan)

6.6 Manifolds spill containers in place under the cargo manifolds located main deck was found
not provided with drainage arrangement

Root Cause Manifolds spill containers in place under the cargo manifolds located main deck was found
(Akar Masalah) not provided with drainage arrangement

Corrective Action Provides spill containers in place under the cargo manifolds loacted main deck
(Tindakan Perbaikan)
Preventive Action Provides spill containers in place under the cargo manifolds loacted main deck
(Tindakan Pencegahan)

Close-Out evidence might be; documents, procedures, photos, certificate, service report, delivery order, etc.)
(Bukti tindak lanjut dapat berupa; dokumen, prosedur, poto, sertifikat, laporan kerja, bukti pengiriman, dll.)

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INSPECTION CLOSED-OUT FORM
Ships Name SPOB ELISABETH 03
(Nama Kapal)
Ship Owner/Operator PT. ELISABETH BERKAT ENERGI
(Pemilik/Pengelola Kapal)
Date | Port of Inspection 26 JANUARI 2023 GANDUS, PANGKALAN PALEMBANG
(Tanggal | Pelabuhan Inspeksi) SUMATERA SELATAN

VIQ / SSSCL Ref. Observation

(Temuan)
8.1 Information on maximun loading rate onboard was found not clearly marked

Root Cause Information on maximun loading rate onboard was found not clearly marked
(Akar Masalah)
Corrective Action Provides information on maximum loading rate onboard
(Tindakan Perbaikan)
Preventive Action Provides information on maximum loading rate onboard
(Tindakan Pencegahan)

Close-Out evidence might be; documents, procedures, photos, certificate, service report, delivery order, etc.)
(Bukti tindak lanjut dapat berupa; dokumen, prosedur, poto, sertifikat, laporan kerja, bukti pengiriman, dll.)

Page 7 of 10
INSPECTION CLOSED-OUT FORM
Ships Name SPOB ELISABETH 03
(Nama Kapal)
Ship Owner/Operator PT. ELISABETH BERKAT ENERGI
(Pemilik/Pengelola Kapal)
Date | Port of Inspection 26 JANUARI 2023 GANDUS, PANGKALAN PALEMBANG
(Tanggal | Pelabuhan Inspeksi) SUMATERA SELATAN

VIQ / SSSCL Ref. Observation

(Temuan)

10.1 Operating instruction of diesel engine located at engine room was found not clearly displayed near
the engine

Root Cause Operating instruction of diesel engine located at engine room was found not clearly displayed near
(Akar Masalah) the engine

Corrective Action Provides operating instuction of diesel engine

(Tindakan Perbaikan)
Preventive Action Provides operating instuction of diesel engine
(Tindakan Pencegahan)

Close-Out evidence might be; documents, procedures, photos, certificate, service report, delivery order, etc.)
(Bukti tindak lanjut dapat berupa; dokumen, prosedur, poto, sertifikat, laporan kerja, bukti pengiriman, dll.)

MAIN ENGINE

AXULIARY ENGINE
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INSPECTION CLOSED-OUT FORM
Ships Name SPOB ELISABETH 03
(Nama Kapal)
Ship Owner/Operator PT. ELISABETH BERKAT ENERGI
(Pemilik/Pengelola Kapal)
Date | Port of Inspection 26 JANUARI 2023 GANDUS, PANGKALAN PALEMBANG
(Tanggal | Pelabuhan Inspeksi) SUMATERA SELATAN

VIQ / SSSCL Ref. Observation

(Temuan)

10.12 Planned maintenance system of engine department was found not avalble onboard

Root Cause Planned maintenance system of engine department was found not avalble onboard
(Akar Masalah)
Corrective Action Provides planned maintenance system of engine departmen
(Tindakan Perbaikan)
Preventive Action Provides planned maintenance system of engine departmen
(Tindakan Pencegahan)

Close-Out evidence might be; documents, procedures, photos, certificate, service report, delivery order, etc.)
(Bukti tindak lanjut dapat berupa; dokumen, prosedur, poto, sertifikat, laporan kerja, bukti pengiriman, dll.)

Page 9 of 10
INSPECTION CLOSED-OUT FORM
Ships Name SPOB ELISABETH 03
(Nama Kapal)
Ship Owner/Operator PT. ELISABETH BERKAT ENERGI
(Pemilik/Pengelola Kapal)
Date | Port of Inspection 26 JANUARI 2023 GANDUS, PANGKALAN PALEMBANG
(Tanggal | Pelabuhan Inspeksi) SUMATERA SELATAN

VIQ / SSSCL Ref. Observation

(Temuan)

10.19 Fuel delivery pipes of diesel engine located at angine room was found not provided with “anti splash
tape”

Root Cause Fuel delivery pipes of diesel engine located at angine room was found not provided with “anti splash
(Akar Masalah) tape”

Corrective Action Provides “pita anti cipratan” on pipe diesel engine fuel lines
(Tindakan Perbaikan)
Preventive Action Provides “pita anti cipratan” on pipe diesel engine fuel lines
(Tindakan Pencegahan)

Close-Out evidence might be; documents, procedures, photos, certificate, service report, delivery order, etc.)
(Bukti tindak lanjut dapat berupa; dokumen, prosedur, poto, sertifikat, laporan kerja, bukti pengiriman, dll.)

MAIN ENGINE

AXULIARY ENGINE

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