PT.

LIS INTERNASIONAL
LVOM 100.12 – MONTHLY STANDARD SHIPBOARD RECORD/Laporan Kapal Bulanan

CONTENTS / DAFTAR ISI

1. Monthly Inspection Report / Laporan Inspeksi Bulanan

2. Oil Change Schedule/ Jadwal Penggantian Oli
3. Monthly Maintenance Summary Report / Laporan Perawatan Bulanan
4. Monthly Shipboard Drills Record / Catatan Latihan Bulanan di atas Kapal
5. Record of Safety Meeting / Catatan Rapat Keselamatan
6. Record of Garbage Discharge / Catatan Pembuangan Sampah
7. Critical Item Checklist / Daftar Peralatan Kritis

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1. MONTHLY INSPECTION REPORT

LAPORAN INSPEKSI BULANAN
Port/ Pelabuhan : PROYEK PELABUHAN WILMAR GRESIK

Inspected By/ Diperiksa Oleh :P.U / SUPERVISOR Date / Tanggal : 25 FEBRUARI 2022

1 A) Crew Document Control / Kendali Dokumen Kru

MCU
Rank Name / Date Passport Seaman HSQE Rigger/ Crane Bosiet / Food
Flag State/ Client (if any) Bosiet
/ Posisi Nama Joined Expiry / Tgl Book/ Buku Passport Signalman Operator / Handler /
Pemerintah / Klien (jika ada)
/ Tgl Join Berlaku Paspor Pelaut / Paspor / Juru ikat/ Petugas Penyaji
Expire HSQE sinyal Derek makanan
P.U TEGUH PRIYONO 15-11-18 - 26-09-2022 IND 03/12/2023 - - - - -
KKM M. YONO 15-11-18 - 30-08-2023 IND 02/12/2023 - - - - -
OPRTR I SUTOJO 15-11-18 - 10-08-2023 IND - - SIO - -
-
OPRTR II SUKARDI 15-11-18 - 27-09-2022 IND - - SIO - -
03/12/2023
OPRTR III VADLY R - 09/11/2023 IND 01/12/2023 - - SIO - -
Masinis I HEDY DARYANTO 15-11-18 - 17-06-2024 IND - - - - -
02/12/2023
Masinis II ZEKI ALFATONI 30-07-19 - 16-04-2024 IND - - - - -
26/11/2022
OILER HERU BAGUS S 15-11-18 - 08-08-2023 IND - - - - -
01/12/2023
ELECTCN KARNALI 15-11-18 - 09-10-2023 IND - - - - -
01/12/2023
WELDER DIMAS BAGUS C 25-07-19 - 24/09/2023 IND - - - - -
-
BOSUN YASIN SYAMNGANI 30-07-19 - 31/08/2023 IND 02/12/2023 - - - - -
KELASI ANWARI 15-11-18 - 12-10-2023 IND - - - - -
06/12/2023
KELASI IMAN ADIN 15-11-18 - 15-10-2023 IND - - - - -
01/12/2023
KELASI AAS ASTORI 15-11-18 - 11-09-2024 IND 06/09/2023 - - - - -
KELASI CAHYO SAPUTRO 15-11-18 - 08-08-2023 IND 01/12/2023 - - - - -

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KELASI RIAN A 01-06-18 - 15-08-2023 IND - - - - -

28/07/2022
KELASI AHMAD ZAKI 24-07-19 - 03/04/2023 IND - - - - FOOD
02/12/2023- HANDLER

1 B) Crew STCW/ Kru STCW

Name/ COC BST SCRB AFF MFA MC RS AS GMDSS SSO BRM/ SAT SDSD ISM GOC/ ORU
Nama Endorse ERM Code

TEGUH PRIYONO - √ - - - - - - - - - - - - -
M. YONO ATT III
√ √ √ √ √ - - - - √ √ - √ √
SUTOJO SIO √ - - - - - - - - - - - - -
SUKARDI SIO √ - - - - - - - - - - - - -
VADLY R SIO √ - - - - - - - - - - - - -
HEDY DARYANTO ATT IV √ √ - - - - - - - - √ - - -
ZEKI ALFATONI ATT V √ - - - - - - - - - - - - -
HERU BAGUS S ATT V √ - √ √ - - - - - - √ - - -
KARNALI ELECTR √ - √ - - - - - - - √ - - -
DIMAS BAGUS C WELDER √ - - - - - - - - - - - - -
YASIN SYAMNGANI - √ - √ - - - - - - - √ - - -
ANWARI - √ - - - - - - - - - - - - -
IMAN ADIN - √ - - - - - - - - - - - - -
AAS ASTORI - √ - - - - - - - - - - - - -
RIAN APRIANSYAH - √ - √ - - - - - - - √ - - -
CAHYO SAPUTRO - √ - √ - - - - - - - √ - - -
AHMAD ZAKI FOOD
HANDLING √ - √ √ - - - - - - √ √ - -
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List of Abbreviations / Daftar Singkatan:

COC: Certificate of Competency GMDSS: Global Maritime Distress Safety System

BST: Basic Safety Training SSO: Ship Security Officer
SCRB: Survival Craft & Rescue Boat BRM: Bridge Resources Management
AFF: Advance Fire Fighting ERM: Engine Resources Management
MFA: Medical First Aid SAT: Security Awareness Training
MC: Medical Care onboard Ship SDSD: Seafarer Designated Security Duties
RS: Radar Simulator ISM Code: International Safety Management Code
AS: ARPA Simulator GOC: General Operator Certificate

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1 C) PPE Inspection Checklist / Ceklis Pemeriksaan APD

Sarung Tangan Anti Go

Sarung Tangan Pelindu
High Impact Gloves
Sepatu Keselamatan

Kacamata Pelindung
Sarung Tangan Kain

Helm Keselamatan
Anti Cut Gloves

Pelindung Telinga
Safety Glasses
Cotton Gloves

ER Bump Cap
Safety Helmet

Di Ruang Mesin
Safety Shoes

Ear Defender

Topi Pelindung
ng Benturan
Baju Kerja
Coverall
DESCRIPTION / Deskr

res
ipsi

No Crew Name/ Nama Kru Condition / Kondisi *

1
TEGUH PRIYONO
Good Good NIL Good NIL Not √ NIL NIL
good
2 M. YONO Good Good NIL Good NIL Good √ √ NIL
3 SUTOJO Good Good NIL Good NIL Good √ NIL NIL
4 SUKARDI Good Good NIL Good NIL Good √ NIL NIL
5
VADLY R
Good Good NIL Good NIL Not √ NIL NIL
good
6 HEDY DARYANTO Good Good NIL Good NIL Good √ √ NIL
7
HERU BAGUS S
Good Good NIL Good NIL Not √ NIL NIL
good
8 KARNALI Good Good NIL Good NIL Good √ NIL NIL
9 ZEKI ALFATONI Good Good NIL Good NIL NIL √ NIL NIL
10
DIMAS BAGUS C
Good Good NIL Good NIL Not √ NIL NIL
good
11
YASIN SYAMNGANI
Good Good NIL Good NIL Not √ NIL NIL
good
12
ANWARI
Good Good NIL Good NIL Not √ NIL NIL
good
13 CAHYO SAPUTRO Good Good NIL Good NIL Not √ NIL NIL
good
14 IMAN ADIN Good Good NIL Good NIL Good √ NIL NIL
15 RIAN APRIANSYAH Good Good NIL Good NIL Not √ NIL NIL
good
16 AAS ASTORI Good Good NIL Good NIL Not √ NIL NIL
good
17 AHMAD ZAKI Good Good NIL Good NIL NIL √ NIL NIL
(*Condition : good/ poor / Kondisi : baik/ buruk)
(**Shall there any broken PPE found is to be attached with photos and put remarks below/ Jika ditemukan ada APD
yang rusak lampirkan foto dan tulis keterangan dibawah ini)

**REMARKS/ KETERANGAN :-
 Wearpack telah disupply per Januari 2022 * Safety Helmet beberapa sudah rusak
 Safety Shoes telah di supply per January 2022
 Permintaan Earplug atau head

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Note / Catatan :

1. Crew is responsible for all crew inventory

Awak kapal bertanggung jawab atas semua perlengkapannya

2. Crew is to ensure PPE inspected prior to use

Awak kapal harus memastikan APD diperiksa sebelum dipakai

3. Master will responsible for PPE inventory on board

P.U /<aster of Barge bertanggung jawab atas perlengkapan APD di atas kapal

4. Master has to raise requisition to replace damaged PPE while still valid with a one to one
exchange
P.U diharuskan membuat permintaan untuk penggantian APD yang telah rusak dan masih berlaku dengan
menukarkan dengan yang baru

5. Re-joining crew without the full Standard PPE kit after the first issuance will have to pay for the
renewal of the missing PPE
Kru yang join kembali tanpa standar penuh APD Kit setelah diberikan pertamakali oleh perusahaan harus
membayar penggantian APD yang hilang

6. PPE must be worn at all times when carrying out hazardous works refer to PPE Matrix
APD harus digunakan saat melaksanakan pekerjaan yang beresiko bahaya mengacu pada Matriks APD

7. The validation of PPE is for one year

Masa berlaku APD adalah satu tahun

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D) Trading Certificates / Sertifikat kapal

No. Certificates / Sertifikat Date of Issue / Validity / Validasi Remarks /
Tanggal Penerbitan
Keterangan
1 SURAT LAUT 17 JAN 2019 17 JAN 2020 JAKARTA

2 SURAT UKUR
INTERNATIONAL/INTERNATIONAL
TONNAGE CERTIFICATE 12 DES 2018 PERMANEN JAKARTA
3 SERTIFIKAT KESELAMATAN SYAHBANDAR
PERLENGKAPAN KAPAL BARANG 25 JAN 2019 16 JUL 2019
4 SERTIFIKAT KESELAMATAN SYAHBANDAR
KONTRUKSI KAPAL BARANG 25 JAN 2019 16 JUL 2019
5 SERTIFIKAT KESELAMATAN RADIO SYAHBANDAR
KAPAL BARANG
25 JAN 2019 16 JUL 2019
6 BKI/ PROVISION CLASSIFICATION 30 JUL 2023
CERTIFICATE (LAMBUNG) 30 JUL 2018
7 BKI/ PROVISION CLASSIFICATION
CERTIFICATE (MESIN)
8 SERTIFIKAT GARIS MUAT
INTERNASIONAL 30 JUL 2018 30 JUL 2023 BKI
9 NATIONAL POLLUTION PREVENTION
CERTIFICATE 23 NOV 2018 23 FEB 2019 HUBLA
10 RPT 8 FEB 2019 07 MEI 2019
HUBLA
11 SURAT PERSETUJUAN OLAH GERAK
KAPAL 17 JANUARI 15 FEBRUARI 2019
SYAHBANDAR
2019
12 ISRKL/IZIN STASIUN RADIO KAPAL 28 MEI 2015 27 MEI 2020 BKI
LAUT
13 TANDA PANGGILAN/CALL SIGN
14 SERTIFIKAT NASIONAL SISTEM ANTI
TERITIP
15 MINIMUM SAFE MINNING DOCUMNET
16 CERTIFICATE OF INSPECTION
BOLLARD PULL TEST
17 INFLATABLE LIFE RAFT(s/p)& 20 OKT 2018 19 OK 2019
HYDROSTATIC RELEASE TEST
18 FIRE EXTINGUISHER&CO2 21 MEI 2018 21 APRIL 2022

19 SERTIFIKAT TINDAKAN SANITASI 12 OKT 2021 12 OKT 2022

KAPAL
20 SERTIFIKAT PENGAWASAN OBAT 30-04-2019 30-10-2019 DEPKES
OBATAN DAN ALAT KESEHATAN

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21 SERTIFIKAT NASIONAL DANA

JAMINAN GANTI RUGI PENCEMARAN
MINYAK BAHAN BAKAR

22 PKL CREW 11 NOV 2021 11 NOV 2022

23 BUKU SIJIL
24 SERTIFIKAT PENGAWASAN KUALITAS
AIR
25 DOKUMEN PENYESUAIAN
MANAGEMEN KESELAMATAN
26 BUKU KESEHATAN

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E) Regulatory Compliance and Documentation / Dokumentasi dan Regulasi

No. Records / Catatan Remarks / Keterangan
MAX SCORE /
VALUE / NILAI
NILAI MAX

1 ISM DOC 0 0 NIL ON PROCESS

2 ISM SMC 0 0 NIL ON PROCESS
3 Oil Record Book 10 10 ADA
4 Stability Booklet 10 0 NIL
5 Sounding Table 10 0 NIL
6 Nautical Publications 0 0 NIL
7 List of Lights 10 0 NIL
8 Tide Table 10 10 ADA
9 Chart Correction Log 10 10 NIL
10 Official Deck Log 10 10 ADA
11 Official Engine Log 10 10 ADA
12 Inventory Records 10 10 ADA

Total 120 60

F) Navigational Equipment Performance / Kondisi Alat Navigasi

NO. EQUIPMENT / ALAT MAX SCORE REMARKS / KETERANGAN

VALUE / NILAI
/ NILAI
MAX

1 GPS Navigator 10 10 ADA

2 Public Addressor 0 0 N.I.L
3 Weather Fax / Navtex Receiver 0 0 N.I.L
4 Radar 0 0 N.I.L
5 VHF 10 10 KONDISI BAGUS
6 SSB 10 5 KONDISI RUSAK
7 Echo Sounder 10 10 KONDISI BAGUS
8 Steering Compass 0 0 N.I.L
9 Bearing Compass 0 0 N.I.L
10 Search Light 10 10 BAGUS
11 Signal Equipment 0 0 ADA
Total 50 45

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G) Paint Work (Visual Condition)

/ Pekerjaan Pengecatan (Kondisi Visual) *Note : Photographs to be attached (if possible) /
Catatan : Foto dilampirkan (jika memungkinkan)

NO. LOCATION / DESCRIPTION MAX SCORE REMARKS / KETERANGAN

(LOKASI / DESKRIPSI) VALUE / NILAI
/ NILAI
MAX

1 Main Deck Plating 10 7 NEED REPAINT

2 Main Deck Piping 10 9 NEED REPAINT
3 Engine Room piping 10 8 KONDISI BAGUS
4 Superstructure 10 9 KONDISI BAGUS
5 Winches (Fwd) 10 9 KONDISI BAGUS

Total 50 42

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H) Tanks (Visual Condition) / Tanki (Kondisi Visual)

*Note : Photographs to be attached ( If possible ) / / Catatan : Foto dilampirkan (jika memungkinkan)

NO. LOCATION / CAPACITY MAX SCORE / REMARKS / KETERANGAN

DESCRIPTION (M3) / VALUE / NILAI
(LOKASI / KAPASITAS NILAI
MAX
DESKRIPSI) (M3)
1 Fore Peak Tank - 0 0 NIL

2 Aft Peak Tank 50 m3 10 8 KONDISI BAGUS

3 Fuel Tanks 150 m3 10 8 KONDISI BAGUS 100T&49T
4 Ballast Tanks 750 m3 10 8 KONDISI BAGUS

Total 30 24

I) ACCOMODATION / AKOMODASI
No. AREAS / LOKASI MAX SCORE REMARKS / KETERANGAN
VALUE / NILAI
/ NILAI
MAX
1 Pax Accommodation / Akomodasi 0 0 TIDAK ADA
Penumpang
2 Crew Accommodation / Akomodasi 10 10 BAGUS ( 12 KAMAR ) ada beberapa
Crew kamar crew yang bocor
3 Air-conditioning 10 8 BAGUS
4 Mess Room / Galley 10 8 BAGUS
5 Insect Infestation 0 0 NIL
6 Clean Fragrance 10 8 BAGUS
7 Toilets 10 6 STANDAR ( 3 Ruang ) 1 Toilet Tidak
dapat digunakan

Total 50 40

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J) MACHINERY SPACE / AREA KAMAR MESIN

No. AREAS / LOKASI MAX SCORE REMARKS / KETERANGAN
VALUE / NILAI
/ NILAI
MAX
1 Engine room Bilges 10 10 ADA
2 Steering Gear Flat 0 0 NIL
3 Lightings 10 10 BAGUS
4 Main Engine Room compartment 10 10 ADA
5 Machinery Cleanliness 10 10 BAGUS
6 Bow Thrusters Compartment - - NIL

Total 40 40

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K) Load line Items / Daftar Perlengkapan Kapal

MAX SCORE REMARKS / KETERANGAN
NO. REQUIREMENTS / PERSYARATAN VALUE / NILAI
/ NILAI
MAX
1 Air Pipes 10 8 CUKUP BAGUS
2 Watertight Doors 10 8 CUKUP BAGUS
3 Ventilators 10 8 CUKUP BAGUS
4 Shipside / Guard rails 10 8 CUKUP BAGUS
5 Portholes, Windows / Deadlights 10 8 CUKUP BAGUS
6 Deck Openings (Watertight ?) 10 6 CUKUP BAGUS

Total 60 46

L) LIFESAVING EQUIPMENT / PERLENGKAPAN LIFESAVING

No. REQUIREMENTS / PERSYARATAN MAX SCORE REMARKS /
VALUE / / NILAI
KETERANGAN
NILAI
MAX
1 Fireman’s outfit 10 10 ADA
2 SOLAS Training Manual 10 10 ADA
3 Liferafts and Hydrostatic Release 10 10 ADA
4 Is Liferaft Operating Instructions displayed? / apakah 10 10 ADA
poster pengoperasian liferaft tersedia?
5 Quick-release Man overboard Lifebuoys? - - NIL
6 Pryotechnics, including Line Throwing Apparatus 10 10 ADA
7 SOLAS Signs and Poster 10 10 ADA
8 BA Sets 10 10 ADA
9 Life Jackets/ Work Vest 10 10 ADA
10 Life Buoy 10 10 ADA
11 Muster Station / Station Bill 10 10 ADA
12 General Alarm 10 10 ADA
13 SARTs 10 10 ADA (29/07/22)
14 EPIRB 10 10 ADA (29/07/22)
15 Paraguard Strecher 10 10 ADA
16 First Aid Kit 10 10 ADA
17 Scramble Nets - - NIL

Total 150 150

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M) FIRE-FIGHTING EQUIPMENT / PERLENGKAPAN FIRE-FIGHTING

No. REQUIREMENTS / PERSYARATAN MAX SCORE REMARKS /
VALUE / / NILAI
KETERANGAN
NILAI
MAX
1 Main Fire Pump 10 8 ADA
2 Emergency Fire Pump 10 7 ADA
3 Fire Monitors 0 0 Tidak ada
4 International shore connection of standard size - - -
5 Are Fire Appliances located in compliance with fire 10 7 ADA/TIDAK
plans?
6 Fire Control Plan 10 7 ADA
7 Fire Detection System 10 7 ADA
8 Are Vent stops operational and clearly marked? 10 7 ADA
9 Fireman Outfit 10 10 ADA
10 Fire Hydrants and nozzle 10 8 ADA
11 Fire Extinguishers 10 8 ADA

Total 80 69

N) E/R MACHINERY / MESIN DI KAMAR MESIN

REQUIREMENTS / MAX SCORE REMARKS / KETERANGAN
NO. VALUE / / NILAI
PERSYARATAN
NILAI
MAX
1 Main Engine 10 8 Cukup Baik
2 Aux. Engine 10 8 Cukup Baik
3 Main Air Compressor 10 8 Cukup Baik
4 Purifier - - NIL
5 Pumps 10 7 Cukup Baik
6 Emergency Stops 10 8 Cukup Baik
7 High Level Bilge Alarm - - Cukup Baik
8 Emergency Power 10 8 Cukup Baik
9 Machinery Alarms 10 7 Cukup Baik
10 Steering Gear - - -
11 Bridge – E/R Comms - - -
Total 60 54

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O) DECK EQUIPMENT / MACHINERY / (PERLENGKAPAN DECK / MESIN)

REQUIREMENTS / MAX SCORE REMARKS / KETERANGAN
NO. VALUE / / NILAI
PERSYARATAN
NILAI
MAX
1 Deck Planking - - NIL
2 Anchor Windlass 10 8 Cukup Baik
3 Outboard Fenders 10 8 Kurang memadai dan Perlu Dipasang
4 General condition 10 8 Kondisi cukup baik
5 Speed - - -

Total 30 24

P) MACHINERY RUNNING HOURS / RUNNING HOURS MESIN

Date Last Running Hrs
NO. MACHINERY O/H (Tanggal since last INTERVAL SCHEDULE
/ MESIN FOR O/H FOR NEXT
Terakhir Over O/H (Running (JARAK O/H (JADWAL
houl) Hours sejak ANTARA OVERHOUL
OVERHOUL) KEDEPAN)
terakhir
Overhoul)
1 NIGATA 18/11/2019 16.076 hours - 18.000 hours
2 AE 1 MITSUBISHI 10/02/2021 10.473 hours - 18.000 hours
6D22MPT
3 AE 2 VOLVO - 7.509 hours - 18.000 hours
PENTA THD 1241
TAG
4 AE 3 DINYO 10/01/2021 4.825 hours - 18.000 hours
WOD4T
5 AE 4 MITSUBISHI - - - -

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Q) REMARKS / OTHER DEFECTS (KETERANGAN / KERUSAKAN LAINNYA)

NO.
1  KERUSAKAN & PERBAIKAN H.T KOMUNIKASI DAN RADIO MARINE 10 UNIT
2  KERUSAKAN DAN PENGGANTIAN SKIP ROLL JANGKAR KANAN
3  KERUSAKAN MESIN CUCI

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Section MAX SCORE / PERCENTAGE

No. VALUE / NILAI %/
NILAI MAX PERSENTASE %
1 120 60 50%
2 50 45 90%
3 50 42 88%
4 30 24 80%
5 50 40 90%
6 40 40 100%
7 60 46 90%
8 150 150 100%
9 80 69 86%
10 60 54 90%
11 30 24 80%

Total 720 594 82%

TEGUH PRIYONO/ MASTER OF BARGE 28 Februari 2022

Name / Designation (Nama / Jabatan) Date of Inspection / Tanggal Inspeksi

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2. OIL CHANGE SCHEDULE

JADWAL PENGGANTIAN OLI

No Date / Tanggal Engine / Total R/H Interval / Remarks / Keterangan

(Jumlah
Mesin Running Jarak
Hour)
1. 1 Januari 2022 AE 1 750 - Oil changed 15-40 (40 L)

2. 25 Januari 2022 1000 Oil Filter Change

3.

4.

M. YONO / Chief engineer 28 Februari 2022

_________________________________ _________________

Name / Designation (Nama / Jabatan) Date of Inspection / Tanggal Inspeksi

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3. MONTHLY MAINTENANCE SUMMARY REPORT

LAPORAN PERAWATAN BULANAN

Date / Tanggal Work Done / Pekerjaan yang selesai

# CABUT LINER AE1

Februari 2022 # PASANG LINER 4G

# STEL KLEP AE1

# PASANG PIPA PENDINGIN CRANE

# PERBAIKAN OMEGA CRANE

# PEMASANGAN TAG LINE CRANE

# GANTI FUELER L.O

# TAP L.O COOLER G/B

# CAT LANTAI TANGGA SW PUMP

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Date / Tanggal Work Done / Pekerjaan yang selesai

Februari Cleaning Buritan kapal

2022
Bunker BBM 90 Ton

Bunker fresh water 140 Ton

Grase Bucket Clamshell

Perbaikan Railing Deck Belakang

Kebersihan Akomodasi Kapal

Bersihkan Anjungan, Akomodasi, Mess Room

Bersihkan Ruang Mesin

Las Penggantian Sling Wire

Penggantian Bushing Heavy Bucket

Pemasangan Fender Kapal deck belakang

M. YONO / ChiefOfficer 28 Februari 2022

Name / Designation (Nama / Jabatan) Date of Inspection / Tanggal Pemeriksaan

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4. MONTHLY SHIPBOARD DRILLS RECORD
CATATAN LATIHAN BULANAN DI ATAS KAPAL

No. Type of Drill / Jenis Latihan Date Conducted / Tanggal Duration Ship’s No. of Participation / Remarks / Keterangan
Pelaksanaan of Drill / Position / Jumlah yang hadir
Durasi Posisi Kapal
Latihan
1.

2.

3.

4.

5.

6.

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5. RECORDS OF SAFETY MEETING

CATATAN RAPAT KESELAMATAN
No of crew attended / Jumlah crew yg hadir: 5 person

Date / Tanggal: 01 Januari 2022 From / Dari: 07:30 Lt To / Sampai:07:45 Lt

Location / Lokasi: PELABUHAN PT WILMAR NABATI Action By / Dilakukan Date of Completion /

oleh: Tanggal pelaksanaan:

Topics of Discussion (SAFETY MATTERS) / Bahasan diskusi SAFETY 12 Januari 2022

(Sehubungan dengan keselamatan):
- Kegiatan Keruk Pelabuha PT Wilmar

- Info Alat Komunikasi dan List H.T

Action By / Dilakukan Date of Completion /

oleh: 15 Februari 2022

Topics of Discussion (SAFETY MATTERS) / Bahasan diskusi

(Sehubungan dengan keselamatan):

Action By / Dilakukan Date of Completion /

oleh: Tanggal pelaksanaan:

Topics of Discussion (SAFETY MATTERS) / Bahasan diskusi

(Sehubungan dengan keselamatan):
.

Conclusion and Master Remarks / Kesimpulan dan Catatan KOORDINASI DAN INFORMASI HARUS

Nahkoda: Teguh Priyono TETAP DIJAGA

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Date / Tanggal: 20 Februari 2022 No of crew attended / : KKC Dewi Arimbi

Location / Lokasi: PT WilmAR Nabati Gresik From / Dari: 15:00 pm To / Sampai: 17:00 pm

Topics of Discussion (SAFETY MATTERS) / Bahasan diskusi Action By / Date of Completion

(Sehubungan dengan keselamatan): Dilakukan oleh: / Tanggal
pelaksanaan:
- Informasi tentang APAR HSE LISI 22 Desember 2019

Topics of Discussion (SAFETY MATTERS) / Bahasan diskusi Action By / Date of Completion

(Sehubungan dengan keselamatan): Dilakukan oleh: / Tanggal
pelaksanaan:
-

Topics of Discussion (SAFETY MATTERS) / Bahasan diskusi Action By / Date of Completion

(Sehubungan dengan keselamatan): Dilakukan oleh: / Tanggal
pelaksanaan:

Conclusion and Master Remarks / Kesimpulan dan Catatan

Nahkoda:

Semua kegiatan Harus dilakukan dengan Aman / Safety First

TEGUH PRIYONO 20 Februari 2022

Name / Designation(P.U) Date of Meeting / Tanggal Rapat

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6. RECORDS OF GARBAGE DISCHARGE

CATATAN PEMBUANGAN SAMPAH
Garbage Categories / Kategori Sampah
1 dunnage, lining and packing materials / Dunnage, Lapisan dan bahan kemasan

2 Cargo Residue, paper, rags, glass, metal, bottles, crockery or similar / Sisa muatan, kertas, kain, kaca, kaca, besi, botol,
peralatan atau sejenisnya

3 All other garbage including paper, rags, glass, etc. comminuted or ground / Semua sampah termasuk kertas, kain,kaca dan
lainnya yang tidak bias terurai atau di tanah

4 Food wastes not comminuted or ground / Limbah makanan yang tidak bias terurai atau ditanah

5 Food wastes comminuted or ground / Limbah makanan yang terurai atau di tanah

6 Mixed refuse / Campuran sampah

Date/Time Position For Cargo Estimated Amount Discharged into Estimated Estimated Amount Certification
(GMT) / of the Residue,Inclu Sea (m3) / Estimasi Jumlah Amount Incinerated (m3) / /Signature /
Tanggal/Wa Ship / de Start /Stop Pembuangan ke Laut (m3) Discharged to Estimasi Jumlah yang Sertifikasi /
ktu (GMT) Posisi Position / Reception dibakar Tanda
Kapal Untuk Sisa Facilities or to tangan
Muatan, other ship
LAT/LON termasuk (m3) / Estimasi
G/PORT Posisi mulai / jumlah
posisi berhenti pembuangan
ke fasilitas
penerima atau
kapal lainnya

Start Stop CAT CAT CAT CAT CAT CAT Other

2 3 4 5 6 1 / Lain

02.02.2022 Port of V V V V V 15 Kg At TanjungLumpur

Wilmar
08.02.2022 Port of V V V 5 Kg At Tanjung Lumpur
Wilmar
10.00 Wib
15.02.2022 Port of V V V V 15 kg At Tanjung Lumpur
WIlmar
11
20.02.2022 Port of V V 10 kg At Tanjung Lumpur
101 Wilmar
25.02.2022 Port of V 10 kg At Tanjung Lumpur
Wilmar
28.02.2022 Port of V V 8 kg At Tanjung Lumpur
Wilmar
01.03.2022 Port of 10 kg At Tanjung Lumpur
Wilmar

Note / Catatan: Plastic is NEVER to be thrown overboard / sampah plastic TIDAK PERNAH dibuang ke laut

“Discharge Of Cargo Residue require START and STOP Positions to be recorded.” / Pembuangan sisa
muatan pada posisi MULAI dan BERHENTI harus dicatat

Master / Nahkoda: Teguh Priyono, 28 Februari 2022

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Signature / Date(Tanda Tangan / Tangg

7 CRITICAL ITEM CHECKLIST

DAFTAR PERALATAN KRITIS

No. Description / Penjelasan Interval / Interval Date inspected / Date inspected /

pemeriksaan Tanggal Tanggal
Pemeriksaan Pemeriksaan
A STEERING GEAR SYSTEM/SISTEM NIL NIL NIL
STEERING GEAR

1 Sluggish operation check prior arrival & Every port / 25 Januari 2022
departure / Pengoperasian sangat lambat dan Setiap Pelabuhan
cek selama Kegiatan Loading dan Dumping

2 All filter in system to check daily / Semua Daily / Setiap hari NIL NIL
filter pada system harus dicek setiap hari

3 Oil to top up / Oli sampai ke atas As and when / NIL NIL

Ketika & kapan

4 Linkages and bearing to grease/Pelumas Weekly/Mingguan - -

untuk sambungan dan bantalan

5 Change over steering gear pump to check / Daily/Setiap hari NIL NIL
Perubahan pompa steering gear untuk
diperiksa

6 Pumps motors maintenance to carry out / Yearly / Tahunan - -

Pemeriksaan motor pada pompa
dilaksanakan

7 Rudder indicator in Bridge and aft control Every port / NIL NIL
to check / Indikator kemudi di anjungan dan Setiap Pelabuhan
after control untuk diperiksa

B EMERGENCY FIRE PUMP AND BILGE

PUMP / FIRE PUMP DAN BILGE PUMP
DARURAT

1 To check pump leakages / Pemeriksaan Daily / Setiap Daily Daily

pada kebocoran pompa Hari

2 To check electric motors and couplings / Daily / Setiap Daily Daily

Pemeriksaan pada motor listrik dan coupling Hari

3 To service pump / Perawatan pompa Yearly / Tahunan Yearty Yearty

4 To check piping, hoses and clamp / Daily / Setiap Weekly Weekly

Pemeriksaan pipa, selang dan clamp Hari

5 Test run pump for 10mins / Pengetesan Weekly / Weekly Weekly

pompa selama 10 menit Mingguan

C Engine start up system / Sistem penyalaan

Mesin induk

1 Charges DC. 12 Volt to check / Pengisian Daily / Setiap Weekly Weekly

DC 12 Volt untuk diperiksa Hari

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2 Charges DC 24 Volt to check / Pengisian Daily / Setiap Weekly Weekly

DC. 12 Volt untuk diperiksa Hari

3 Top up distilled water and check / Top up Daily / Setiap Weekly Weekly
air aki dan pemeriksaan Hari

4 Terminal to check / Sambungan untuk Daily / Setiap Weekly Weekly

diperiksa Hari

5 Electric starter to check mounting bolts / Daily / Setiap Weekly Weekly

Electric starter untuk diperiksa pemasangan Hari
bautnya

6 Electric starter to check carbon brushers / Daily / Setiap Weekly Weekly

Electric Starter untuk diperiksa carbon Hari
brusher

M.Yono / chief engineer 28 Februari 2022

Chief Engineer / Kepala Kamar Mesin Date / Tanggal

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Proposed Periodic Maintenance Schedule for PTHTC Vessels / Jadwal Perawatan

Berkala untuk KKC DEWI ARIMBI
(A) All Vessels, (Crew Boat, Offshore Supply Vessels) / Semua kapal (Crew boat, Offshore Supply Vessel)

Main Engine / Mesin Induk Crane Interval / Interval Date inspected / Date inspected /
Pemeriksaan Tanggal Pemeriksaan Tanggal Pemeriksaan

Clean Filter 250hr / 250 jam 25-01-2022 25-02-2022

Periodic Oil Change 700hr / 700 jam 25-01-2022 25-03-2022
Alarm testing (Low LO Pressure) Monthly / Bulanan - -
Alarm testing (High FW Temp) Monthly / Bulanan - -
Engine Mounting Daily / Harian 01-01-2022 01-02-2022
Major Overhaul OEM Rec

Gear Box Interval / Interval Date inspected / Date inspected /

Pemeriksaan Tanggal Pemeriksaan Tanggal Pemeriksaan

Periodic Oil Change 1000hr / 1000 jam 25-.01-.2022 25-04-2022

Clutch Disc visual inspection Monthly / Bulanan - -
Major Overhaul OEM Rec - -

Auxiliary Engine I Interval / Interval Date inspected / Date inspected /

Pemeriksaan Tanggal Pemeriksaan Tanggal Pemeriksaan

Clean Filter 250hr / 250 jam 12-01-2022 12-03-2022

Periodic Oil Change 400hr / 400 jam 16-01-2022 16-03-2022
Alternator Weekly / Mingguan 19-01-2022 16-02-2022
Alarm testing (Low LO Pressure) Monthly / Bulanan - -
Alarm testing (High FW Temp) Monthly / Bulanan - -
Engine Mounting Daily / Harian 20-01-2022 20-02-2022
Major Overhaul OEM Rec -

Auxiliary Engine II Interval / Interval Date inspected / Date inspected /

Pemeriksaan Tanggal Pemeriksaan Tanggal Pemeriksaan

Clean Filter 250hr / 250 jam -

Periodic Oil Change 400hr / 400 jam -
Alternator Weekly / Mingguan -
Alarm testing (Low LO Pressure) Monthly / Bulanan -
Alarm testing (High FW Temp) Monthly / Bulanan -
Engine Mounting Daily / Harian -
Major Overhaul OEM Rec -

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Auxiliary Engine III (Emergency) Interval / Interval Date inspected / Date inspected /
Pemeriksaan Tanggal Pemeriksaan Tanggal Pemeriksaan

Fully Automated System Monthly / Bulanan 03-01-2022 03-02-2022

Low Oil pressure alarm & trip Monthly / Bulanan 03-01-2022 03-02-2022
High FW temp alarm & trip Monthly / Bulanan 03-01-2022 03-02-2022
Emergency Alternator Monthly / Bulanan 03-01-2022 03-02-2022
Battery Charger Monthly / Bulanan 03-01-2022 03-02-2022

Bow Thruster Interval / Interval Date inspected / Date inspected /

Pemeriksaan Tanggal Pemeriksaan Tanggal Pemeriksaan

Hydraulic Power Pack Weekly / Mingguan - NIL

Motor/ coupling Weekly / Mingguan - NIL
SW General Managerling Pump Weekly / Mingguan - NIL
Motor/ coupling Weekly / Mingguan - NIL
System Servicing Drydock / naik dok - NIL

Stern Thruster Interval / Interval Date inspected / Date inspected /

Pemeriksaan Tanggal Pemeriksaan Tanggal Pemeriksaan

Hydraulic Power Pack Weekly / Mingguan - NIL

Motor/ coupling Weekly / Mingguan - NIL
SW General Managerling Pump Weekly / Mingguan - NIL
Motor/ coupling Weekly / Mingguan - NIL
System Servicing Drydock / naik dok - NIL

FIFI System Interval / Interval Date inspected / Date inspected /

Pemeriksaan Tanggal Pemeriksaan Tanggal Pemeriksaan

Fire Pump Weekly / Mingguan - NIL

Motor/ Coupling Weekly / Mingguan - NIL
Fifi Monitor Weekly / Mingguan - NIL
Remote Control Weekly / Mingguan - NIL
System Servicing Drydock / naik dok - NIL

Pumps (If applicable) Interval / Interval Date inspected / Date inspected /

Pemeriksaan Tanggal Pemeriksaan Tanggal Pemeriksaan

Mud Pumps Weekly / Mingguan 30-01-2022 30-01-2022

Bilge Pump Weekly / Mingguan 230-01/2022 230-01/2022
Cement Pump Weekly / Mingguan - -
Drill Water Pump Weekly / Mingguan 31-01-2022 31-01-2022
Cargo Transfer Pump Weekly / Mingguan - -
LO Pump (Main Engine) Weekly / Mingguan 29/01/2022 29/01/2022
LO Pump (Gear Box) Weekly / Mingguan 29/01/2022 29/01/2022

(B) Anchor Handlers, Tug & Supply Boats

Deck Machinery Interval / Interval Date inspected / Date inspected /
Pemeriksaan Tanggal Pemeriksaan Tanggal Pemeriksaan

Anchor Windlass Daily / Harian 01-01-2022 03-02-2022

Deck Crane Daily / Harian 04-01-2022 04-02-2022
Tugger Winch Daily / Harian 12-01-2022 12-02-2022
Anchor Handling Winch Daily / Harian 12-01-2022 12-02-2022
Hydraulic Power Pack Daily / Harian 15-01-2022 15-02-2022

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Air Compressor Crane I Interval / Interval Date inspected / Date inspected /

Pemeriksaan Tanggal Pemeriksaan Tanggal Pemeriksaan

Motor/ coupling Daily / Harian 15-01-2022 15-02-2022

Air Compressor Crane II Interval / Interval Date inspected / Date inspected /

Pemeriksaan Tanggal Pemeriksaan Tanggal Pemeriksaan

Motor/ coupling Daily / Harian 28-01-2022 28-02-2022

Air Compressor Gerak Winch Interval / Interval Date inspected / Date inspected /
Pemeriksaan Tanggal Pemeriksaan Tanggal Pemeriksaan

Motor/ coupling Daily / Harian 10-01-2022 10-02-2022

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