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Document No D-07A

PT. HABCO TRANS MARITIMA Issued Date 01-01-2023


Issued Status 1
DECK FORM & CHECKLIST
Revision 0
MAINTENANCE AND INSPECTION OF FIRE PROTECTION SYSTEM, LSA AND APPLIANCES
Vessel: Date:
Starting Icon Set 1 Poor Due date
: 2 Fair
1/1/2023 1/8/2023 1/15/2023 1/22/2023 1/29/2023
3 Good
Description Interval Result Result Result Result Maintenance work Remarks
1. Lifeboat
Davits to be lubricated.
Winches to be lubricated.
Boats to be lowered to embarkation lever, weather permitting Weekly By ship
on alternative weeks.
Davit limit switch to be checked for correct operation.
2. Lifeboat engine
Engines to be run, throtlle and reversing gear lever operated,
follow makers instructions.
Weekly By ship
Fuel tanks to be checked, topped up if necessary.
Bilge pump to be checked.
3. Lifeboats (except free fall lifeboats)
Inspection of the hook, their attachment.
On load release gear and reset operation.
Running for 3 min for lifeboat engine and verifying gearbox
and gear train are engaged satisfactorily.
Weekly By ship
For cargo ships moved from their stowed position, without any
persons on board, to the extent necessary to demonstrate the
satisfactory operation of launching appliances, if weather and
sea conditions so allow.
4. Rescue boat
Inspection of the hook, their attachment.
On load release gear and reset operation, if fitted.
Weekly By ship
Running for 3 min for lifeboat engine and verifying gearbox
and gear train are engaged satisfactorily.
5. Signaling lamp
Lamps are operating correctly.
The independent source of power from the ship's mains is Weekly By ship
operating correctly.
Page 1 of 2

Description Interval Result Result Result Result Maintenance work Remarks


6. Emergency generator
Start and run on load for least five minutes.
Check fuel tank- full Weekly By ship
Starts by local and remote starts on alternative weeks.
7. Self contained breathing apparatus (SCBA)
Examine all breathing apparatus cylinders for correct pressure
Weekly By ship
range.
8. Emergency escape breathing device
Examine all EEBD cylinders for correct pressure range. Weekly By ship
9. PA + Gen. Alarm systems
Verify all public address systems and general alarm systems
Weekly By ship
are functioning properly.
10. Fire doors
Verify that all fire door control panel indicators, if provided, are
Weekly By ship
functional by operating the lamp/indicator switch.
11. Fixed fire detection and alarm system
Verify all fire detection and fire alarm control panel indicators
Weekly By ship
are functional by operating the lamp/indicator test switch.
12. Low location lighting systems
Verify low-location lighting systems are functional by switching
Weekly By ship
off normal lighting in selected locations.
13. Water mist, water spray and sprinkler systems
Verify that all control panel indicators and alarms are
functional.
Visually inspect pump unit and its fittings. Weekly By ship
Check the pump unit valve positions, if valves are not locked,
as applicable.
14. Fuel tanl shut-off valves
Air cylinder is always charged with correct pressure.
Weekly By ship
Press gauge in good condition.

Signature:
Result: This column shall indicate an assessment of condition as follows: Maintenance work: This column is to be used for recording work carried out.
GOOD = Condition without problem Date: Use format MONTH/YEAR, eg. 01/01/2021 for work done.
FAIR = Condition only with minor problems Remaks: Reference for any comments.
POOR = Condition with major problems in specific areas or general condition below acceptable levels (…...................................) (…...................................)
Safety Officer / 3rd Officer Master
Page 2 of 2
Doc No D-07B
PT. HABCO TRANS MARITIMA Issued Date 01-01-2023
Issued Statu 1
DECK FORM & CHECKLIST
Revision 0
MAINTENANCE AND INSPECTION OF FIRE PROTECTION SYSTEM, LSA AND APPLIANCES
Vessel: Date:
Starting 1 Poor Due date
: 2 Fair
Icon Set
1/1/2023 1/31/2023 3/2/2023 4/1/2023 5/1/2023 5/31/2023 6/30/2023 7/30/2023 8/29/2023 9/28/2023 10/28/2023 11/27/2023 12/27/2023 1/26/2024
3 Good
Description Interval Result Result Result Result Result Result Result Result Result Result Result Result Result
1. Lifeboat

Lights to be tested and defect made good.

Falls used in launching appliances: Inspection and Lubrication


as required. Special concern to hidden areas and areas of
end terminations.
Replacements of first-aid outfits and anti- seasickness Monthly
medicine of lifeboat equipment on the expiry date.
Replacement of food rations of lifeboat equipment on the
expiry date.
Inspection of lifeboat equipment
Battery replacement of lifebuoy lights.
2. Immersion suits and anti-exposure suits
Check the condition of the storage bag as well as the general
condition of the bag for ease of removal of the suit.
Ensure donning instructions are legible.
Confirm that suit is the type and size identified on the bag.
Visually check for damage, rip and tear any repair to be as
per manufacturer and by service station authorised by
manufacturer or acceptable by the administration.
Monthly
Condition of zipper for ease of operation , if not functional
same to be discarded or repaired at a service station.
Check, if fitted any inflatable head support or buoyancy ring
for damage and its proper attachment and inflation hose for
any deterioration.
Check the condition of retro reflective tape for condition and
adhesion.
If the fitted condition of whistle , expiry date of light and
battery.

Page 1 of 4
Description Interval Result Result Result Result Result Result Result Result Result Result Result Result Result
3. Lifeboats (except free fall lifeboats)
Turned out from their stowed position, without any persons on
Monthly
board if weather and sea conditions so allow.
4. Pyrotechnic
Replacement of rocket parachute flares and rockets line
throwing appliances on the expiry date. Monthly
Replacement of smoke signals on the expiry date.
5. Fixed fire detection and alarm system
Performance test to be carried out fire alarm panels. Monthly
Performance test to be carried out for each fire detector by
Monthly
test kit.
6. Wheeled (mobile) fire extinguishers
Verify all extinguishers are in place, properly arranged, and in
Monthly
proper condition.
7. Fire –fighters outfit
Verify lockers providing storage for fire- fighting equipment
contain their full inventory and equipment is in serviceable Monthly
condition.
8. Main fire pump
Operate satisfactorily.
Proper pressure maintained. Monthly
Pressure gauge in good order.
9. Emergency fire pump
Operate satisfactorily.
Proper pressure maintained.
Monthly
Pressure gauge in good order.
Prime mover in good condition.
10. Fire main piping
No leakage, heavy wastage in lines.
Monthly
No doublers clamps, soft patches in lines.
11. Isolation valves
Operate satisfactorily. Monthly
12. Hydrants
Fire hoses easily coupled to hydrants.
Satisfactory operation of valves. Monthly
Valve handles not broken.
13. Fire hoses
All hoses in good condition, without leakage and cracked
lining.
Checking the number of hoses acc. to the fire control plan. Monthly
Complete with nozzle and couplings.
Page 2 of 4
Description Interval Result Result Result Result Result Result Result Result Result Result Result Result Result
14. Nozzles
All nozzles in good condition, without leakage.
Jet type nozzles and jet/spray dual type in engine room.
Operation of easy change mode. Monthly
Jet/spray dual type with shut-off device for all nozzles.
Operation of easy change mode and shut-off devices.
15. Stowed boxes of fire hoses and nozzles
Stowed in good condition and easily usable.
Monthly
Clearly painted (red coor) boxes.
16. Portable fire extinguisher
Checking the number of FPE of each type according to fire
plan.
Cylinders in good condition without serious Monthly
corrosion/damaged.
17. Portable foam applicators unit
Checking the air-foam nozzle, portable tank foam making
liquid and on spare tank.
Monthly
Testing the connection of fire main by a fire hose.
Condition of stowage container in good order.
18. CO2 fire-extinguishing systems
General visual inspection of the overall system condition for
obvious signs of damage.
Verify that all stop valves are in the closed position.
Verify that all releasing controls are in the proper position and
readily accessible for immediate use.
Verify all discharge piping and pneumatic tubing is intact and Monthly
has not been damaged.
Verify that all high pressure cylinders are in place and
properly secured.
Verify that the alarm devices are in place and do not appear
damaged.
19. In addition, for Low Pressure CO2 systems
Verify that the pressure gauge is reading in the normal range.
Verify that the liquid level indicator is reading within the proper
level.
Verify that the manually operated storage tank main service Monthly
valve is secured in the open position.
Verify that the vapour supply line valve is secured in the open
position.
Page 3 of 4

Description Interval Result Result Result Result Result Result Result Result Result Result Result Result Result
20. Water mist, water spray and sprinkler systems
Verify all control, pump unit and section valves are in the
proper open or closed position.
Verify sprinkler pressure tanks or other means have correct
levels of water.
Test automatic starting arrangements on all system pumps so
designed.
Monthly
Verify that all standby pressure and air/gas pressure gauges
are within the proper pressure ranges.
Test a selected sample of system section valves for flow and
proper initiation of alarms (Note – The valves selected for
testing should be chosen to ensure that all valves are tested
within a one-year period.)

Maintenance Work Date Remarks

Note:
Result: This column shall indicate an assessment of condition as follows: Maintenance work: This column is to be used for recording work carried out.
GOOD = Condition without problem Date: Use format MONTH/YEAR, eg. 01/01/2021 for work done.
FAIR = Condition only with minor problems Remaks: Reference for any comments.
POOR = Condition with major problems in specific areas or general condition below acceptable levels

Signature:

(…...................................) (…...................................)
Safety Officer / 3rd Officer Master
Page 4 of 4
Doc No D-07C
PT. HABCO TRANS MARITIMA Issued Date 01-01-2023
Issued Statu 1
DECK FORM & CHECKLIST
Revision 0
MAINTENANCE AND INSPECTION OF FIRE PROTECTION SYSTEM, LSA AND APPLIANCES
Vessel: Date:
Starting 1 Poor Due date
: 2 Fair
Icon Set
1/1/2023 4/1/2023 6/30/2023 9/28/2023 12/27/2023
3 Good
Description Interval Result Result Result Result Maintenance work Date Remarks
1. Lifeboat water
Empty and refill lifeboat water. 3 months By ship
2. Immersion suits and anti-exposure suits
The head support/buoyancy ring to be inflated and tested for
3 months By ship
leaks.
3. Fire dampers
Test all fire dampers for local operation.
3 Months By ship
Clear marking "Close-Open".
4. Fire doors
Test all fire doors located in main vertical zone bulkheads for
3 Months By ship
local operation.
5. International Shore Connections
Verify that international shore connection(s) is in serviceable
3 Months By ship
condition.
6. Water sprinkler systems
Assess system water quality in the header tank and pump unit
3 Months By ship
against the manufacturer’s water quality guidelines.
7. Fuel oil tank shut-off valves
All valves to be closed by remote control from fire control
3 Months By ship
station. Satisfactory operation of valves.
8. Emergency stop
Satisfactory operation of emergency stop tobe carried out
from each location. (including accommodation, engine, 3 Months By ship
abandon ship and local application fire fighting system parts).

Page 1 of 2
Note:
Result: This column shall indicate an assessment of condition as follows: Maintenance work: This column is to be used for recording work carried out.
GOOD = Condition without problem Date: Use format MONTH/YEAR, eg. 01/01/2021 for work done.
FAIR = Condition only with minor problems Remaks: Reference for any comments.
POOR = Condition with major problems in specific areas or general condition below acceptable levels

Signature:

(…...................................) (…...................................)
Safety Officer / 3rd Officer Master

Page 2 of 2
Doc No D-07D
PT. HABCO TRANS MARITIMA Issued Date 01-01-2023
Issued Statu 1
DECK FORM & CHECKLIST
Revision 0
MAINTENANCE AND INSPECTION OF FIRE PROTECTION SYSTEM, LSA AND APPLIANCES
Vessel: Date:
Starting 1 Poor Due date
: 2 Fair
Icon Set
1/1/2023 12/27/2023
3 Good
Description Interval Result Maintenance work Date Remarks
1. Lifeboat
Annual servicing maintenance of hydrostatic release units (non-disposable). Annually By shore
2. Liferaft
Servicing of inflatable liferaft Annually By shore
3. Lifejacket
Servicing of the lifejacket. Annually By shore
4. Air recharging system for SCBAs
Check breathing apparatus air recharging systems, if fitted, for air quality. By shore
Annually
Check face mask and air demand valves are in serviceable condition. By ship
5. Emergency escape breathing device
Check EEBDs according to maker's instructions. Annually By ship
6. Fire dampers
Test all fire dampers for remote operation. Annually By ship
7. Ventilation systems
Test all ventilation controls interconnected with fire-protection systems for proper
Annually By ship
operation.
8. Fire doors
Test all remotely controlled fire doors for proper release. Annually By ship
9. Fixed fire detection and alarm system
Test all fire detection systems and fire detection systems used to automatically
release fire- extinguishing systems for proper operation, as appropriate.
Visually inspect all accessible detectors for evidence of tempering obstruction, Annually By ship
etc., so that all detectors are inspected within one year.
Test emergency power supply switchover.
10. Portable Fire Extinguishers
Inspection in accordance with the manufacturer 's instruction and based on
Annually By shore
inspection guide in Res. A.951(23), table 9.1.3.

Page 1 of 4
Description Interval Result Maintenance work Date Remarks
11. Wheeled (mobile) fire extinguishers
Inspections in accordance with the manufacturer's instruction.
Visually inspect all accessible components for proper condition.
Annually By ship
Check the hydrostatic test date of each cylinder.
for dry powder extinguishers, invert extinguishers to ensure powder is agitated.
12. Galley exhaust ducts
Verify galley exhaust ducts and filters are free of grease build-up. Annually By ship
13. Fire mains, fire pumps, hydrants, hoses and nozzles
Visually inspect all accessible components for proper condition.
Flow test all fire pumps for proper pressure and capacity. Test emergency fire
pump with isolation valves closed.
Test all hydrant valves for proper operation.
Pressure test a sample of fire hoses at the maximum fire main pressure, so that Annually By ship
all fire hoses are tested within five years.
Verify all fire pump relief valves, if provided, are properly set.
Examine all filters/ strainers to verify they are free of debris and contamination.
Verify that all nozzles size/type are correct, maintained and working.
14. Portable foam applicators unit
Verify all portable foam applicators are set to the correct proportioning ratio for the
foam concentrate supplied and the equipment is in proper order.
Verify all portable containers or portable tanks containing foam concentrate
remain factory sealed, and the manufacturer's recommended service life interval
has not been exceeded. Annually By ship
The foam concentrates of any non-sealed portable containers and portable tanks,
and portable containers and portable tanks where production data is not
documented, should be subjected to the periodical foam control tests required in
MSC.1/Circ.1312
15. Galley and deep fat cooking fire-extinguishing system
Check galley and deep fat cooking fire- extinguishing systems in accordance with
Annually By ship
the manufacturer's instructions.
16. In addition, for Low Pressure CO2 systems
The boundaries of the protected space should be visually inspected to confirm
that no modifications have been made to the enclosure that have created unclose
able openings that would render the system ineffective.
Annually By ship
All storage containers should be visually inspected for any signs of damage, rust
or loose mounting hardware. Cylinders that are leaking, corroded, dented or
bulging should be hydrostatically retested or replaced.

Page 2 of 4
Description Interval Result Maintenance work Date Remarks
System piping should be visually inspected to check for damage, loose supports
and corrosion. Nozzles should be inspected to ensure they have not been
obstructed by the storage of spare parts or a new installation of structure or
machinery.
The manifold should be inspected to verify that all flexible discharge hoses and
fittings are properly tightened.
All entrance doors to be protected space should close properly and should have
warning signs, which indicate that the space is protected by a fixed carbon dioxide
systems and that personnel shall evacuate immediately if the alarms sound. All
remote releasing controls shall be checked for clear operating instructions and
indication as to the space served.
Verify proper operation of all water mist, water-spray and sprinkler system using
the test valves for each section.
Visually inspect all accessible components for proper condition.
Externally examine all high pressure cylinders for evidence of damage or
corrosion.
Check the hydrostatic test date of all high pressure cylinders.
Functionally test all fixed system audible and visual alarms.
Flow test all pumps for proper pressure and capacity.
Test all antifreeze systems for adequate freeze protection.
Test all system cross connections to other sources of water supply for proper
operation. Annually By ship
Verify all pump relief valves, if provided, are properly set.
Examine all filters/strainers to verify they are free of debris and contamination.
Verify that all control/section valves are in the correct position.
Blow dry compressed air or nitrogen through the discharge piping of dry pipe
systems or otherwise confirm the pipe work and nozzles are clear of any
obstructions. This may require the removal of nozzles, if applicable.
Test emergency power supply switchover, where applicable.
Visually inspect all sprinklers focusing in areas where sprinklers are subject to
aggressive atmosphere (like saunas, spas, kitchen areas) and subject to physical
damage (like luggage handling areas, gyms, play rooms, etc) so that all sprinklers
are inspected within one year. Sprinklers with obvious external damage, including
paint, should be replaced and not included in the number of sprinklers tested in
accordance with the flow charts Part 1 – Basic Testing and Part 2 – Extended
Testing as indicated in MSC. 1/Circ. 1516
Check for any changes that may affect the system such as obstructions by
ventilation ducts, pipes, etc.
Test a minimum of one section in each open head water mist system by flowing
water through the nozzle. The section tested should be chosen so that all sections
are tested within a five-year period.
Page 3 of 4

Description Interval Result Maintenance work Date Remarks


Test automatic sprinklers and automatic water mist nozzles in accordance with the
flow charts Part 1 – Basic Testing and Part 2 – Extended Testing as indicated in
MSC. 1/Circ. 1516.
By ship
During basic testing, and extended testing when applicable, of automatic sprinkler
heads/nozzles as outlined above, water quality testing should be conducted in
each corresponding piping section.

Note:
Result: This column shall indicate an assessment of condition as follows: Maintenance work: This column is to be used for recording work carried out.
GOOD = Condition without problem Date: Use format MONTH/YEAR, eg. 01/01/2021 for work done.
FAIR = Condition only with minor problems Remaks: Reference for any comments.
POOR = Condition with major problems in specific areas or general condition below acceptable levels

Signature:

(…...................................) (…...................................)
Safety Officer / 3rd Officer Master

Page 4 of 4
Doc No D-07E
PT. HABCO TRANS MARITIMA Issued Date 01-01-2023
Issued Statu 1
DECK FORM & CHECKLIST
Revision 0
MAINTENANCE AND INSPECTION OF FIRE PROTECTION SYSTEM, LSA AND APPLIANCES
Vessel: Date:
Starting 1 Poor Due date
: 2 Fair
Icon Set
1/1/2023 6/19/2025
3 Good
Description Interval Result Date Remarks
1. In addition, for Low Pressure CO2 systems
All high-pressure cylinders and pilot cylinders shall be weighed or have their contents verified by other reliable means to confirm that
the available charge in each is above 90% of the nominal charge. Cylinders containing less than 90% of the nominal charge should be
refilled. Low-pressure CO2 System: The liquid level of low-pressure storage tanks should be checked to verify that the required
amount of carbon dioxide to protect the largest hazards is available. 2,5 years By shore
The hydrostatic test date of all storage containers should be checked.
The discharge piping and nozzles shall be tested to verify that they are not blocked. The test shall be performed by the discharge
piping from the system and flowing dry air or nitrogen from test cylinders or suitable means through the piping.

Maintenance Work

Note:
Result: This column shall indicate an assessment of condition as follows: Maintenance work: This column is to be used for recording work carried out.
GOOD = Condition without problem Date: Use format MONTH/YEAR, eg. 01/01/2021 for work done.
FAIR = Condition only with minor problems Remaks: Reference for any comments.
POOR = Condition with major problems in specific areas or general condition below acceptable levels

Signature:

(…...................................) (…...................................)
Safety Officer / 3rd Officer Master

Page 1 of 1
Doc No D-07F
PT. HABCO TRANS MARITIMA Issued Date 01-01-2023
Issued Statu 1
DECK FORM & CHECKLIST
Revision 0
MAINTENANCE AND INSPECTION OF FIRE PROTECTION SYSTEM, LSA AND APPLIANCES
Vessel: Date:
Starting 1 Poor Due date
: 2 Fair
Icon Set
1/1/2023 12/16/2025
3 Good
Description Interval Result Date Remarks
1. Immersion suits and anti-exposure suits (MSC/Circ.1114)
Air pressure test (seams and closure), suit to be inflated to a pressure of .1 to .2 psi and if auxiliary inflatable means of buoyancy is
provided, it should be inflated through the oral valve to a pressure of 0.1 psi.
Each seam and closure of the suit and each seam, oral tube and attachment points, joint or valve of any auxiliary means of inflatable 3 years By shore
to be covered with soapy water to check leakage. if any repair is needed, it is strongly recommended that any, repairs to a suit be
carried out by a facility that has access to the original manufacturer's recommended servicing instructions, parts and adhesives, and
suitably trained personnel.

Maintenance Work

Note:
Result: This column shall indicate an assessment of condition as follows: Maintenance work: This column is to be used for recording work carried out.
GOOD = Condition without problem Date: Use format MONTH/YEAR, eg. 01/01/2021 for work done.
FAIR = Condition only with minor problems Remaks: Reference for any comments.
POOR = Condition with major problems in specific areas or general condition below acceptable levels

Signature:

(…...................................) (…...................................)
Safety Officer / 3rd Officer Master

Page 1 of 1
Doc No D-07G
PT. HABCO TRANS MARITIMA Issued Date 01-01-2023
Issued Statu 1
DECK FORM & CHECKLIST
Revision 0
MAINTENANCE AND INSPECTION OF FIRE PROTECTION SYSTEM, LSA AND APPLIANCES
Vessel: Date:
Starting 1 Poor Due date
: 2 Fair
Icon Set
1/1/2023 12/6/2027
3 Good
Description Interval Result Date Remarks
1. Lifeboat (SOLAS III/20.4)
Falls used in launching appliances: Renewal after 5 years or earlier when necessary due to deterioration. 5 years By shore
2. Air recharging system for SCBAs
Hydrostatic pressure testing of all SCBA cylinders. 5 years By shore
3. Emergency escape breathing device
Hydrostatic pressure testing of all EEBD cylinders as per manufacturer’s instructions. 5 years By shore
4. Portable Fire Extinguishers
At least one fire extinguisher of each type manufactured in the same year and kept on board a ship should be test discharged at five
5 years By ship
yearly intervals (as part of a fire drill).
5. Wheeled (mobile) fire extinguishers (by ship)
Visually examine at least one extinguisher of each type manufactured in the same year and kept on board. 5 years By shore
6. Low location lighting systems
Test the luminance of all systems in accordance with the procedures in Resolution A.752(18). 5 years By shore
7. In addition, for Low Pressure CO2 systems
All high-pressure cylinders and pilot cylinders shall be weighed or have their contents verified by other reliable means to confirm that
the available charge in each is above 90% of the nominal charge. Cylinders containing less than 90% of the nominal charge should
be refilled. Low-pressure CO2 System: The liquid level of low-pressure storage tanks should be checked to verify that the required
amount of carbon dioxide to protect the largest hazards is available.
The hydrostatic test date of all storage containers should be checked.
The discharge piping and nozzles shall be tested to verify that they are not blocked. The test shall be performed by the discharge
piping from the system and flowing dry air or nitrogen from test cylinders or suitable means through the piping.
5 years By shore
Where possible, all activating heads should be removed from the cylinder valves and tested for correct functioning by applying full
working pressure through the pilot lines.
In case where this is not possible, pilot lines shall be disconnected from the cylinder valves and blanked off or connected together
and tested with full working pressure from the release station and checked for leakage.
In both cases this shall be carried out from one or more release stations when installed.
If manual pull cables operate the remote release controls, they shall be checked to verify the cables and corner pulleys are in good
condition and freely move and do not require an excessive amount of travel to activate the system.
Page 1 of 2
Description Interval Result Date Remarks
All cable components should be cleaned and adjusted as necessary, and the cable connectors shall be properly tightened, If the
remote release controls are operated by pneumatic pressure, the tubing shall be checked for leakage, and the proper charge of the
remote releasing station pilot gas cylinders shall be verified. All controls and warning devices shall function normally, and the time
delay, if fitted shall prevent the discharge of gas for the required time period. 5 years By shore
After completion of the work, the system shall be returned to service. All releasing controls shall be verified in the proper position
and connected to the correct control valves. All pressure switch interlocks shall be rest and returned to service. All stops valves shall
be in the
closed position.
8. Water mist, water spray and sprinkler systems (by ship)
Perform internal inspection of all control/section valves; water quality testing should be conducted in all corresponding piping
section, if not previously tested within the last five year.
Check condition of any batteries, or renew in accordance with manufacturer’s recommendations.
For each section where the water is refilled after being drained or flushed, water quality should meet manufacturer’s guidelines. 5 years By shore
Testing of the renewed water quality should be conducted and recorded as a new baseline reference to assist future water quality
monitoring for each corresponding section.
Perform a hydrostatic test and internal examination for gas and water pressure cylinders according to flag Administration guidelines
or, where these do not exist, EN 1968:2002 +A1.

Maintenance Work

Note:
Result: This column shall indicate an assessment of condition as follows: Maintenance work: This column is to be used for recording work carried out.
GOOD = Condition without problem Date: Use format MONTH/YEAR, eg. 01/01/2021 for work done.
FAIR = Condition only with minor problems Remaks: Reference for any comments.
POOR = Condition with major problems in specific areas or general condition below acceptable levels

Signature:

(…...................................) (…...................................)
Safety Officer / 3rd Officer Master
Page 2 of 2
Page 2 of 2
Doc No D-07H
PT. HABCO TRANS MARITIMA Issued Date 01-01-2023
Issued Statu 1
DECK FORM & CHECKLIST
Revision 0
MAINTENANCE AND INSPECTION OF FIRE PROTECTION SYSTEM, LSA AND APPLIANCES
Vessel: Date:
Starting 1 Poor Due date
: 2 Fair
Icon Set
1/1/2023 11/9/2032
3 Good
Description Interval Result Date Remarks
1. Portable Fire Extinguishers
All fire extinguishers together with propellant cartridges to be hydraulically tested in accordance with the recognized standard or the At least 10-
By shore
manufacturer's instruction. yearly
2. Wheeled (mobile) fire extinguishers
All extinguishers together with propellant cartridges to be hydrostatically tested in accordance with recognized standards or the At least 10-
By shore
manufacturer's instructions. yearly
3. In addition, for Low Pressure CO2 systems
High pressure cylinders shall be subjected to periodical tests at intervals not exceeding 10 years. At the 10-years inspection, at least
10% of the total number provided should be subjected to an internal inspection and hydrostatic test. If one or more cylinders fail, a
total of 50% of the onboard cylinders should be tested. If further cylinders fail, all At least 10-
By shore
cylinders should be tested. yearly

Flexible hoses shall be replaced at the intervals recommended by the manufacturer and not exceeding 10 years.

Note:
Result: This column shall indicate an assessment of condition as follows: Maintenance work: This column is to be used for recording work carried out.
GOOD = Condition without problem Date: Use format MONTH/YEAR, eg. 01/01/2021 for work done.
FAIR = Condition only with minor problems Remaks: Reference for any comments.
POOR = Condition with major problems in specific areas or general condition below acceptable levels

Signature:

(…...................................) (…...................................)
Safety Officer / 3rd Officer Master

Page 1 of 1

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