Bunkering Checklist

• Conducted on

  Date

• Document No.

• Vessel

• Berth

To be completed by Vessel Operative

• m3 required to be Loaded

• Product to be Loaded (e.g. MGO)

• Amount on board in Litres/Tonnes (specify)

• Total Fuel Capacity in Litres/Tonnes (specify)

• Signature

  Sign

• Name

• Rank

• Date & Time

  Date

NorSea Use Only

• Marine Bunkering Delivery Note Number:

• Time Commenced

  Date

• Time Completed

  Date

• Operations can not commence until all elements of the checklist have been addressed and both Ship and Shore representative are in agreement that they are completed satisfactorily.

• Is Vessel Securely Moored?

  Yes

  No

• Is There Safe Access Between Vessel and Shore?

  Yes

  No

• Have Bunkering Handling Procedures Been Agreed? (emphasis should be given to communication methods).

  Yes

  No

• Is Fire Fighting Equipment Ready For Use?

  Yes

  No

• Are Smoking Regulations Being Observed?

  Yes

  No

• Are Naked Light Requirements Being Observed?

  Yes

  No

• Are All Unused Cargo/Bunker Connections Blanked?

  Yes

  No

• Are Scuppers Effectively Plugged?

  Yes

  No

• Are Bunker Tank Lids Closed and Secured?

  Yes

  No

• What is the Max Flow Rate Agreed (m3)?

• All Bunker Hoses Visually Checked, in Good Condition, and Appropriate for Service Intended?

  Yes

  No

• Is there an Effective Watch on the Quayside and on the Ship Receiving Bunkers?

  Yes

  No

• Is the Transfer Hose Properly Rigged and Secured to Manifolds on Ship and Shore?

  Yes

  No

• Will Bunker Tank Contents be Monitored at Regular Intervals?

  Yes

  No

• Is there a Supply of Oil Spill Clean Up Material Readily Available for Immediate Use?

  Yes

  No

• Has the Safety Data Sheet (SDS) for the Bunker Transfer been Exchanged where Requested?

  Yes

  No

• Comments:

DECLARATION

• We the undersigned have satisfied ourselves that the entries we have made are correct to the best of our knowledge. We also acknowledge that should the status of any item change we are required to inform the other party immediately.

• Checked for Vessel (Vessel Name):

• Checked for Vessel by (Vessel Operatives Name):

• Checked for Vessel by (Vessel Operatives Signature):

  Sign

• Operations can not commence until all elements of the checklist have been addressed and both Ship and Shore representative are in agreement that they are completed satisfactorily.

• Is Vessel Securely Moored?

  Yes

  No

• Is There Safe Access Between Vessel and Shore?

  Yes

  No

• Have Bunkering Handling Procedures Been Agreed? (emphasis should be given to communication methods).

  Yes

  No

• Is Fire Fighting Equipment Ready For Use?

  Yes

  No

• Are Smoking Regulations Being Observed?

  Yes

  No

• Are Naked Light Requirements Being Observed?

  Yes

  No

• Are All Unused Cargo/Bunker Connections Blanked?

  Yes

  No

• Are Scuppers Effectively Plugged?

  Yes

  No

• Are Bunker Tank Lids Closed and Secured?

  Yes

  No

• What is the Max Flow Rate Agreed (m3)?

• All Bunker Hoses Visually Checked, in Good Condition, and Appropriate for Service Intended?

  Yes

  No

• Is there an Effective Watch on the Quayside and on the Ship Receiving Bunkers?

  Yes

  No

• Is the Transfer Hose Properly Rigged and Secured to Manifolds on Ship and Shore?

  Yes

  No

• Will Bunker Tank Contents be Monitored at Regular Intervals?

  Yes

  No

• Is there a Supply of Oil Spill Clean Up Material Readily Available for Immediate Use?

  Yes

  No

• Has the Safety Data Sheet (SDS) for the Bunker Transfer been Exchanged where Requested?

  Yes

  No

• Comments:

DECLARATION

• We the undersigned have satisfied ourselves that the entries we have made are correct to the best of our knowledge. We also acknowledge that should the status of any item change we are required to inform the other party immediately.

• Checked for NorSea by (Operatives Name):

• Checked for NorSea by (Operatives Signature):

  Sign