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• Ships name and Nr:

• Location:
  Address

• Date:

  Date

• Prepared by:

• Vessels name & number:

• Kind of inspection:

  Internal audit

  Technical inspection

  Other

Initials & date :

• JVB

• EBO

• JLA

• OTO

• JZO

• MPR

• QA

• Crewing

• OPS

• The person who last read this report, please deliver same to the responsible person mentioned.

• Date :

  Date

• Name :

• Are wthe ncn's / obs or NOK checked in GLSM

• Is the report scanned and placed on the X-drive under vessels including the photographs

• Is a crew list & evaluation report(s) attached:

• Is the internal audit over view list updated for a.m. vessel (only applicable for QA dept).

• Is the portfolio updated from the internal auditor ( only applicable for QA dept).

• Is the planning overview of the ships visits tech / nautical / QA updated in GLSM by responsible person