船舶污染物接收作业安全和防污染确认书式样.doc

船舶污染物接收作业安全和防污染确认书

POLLUTANTRECEIVINGCHECKLIST

NO.

接收船船名（车辆）船名

ReceivingShipName__________________ShipName________________________

污染物种类污染物数量

Kindofpollutant_____________________Quantity________________________

作业时间及地点

TimeandPlaceoftheOperation_____________________

泵压（如适用）泵速

PumpPressure（Mpa）_____________________PumpRate（m3/h）_____________________

检查项目

Items

接收方

Receiver

船方

Ship

备注

Remarks

1．管线是否完好？

Arehosesingoodcondition?

2．管线是否接妥，并在结合处放置了接收容器？

ArehosescorrectlyconnecteddripcollectingtraysinPositionatJoiningPart?

3．阀件是否打开？

Isthevalveofreceivingtankopen?

4．接收舱的剩余舱容是否已检查？

Isthecapacityofreceivingtankchecked?

5．所有落水孔是否已有效堵塞？

Areallscupperseffectivelyplugged?

6．双方是否约定了联系信号？

Isthecommunicationsystemagreedonbybothparts?

7．双方是否安排了专人值班？

Aredutypersonassignedbybothparts?

8．双方的操作程序是否已商定？

IstheoperationProcedureagreedonbybothparts?

9．双方是否备妥了必要的吸附材料，以应付意外跑冒事故？

Arenecessaryabsorbingmaterialsavailablefordealingwithaccidentalescapeofoil?

10．不使用的管线是否用盲板封死并上齐所有螺栓？

Areclosedmanifoldconnectionsblankedfullybolted?

11．船舱壁、管线、阀门和船壳是否状况良好无渗漏？

Arebulkheads、pipelines、valveshullingoodconditionwithnoleaks?

12．缆绳是否状态良好？

Areropesingoodcondition?

13．船舶是否安全系泊？

Isvesselsecurelymoored?

14．碰垫是否状况良好并布放合理？

Arefendersingoodorderandsuitablypositioned?

15．货物网兜、吊具、吊绳等设备是否处于良好状态？

Arecargonetsorliftingcages,stropsetcingoodcondition?

16．管线是否已安全适当的连接并上满螺丝？

Isthetransferhoseproperlyriggedandfullybolted?

17．接收方是否规定停止作业风力等级？如果规定，风力几级时停止接收作业？

Istheenvironmentalthresholdforthecargooperationregulatedbysupplier?Ifregulated，whichscaleofwindforcebunkeringoperationwillbestopped?

18．双方是否在作业过程中做好船舶溢漏应急防备工作？

Istheshippollutantspillemergencypreparednessworkdoneintheprocessofoperation?

注：1．双方必须按表内所列项目检查、落实，符合要求者用“√”，不符合要求者在备注栏内说明。

Note:1．Bothpartiesshallcheckandimplementalltheitemsofthelist,