船舶安全自查结果汇总表.docxVIP

船舶安全自查结果汇总表 Summary of Ship Safety Self-check Results 编号：120101-2 No.120101-2 船名： 日期： MV: ________________ Date: ______________ 职务Rank 姓名 Name 自查结果及缺陷描述 Self-check Results and Description of Deficiency 备注 Remarks 签名 Signature 船长 Master 大副 Chief Officer 二副 Second Officer 三副 Third Officer 轮机长 Chief Engineer 大管轮 Second Engineer 二管轮 Third Engineer 三管轮 Fourth Engineer 电子电气员 Electrical Engineer 船长签名：Signature of the Master 年 月 日 Month Day Year 海务主管意见： Comments of the Marine Dept. Supervisor 签名： 年 月 日 Signature Month Day Year 机务主管意见： Comments of the Technical Dept. Supervisor 签名： 年 月 日 Signature Month Day Year 指定人员验证： Verification of the Designated Person 签名： 年 月 日 Signature Month Day Year 备注： 1、自查结果填写“正常”或缺陷描述，备注栏填写已采取纠正措施或需要的岸基支持，若需要岸基支持应按照体系相关规定填报申请单、修理单等； 2、缺陷描述是对缺陷的简单描述，可加附页进行详细描述； 3、本表由船长根据各负责人签字上报的安全检查表填写并签字确认后报公司指定人员； 4、自查依据参见综合须知120101《船舶安全自查表》； 5、本表每月填报一次，分别由船长与指定人员存档。 Notes: 1. Fill in the Normal or Deficiencies Description in the self-check results, and fill in the Remarks column with the corrective measures or shore-based support required. If shore- based support is required, the application form and repair list shall be filled in according to the relevant provisions of the system; 2. Deficiencies description is a simple description of the defect, which can be described in detail with attached pages; 3. This form shall be filled in by the Master according to the safety inspection form signed and reported by each responsible person, and then submitted to the designated