船舶机损污染事故报告.docxVIP

船舶机损/污染事故报告表 编号:090102-1 Ship Mechanical Damage/Pollution Accident Report Form No. 090102-1 船名 Ship’s name 事故发生地点Place of Accident 发 生 时 间 Time of Occurrence 事 故 种 类 Accident Types 事故经过、原因、损失情况、事后措施、纠正或预防措施、对失职人员处理意见： （可附页说明） The cause of the accident, the circumstances of the loss, the subsequent measures, corrective or preventive measures, and opinions on the handling of dereliction of duty: (Explanatory notes may be attached) 轮机长签名Signature of Chief Engineer： 年 月 日 Month Day Year 损 失 情 况Loss situation 受损范围Scope of damage 营运时间Operating time 费用 Cost 船 长 确 认 Confirm by Master 船长签名Signature of Master： 年 月 日 Month Day Year 机 务 部 意 见Comments from Technical Dept. 机务部经理签名Signature of Technical Dept. Manager： 年 月 日 Month Day Year 指 定 人 员 意 见 Opinion of designated person 指定人员签名Signature of designated person： 年 月 日 Month Day Year 备注：此报告由轮机长填写，船长确认，报机务部；机务部经理签署意见，报指定人员批示后分别由机务部与船长存档。 Note: This report shall be filled in by Chief Engineer, confirmed by Master, and submitted to Technical Department; Technical Department Manager shall sign the opinions and submit them to the designated person for approval. It is filed by the Technical Department and the Master.