Comments in Box: Yes (X), No (-), Or Not Applicable (NA)

Authorization No.:

INTERNATIONAL SAFETY MANAGEMENT (ISM CODE) DOC-Checklist for: Annual Verification (For Company)

In accordance with Part B, Section 13-Certification & Periodical Verification of the ISM Code, as applicable, including the IMO Resolution A. 1022(26) “Guidelines on the Implementation of the ISM Code by Administrations” (as amended)

Place: Date ( Place of issue of Checklist) ( Day, Month, Year)

Name of Company

Address of Company

IMO Unique Company Identification Number:

The company operates the following types of ships: Comment in Box: Yes (X) or No (-)

Passenger Ship Chemical Tanker

Passenger High-Speed Craft Gas Carrier

Cargo High-Speed Craft Mobile Offshore Drilling Unit

Bulk Carrier Other Cargo Ship

Oil Tanker

Company No. Questions Comments ISM Code/DOC-Checklist for Annual Verification (2015/01) 1/8 Comments in box: Yes (X), No (-), or Not Applicable (NA)

Yes No

Section 1. General (1.2 Objectives & 1.4 Functional requirements for a Safety Management System)

1. Has the Company introduced any modifications to approved Safety Management System?

2. Was the procedure for introducing modifications observed

3. Has the procedure for assessment of all identified risks to Company´s ships,

personnel, the environmental and appropriate safeguards been maintained and observed?

4. Does the Company have documented evidence to confirm the operation of all the ship types mentioned in DOC? Additional comments:

Section 2. Safety and Environmental-Protection Policy

5. Are the shore-based personnel familiar with the Company’s safety policy? Additional comments:

Section 3. Company Responsibilities and Authority (A copy of the Declaration of Company (DC) and Declaration of Designated Person Ashore (DPA) to be attached)

6. Does the Company audit the subcontractors for fulfilling their responsibilities in accordance with the Company’s policy and procedures? Additional comments:

ISM Code/DOC-Checklist for Annual Verification (2015/01) 2/8 Comments in box: Yes (X), No (-), or Not Applicable (NA)

Company No. Questions Comments Yes No Section 4. Designated Person (s)

7. Does the designated person control the safe operation of each ship?

8. Did the top level management allocate the necessary resources and provide support from shore-based divisions to the designated person(s) to ensure that his/her duties connected with the safe operation of the ships are fulfilled?

9. Does the designated person use all communication links provided in the SMS for an efficient exchange of information on matters connected with the safety of ship operation?

10. Does the designated person have records of his ship visits as a matter of performing his duties? Additional comments:

Section 5. Master’s Responsibility and Authority

11. Has the Company ensured that the Master is made fully conversant with all the requirements relevant to the SMS

12. Are informing procedures used, as listed below:

13.  Including these requirements into the operational procedures and manuals?

14.  Allocating responsibilities in performing work?

15.  Holding official meetings with the management of the Company?

16. Are the records of such meetings maintained?

17. Has the Company ensured that the Master is given the necessary support to perform his duties? Additional comments:

Company No. Questions Comments

Yes No

Section 6. Resources and Personnel The Company should ensure that each ship is: 18. .1 manned with qualified, certificated and medically fit seafarers in accordance with national and international requirements; and .2 appropriately manned in order to encompass all aspects of maintaining safe operations on board*

19. Are instructions, which are identified as essential to be provided prior to sailing given to the shipboard personnel?

20. Does the Company control the training needs of personnel

21. Does the Company take account of the following in identifying training needs:

22.  Results of inspections?

23.  Drills and exercises?

24.  Analysis of accidents?

25.  Analysis of hazardous occurrences?

26.  Results of internal audits?

27. Examination to assess the personnel’s basic knowledge of the operation of equipment?

28.  Previous training and experience?

29.  Required proficiency in the operation of equipment?

30. Does the Company provide the refresher and advanced training courses?

31. Does the Company provide introductory training of shipboard personnel bearing a responsibility for the SMS operation?

32. Does the Company provide introductory training of shore-based personnel responsible for the SMS operation?

33. Has the Company maintained procedures by which the shipboard and shore-based personnel receive all relevant information on the SMS in a working language or languages understood by them?

34. Does the Company verify ability of the crew members to communicate effectively with each other in emergencies? Additional comments:

(*)Refer to the Principles of minimum safe manning, adopted by the Organization by resolution A.1047(27).

Company No. Questions Comments Yes No Section 7. Development of Plans for Shipboard Operations

35. Does the Company perform the key shipboard operations concerning ship safety and pollution prevention in accordance with the procedures and plans included in SMS?

36. Who has the company entrusted with the development of plans and instructions for shipboard operations?

37. Are communication links maintained between ship and shore?

38. Are Company shore-based personnel aware of their duties in carrying out communications with the ship?

39. Is it possible to get in touch with the ship at all times, regardless of the time of day or night? Additional comments:

Section 8. Emergency Preparedness

40. Are shipboard drills and exercises conducted in accordance with the plans developed by the Company?

41. Do the drills and exercises involve the Company’s shore-based personnel?

42. Is instruction conducted before realization of the drills?

43. Are all drills and exercises recorded?

44. Are the results of drills and exercises analyzed to assess their effectiveness?

45. Can the Company respond at any time to hazards, accidents and emergency situations involving its ships? Additional comments:

Company No. Questions Comments

Yes No

Section 9. Reports and Analysis of Non-Conformities, Accidents and Hazardous Occurrences

46. Are reports received from supervision bodies to the effect the requirements of the Company SMS are not observed by the ship crew?

47. Does the Company receive information on emergencies, accidents and hazardous occurrences?

48. Is a list of such reports maintained?

49. Are the reports analyzed?

50. Are corrective/preventive actions taken on the basis of such reports?

51. Is the implementation of corrective actions controlled?

52. Is the efficiency of corrective actions controlled? Additional comments:

Section 10. Maintenance of the Ship and Equipment

53. Does the shore-based management control the shipboard maintenance?

54. Is repair undertaken in accordance with the Company plans?

55. Is it controlled whether repair and maintenance is carried out within prescribed time?

56. Is the validity of ship certificates controlled?

57. Is the realization of plans controlled for checking the operability of equipment, facilities and system whose sudden failure may result in hazardous situations?

58. Does the Company inform the Register about accidents, detentions and non- conformities found by port authorities? Additional comments:

Company No. Questions Comments Yes No

Section 11. Documentation

59. Has the Company documented procedures for ensuring that:

60.  Valid documents are available at all relevant locations?

61.  Changes to documents are reviewed and approved by authorized personnel?

62.  Obsolete documents are promptly removed? Additional comments:

Section 12. Company Verification, Review and Evaluation

63. Does the Company carry out internal SMS audits?

64. Has the Company established an internal SMS audit schedule?

65. Do non-conformities require corrective actions to be raised?

66. Does the internal SMS audit procedure require the corrective actions to be closed out by a certain date?

67 Are the results of the internal SMS audits used in the improvement of the SMS?

68. Has the Company ensured that the personnel carrying out internal audits are independent of the areas being audited?

69. Are the results of internal audits brought to the attention of the personnel responsible for the area being audited?

70. The Company should periodically verify whether all those undertaking delegated ISM-related tasks are acting in conformity with the Company's responsibilities under the Code Additional comments:

ISM Code/DOC-Checklist for Annual Verification (2015/01) 7/8 General comments:

Final recommendation:

It is recommended that:

The Existing DOC Certificate No. has been endorsed at: (Place of issue of endorsement) the of of . (Day) (Month) (Year)

The Existing DOC Certificate No. has not been endorsed until Non-Conformities have been close-up at an Additional Verification (Follow-Up Verification)

Issued at : the of of . (Place of issue of Checklist) (Day) (Month) (Year)

Name and Signature of duly authorized ISM-Code Auditor

By: Intermaritime Certification Services (ICS)

ISM Code/DOC-Checklist for Annual Verification (2015/01) 8/8