<p> Authorization No.: </p><p>INTERNATIONAL SAFETY MANAGEMENT (ISM CODE) DOC-Checklist for: Annual Verification (For Company)</p><p>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)</p><p>Place: Date ( Place of issue of Checklist) ( Day, Month, Year)</p><p>Name of Company </p><p>Address of Company</p><p>IMO Unique Company Identification Number: </p><p>The company operates the following types of ships: Comment in Box: Yes (X) or No (-)</p><p>Passenger Ship Chemical Tanker </p><p>Passenger High-Speed Craft Gas Carrier </p><p>Cargo High-Speed Craft Mobile Offshore Drilling Unit </p><p>Bulk Carrier Other Cargo Ship </p><p>Oil Tanker </p><p>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)</p><p>Yes No</p><p>Section 1. General (1.2 Objectives & 1.4 Functional requirements for a Safety Management System)</p><p>1. Has the Company introduced any modifications to approved Safety Management System?</p><p>2. Was the procedure for introducing modifications observed</p><p>3. Has the procedure for assessment of all identified risks to Company´s ships,</p><p> personnel, the environmental and appropriate safeguards been maintained and observed?</p><p>4. Does the Company have documented evidence to confirm the operation of all the ship types mentioned in DOC? Additional comments: </p><p>Section 2. Safety and Environmental-Protection Policy</p><p>5. Are the shore-based personnel familiar with the Company’s safety policy? Additional comments: </p><p>Section 3. Company Responsibilities and Authority (A copy of the Declaration of Company (DC) and Declaration of Designated Person Ashore (DPA) to be attached)</p><p>6. Does the Company audit the subcontractors for fulfilling their responsibilities in accordance with the Company’s policy and procedures? Additional comments: </p><p>ISM Code/DOC-Checklist for Annual Verification (2015/01) 2/8 Comments in box: Yes (X), No (-), or Not Applicable (NA)</p><p>Company No. Questions Comments Yes No Section 4. Designated Person (s)</p><p>7. Does the designated person control the safe operation of each ship?</p><p>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?</p><p>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?</p><p>10. Does the designated person have records of his ship visits as a matter of performing his duties? Additional comments: </p><p>Section 5. Master’s Responsibility and Authority</p><p>11. Has the Company ensured that the Master is made fully conversant with all the requirements relevant to the SMS</p><p>12. Are informing procedures used, as listed below:</p><p>13.  Including these requirements into the operational procedures and manuals?</p><p>14.  Allocating responsibilities in performing work?</p><p>15.  Holding official meetings with the management of the Company?</p><p>16. Are the records of such meetings maintained?</p><p>17. Has the Company ensured that the Master is given the necessary support to perform his duties? Additional comments: </p><p>Company No. Questions Comments</p><p>ISM Code/DOC-Checklist for Annual Verification (2015/01) 3/8 Comments in box: Yes (X), No (-), or Not Applicable (NA)</p><p>Yes No</p><p>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*</p><p>19. Are instructions, which are identified as essential to be provided prior to sailing given to the shipboard personnel?</p><p>20. Does the Company control the training needs of personnel</p><p>21. Does the Company take account of the following in identifying training needs:</p><p>22.  Results of inspections?</p><p>23.  Drills and exercises?</p><p>24.  Analysis of accidents?</p><p>25.  Analysis of hazardous occurrences?</p><p>26.  Results of internal audits?</p><p>27. Examination to assess the personnel’s basic knowledge of the operation of equipment?</p><p>28.  Previous training and experience?</p><p>29.  Required proficiency in the operation of equipment?</p><p>30. Does the Company provide the refresher and advanced training courses?</p><p>31. Does the Company provide introductory training of shipboard personnel bearing a responsibility for the SMS operation?</p><p>32. Does the Company provide introductory training of shore-based personnel responsible for the SMS operation?</p><p>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?</p><p>34. Does the Company verify ability of the crew members to communicate effectively with each other in emergencies? Additional comments: </p><p>(*)Refer to the Principles of minimum safe manning, adopted by the Organization by resolution A.1047(27).</p><p>ISM Code/DOC-Checklist for Annual Verification (2015/01) 4/8 Comments in box: Yes (X), No (-), or Not Applicable (NA)</p><p>Company No. Questions Comments Yes No Section 7. Development of Plans for Shipboard Operations</p><p>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?</p><p>36. Who has the company entrusted with the development of plans and instructions for shipboard operations?</p><p>37. Are communication links maintained between ship and shore?</p><p>38. Are Company shore-based personnel aware of their duties in carrying out communications with the ship?</p><p>39. Is it possible to get in touch with the ship at all times, regardless of the time of day or night? Additional comments: </p><p>Section 8. Emergency Preparedness</p><p>40. Are shipboard drills and exercises conducted in accordance with the plans developed by the Company?</p><p>41. Do the drills and exercises involve the Company’s shore-based personnel?</p><p>42. Is instruction conducted before realization of the drills?</p><p>43. Are all drills and exercises recorded?</p><p>44. Are the results of drills and exercises analyzed to assess their effectiveness?</p><p>45. Can the Company respond at any time to hazards, accidents and emergency situations involving its ships? Additional comments: </p><p>Company No. Questions Comments</p><p>ISM Code/DOC-Checklist for Annual Verification (2015/01) 5/8 Comments in box: Yes (X), No (-), or Not Applicable (NA)</p><p>Yes No</p><p>Section 9. Reports and Analysis of Non-Conformities, Accidents and Hazardous Occurrences</p><p>46. Are reports received from supervision bodies to the effect the requirements of the Company SMS are not observed by the ship crew?</p><p>47. Does the Company receive information on emergencies, accidents and hazardous occurrences?</p><p>48. Is a list of such reports maintained?</p><p>49. Are the reports analyzed?</p><p>50. Are corrective/preventive actions taken on the basis of such reports?</p><p>51. Is the implementation of corrective actions controlled?</p><p>52. Is the efficiency of corrective actions controlled? Additional comments: </p><p>Section 10. Maintenance of the Ship and Equipment</p><p>53. Does the shore-based management control the shipboard maintenance?</p><p>54. Is repair undertaken in accordance with the Company plans?</p><p>55. Is it controlled whether repair and maintenance is carried out within prescribed time?</p><p>56. Is the validity of ship certificates controlled?</p><p>57. Is the realization of plans controlled for checking the operability of equipment, facilities and system whose sudden failure may result in hazardous situations?</p><p>58. Does the Company inform the Register about accidents, detentions and non- conformities found by port authorities? Additional comments: </p><p>Company No. Questions Comments Yes No</p><p>ISM Code/DOC-Checklist for Annual Verification (2015/01) 6/8 Comments in box: Yes (X), No (-), or Not Applicable (NA)</p><p>Section 11. Documentation</p><p>59. Has the Company documented procedures for ensuring that:</p><p>60.  Valid documents are available at all relevant locations?</p><p>61.  Changes to documents are reviewed and approved by authorized personnel?</p><p>62.  Obsolete documents are promptly removed? Additional comments: </p><p>Section 12. Company Verification, Review and Evaluation</p><p>63. Does the Company carry out internal SMS audits?</p><p>64. Has the Company established an internal SMS audit schedule?</p><p>65. Do non-conformities require corrective actions to be raised?</p><p>66. Does the internal SMS audit procedure require the corrective actions to be closed out by a certain date?</p><p>67 Are the results of the internal SMS audits used in the improvement of the SMS?</p><p>68. Has the Company ensured that the personnel carrying out internal audits are independent of the areas being audited?</p><p>69. Are the results of internal audits brought to the attention of the personnel responsible for the area being audited?</p><p>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: </p><p>ISM Code/DOC-Checklist for Annual Verification (2015/01) 7/8 General comments: </p><p>Final recommendation:</p><p>It is recommended that:</p><p>The Existing DOC Certificate No. has been endorsed at: (Place of issue of endorsement) the of of . (Day) (Month) (Year)</p><p>The Existing DOC Certificate No. has not been endorsed until Non-Conformities have been close-up at an Additional Verification (Follow-Up Verification)</p><p>Issued at : the of of . (Place of issue of Checklist) (Day) (Month) (Year)</p><p>Name and Signature of duly authorized ISM-Code Auditor </p><p>By: Intermaritime Certification Services (ICS)</p><p>ISM Code/DOC-Checklist for Annual Verification (2015/01) 8/8</p>