Vessel: _________________________ Voy. No.: __________________

This form should be completed by the Master or DPA on behalf of “the company Safety Committee” for all relevant ships respectively.

Item	Name of the drill	Points of claim	Attendant required	Confirm the results

MASTER : _____________________DPA/M.R.: _____________________ Date: __________________

Note: To be completed every time and filed in ship's file.

To retain for 2 years.

Issue date: 03.11.2003/Rev.00 PBO-G∗03-F01 Page: 1/1

DRILL RECORDS OF CONTINGENCY PLAN - SHIPS

QSMS PBO-G∗03-F01 Rev. No.00

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