Name of town Month-year

Reason of docking

Kind and name of dock

Name of shipyard

Place from which vessel arrived at dock

Ship's deadweight:

Cargo tons

Bunker “

Water ballast “

Dry ballast “

Fresh water “

Armaments, materials “

____________________________________________________________________

Total DW tons

Draft : Fore Aft Mean

Date entering dock hour

Vessel was placed on blocks hour Dock was drained: hour

Name of paints used before

State of bottom parts

Name of paints used now

Cleaning was started Painting was started

How many coats / anticorrosive area sq.m.

antifouling area sq.m.

Paints used - anticorrosive kos

antifouling kos

boottoping kos

antigalvanic kos

Nos. of chipped plates: No.

Also total sq.m. sq.m.

Quantity of paints

used for additional

Painting of chipped plates

Repairs of bottom parts:

Plates :

Brackets :

Angle beams :

Bilge keels :

Rudder :

Was the plug of rudder

body opened or not :

Height of bottom edge

of rudder stem

When special repairs were date of commence hour

commended and finished : date of finishing hour

Anchor cables:

examined : starboard portside

repaired : starboard portside

painted : starboard ________________ portside __________________________________

State which lengths were reshifted :

Chain locker condition:

Bottom plugs : total number

How many were opened

Was tailshaft drawn or not

Clearance in stern tube

Condition of propeller blades

Hull was examined by : name of surveyor

Classification Society

Underwater painting was finished : date hour

Dock was submerged : date hour

Vessel left dock : date hour

Vessel was moored date hour place

Draft : Fore Aft

State difference in DWT

Weather condition during painting

Was ME used during entering and leaving

dry dock

No. of tugs used

No. of tugs used in lack of ME

Bunker consumpted:

During entering drydock tons

During staying in drydock tons

From drydock to mooring place tons

Name of certificates received:

Expiring date of certificates:

MASTER

Date

* This report should be correctly entered after each drydocking and delivered to Technical Department. Copy should remain on board.

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

To retain for 10 years.

Issue date: 03.11.2003/Rev. 00 PBO-TD03-F03 Page: 3/3

DOCKING REPORT

QSMS PBO-TD03-F03 Rev. No.00

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