Bridge:

Have the following actions been carried out?

1. Master informed

1. Engine Room informed and alternative/emergency steering

engaged

1. Preparation for anchoring if in shallow water

1. “Not Under Command” shapes or lights exhibited

1. Warning broadcasted

Engine Room:

Have the following actions been carried out?

1. Chief engineer informed

1. Prime mover, reverse power/preference trip rest checked

1. Pumps to manual mode

1. Switch board power restored

Duty Officer

Master

Date

Position of vessel

Note: To be completed by case and filed in ship's file.

To retain for 5 years.

Issue date: 03.11.2003/Rev.00 PBO-G∗03-C02 Page: 1/1

EMERGENCY RESPONSE CHECK LIST - POWER FAILURE

QSMS PBO-G∗03-C02 Rev. No.00

---