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pdf9HVVHO6DIHW\&KHFNOLVW
All highlighted equipment and safety topics must be checked off before you leave port.
Do not deploy if any are not verified or current.
9HVVHO QDPH:
USCG/State registration#:
Life Rafts
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,QÀDWDEOHV%XR\DQWDSSDUDWXV None
7oWDO FDSDFLW\
N$
7oWDO SeoSOe on EoDUG
/LIe UDIWV DEOe Wo ÀoDW IUee" Yes
CoPSlete tKe aEoYe stLFNeU as Lt
aSSeaUs on tKe Yessel %e sXUe tKe IolloZLnJ ¿elGs aUe FKeFNeG
'oFXPenteG
No
6eUYLFe sWLFNeU e[SLUDWLon GDWe
,s tKe GeFal YalLG"
/oFatLons
+\GUosWDWLF UeOeDse e[SLUDWLon
Yes No
([SLUatLon \eaU
/LIe UDIW eTXLSPenW"
3$
3%
Immersion Suits
2n EoaUG"
([SLUatLon PontK
62/$6 $ 62/$6 % Coastal
2Fean 6eUYLFe
Yes No
Flares
Required (unless inside 3 miles); 6 handheld, 3 Parachute, 3 Smoke
N$
2ne IoU eaFK SeUson" Yes No
/oFatLons
/oFatLon
+anGKelG KoZ Pan\
([S Gate
3)' IoU eaFK SeUson Yes No /oFatLon
3aUaFKXte KoZ Pan\
([S Gate
6PoNe KoZ Pan\
([S Gate
0eteoU KoZ Pan\
([S Gate
Fire ([tinJuisKers
Present:
Yes
No
Serviceable?
Yes
No
7\Se I9 7KroZaEle
5LnJ
How many?
/oFatLon
CXsKLon /LIeslLnJ
(asLl\ aFFessLEle"
Yes No
NXPEeU
/oFatLons
2tKeU sLJnalLnJ GeYLFes
EPIRBS
3Uesent" Yes No N$ ,n ÀoatIUee loFatLon" Yes No 5eJLsteUeG to tKLs Yessel" Yes No 6LJnal testeG" Yes No
'eFal¶s alSKanXPeULF FoGe PatFKes (3,5% FoGe"
Yes No /oFatLons
%atteU\ e[S Gate
+\GUostatLF Uelease e[S Gate
N2$$ UeJLstUatLon stLFNeU
([S Gate
$GGitional &KeFNs
)LUst aLGe PateULals SUesent" Yes
No /oFatLon
:Ko EesLGes \oX Ls C35 CeUtL¿eG" NaPe SosLtLon
:oUNLnJ UaGLos KoZ Pan\"
7\Se
:ateUtLJKt GooUsKatFKes ZoUNLnJ SUoSeUl\" Yes
No
,s tKeUe an anFKoU SUesent"
Yes
No
'LG \oX see tKe ELlJe SXPSs"
Yes
No
,s tKeUe a 6tatLon %Lll SosteG"
Yes
No
+atFKesSassaJeZa\s XnoEstUXFteG"
Yes
No
:as a ZKeel ZatFK aUUanJeG"
Yes
No
'LG \oX KeaU tKe JeneUalKLJK ZateU alaUPs" Yes
No
CKaUts anG FoPSass SUesent"
Yes
No
,s tKeUe aGeTXate Peans oI esFaSe"
No
:eUe \oX JLYen ePeUJenF\ GLUeFtLons"
Yes
No
Yes
:Kat ZeUe tKe ePeUJenF\ LnstUXFtLons"
2EseUYeU sLJnatXUe
Date:
3ULnt
* Expires the last day of the month displayed. ** Hydrostatic releases are valid for two years from installation date.
20% ContUol No e[S
&omSleteG 9essel Safet\ &KeFNlist
After completing the checklist, sign the form, print your name and date it. Mail, fax or email a copy of the checklist and all
associated notes to your provider. If you have any safety questions or concerns, please contact the following coordinators:
-oKn /a)argXe C$ CoorGinator
) 6tUeet
(XUeNa C$
2I¿Fe:
Cell:
(PaLl: -oKn/a)aUJXe#noaaJoY
SFott /eaFK :$/25 CoorGinator
+at¿elG 0aULne 6FLenFe CenteU
6( 268 DU
NeZSoUt 25
)a[:
2I¿Fe:
Cell:
(PaLl: 6Fott/eaFK#noaaJoY
Notes
File Type | application/pdf |
Author | Phillip.Bizzell |
File Modified | 2015-07-24 |
File Created | 2015-07-23 |