CG-5432 (06/16) Fixed OCS Facility Inspection Report

DEPARTMENT OF HOMELAND SECURITY
U.S. Coast Guard

OMB No. 1625-0044
Exp. Date: 09/30/2021

FIXED OCS FACILITY INSPECTION REPORT
Facility Name

Manned
Unmanned

Number of Persons on Board

OCS Area/Block

Person in Charge

Operator(s)

Owner(s)

Facility Telephone

Name and
Address

Name and
Address

INSPECTION ITEMS: ALL FACILITIES

DEF.

COR.

INSPECTION ITEMS

OUT.

1. Workplace Safety 33 CFR Part 142
2. Rails/Guards/Grating 33 CFR 143.110(a) & (c)
3. Personnel Landings 33 CFR 143.105
4. Means of Escape 33 CFR 143.101:
Primary (# of):
Secondary (# of):
5. Helo Deck Perimeter 33 CFR 143.110(b)

Lease No.

DEF.

COR.

OUT.

20. Lifesaving Appliances 33 CFR Part 144:
20a. Type:
Approval Number:
Location:
Condition:
Equipment/Markings:
Servicing Date:
Launching Devices:
Weight Test Date:

6. Lights/Warning Devices 33 CFR 143.15
7. Firefighting Equip 33 CFR 145:
Portable:
Semi-Portable:
Fixed:
Location:
Size:
Agent:

Operation Test Date:
20b. Type:
Approval Number:
Location:
Condition:
Equipment/Markings:
Servicing Date:
Launching Devices:
Weight Test Date:

INSPECTION ITEMS: UNMANNED FACILITIES
8. Lifesaving Equipment 33 CFR 144.10-1
9. Other Lifesaving Equipment 33 CFR 144.10-10

(See Instructions)

INSPECTION ITEMS: MANNED FACILITIES
10. Emer. Comms. Equipment 33 CFR 144.01-40
11. Station Bill 33 CFR 146.130
12. Emergency Drills 33 CFR 146.125:
Conducted Monthly
Record Keeping
13. Life Preserves 33 CFR 144.01-20:

Operation Test Date:
20c. Type:
Approval Number:
Location:
Condition:
Equipment/Markings:
Servicing Date:
Launching Devices:
Weight Test Date:

Number:
Equipment:
Markings:
Stowage:
14. Work Vests 33 CFR 146.20:

Operation Test Date:
20d. Type:
Approval Number:
Location:
Condition:

Number:
Stowage:
15. Ringbuoys 33 CFR 144.01-25:
Number:
Equipment:

Equipment/Markings:
Servicing Date:
Launching Devices:
Weight Test Date:

Markings:
Stowage:

Operation Test Date:
21. Personnel Record Locations 33 CFR 141.35:

16. General Alarm System 33 CFR 146.105;
Markings 33 CFR 146.135
17. Manning of Survival Craft 33 CFR 146.120
18. First Aid Kit 33 CFR 144.01-30
19. Litter 33 CFR 144.01-35

LIST OF OUTSTANDING ITEMS/COMMENTS (attach additional pages as necessary)

FACILITY OWNER'S OR OPERATOR'S ACKNOWLEDGEMENT
Name

Signature

Date

Title

CG-5432 (04/20)

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INSTRUCTIONS
GENERAL
Facility Name
Manned/Unmanned
Persons on Board
Person in Charge
Operator
Owner
OCS Area/Block
Facility Telephone

Enter official facility name/designation.
Check the space which indicates facility status at the time of the inspection. A new self-inspection form shall be completed
when a facility changes status.
Enter number of persons on board on the day of the inspection.
Enter the full name of the person in charge.
Fill in name and address of company operating the facility.
Fill in name and address of leaseholder or operating partner.
Enter standard OCS area abbreviation and block number.
Enter telephone number if so equipped.

INSPECTION ITEMS
Deficiencies (Def.)
Refers to the total number of deficiencies per item found during this inspection.
Corrected (Cor.)
Refers to the number of deficiencies per item that were corrected this inspection.
Outstanding (Out.)
Refers to number of deficiencies per item remaining outstanding/uncorrected.
• Enter the number of deficiencies found, the number of deficiencies corrected, and the number of deficiencies that remain outstanding for each item in
the appropriate box.
•
•
•
•

○ (Cor. + Out. = Def.)
Enter N/A for any item that is not applicable.
ITEM NUMBERS 1-7: MUST BE COMPLETED FOR ALL FACILITIES, BOTH MANNED AND UNMANNED.
ITEMS NUMBERS 8&9: MUST BE COMPLETED FOR ALL UNMANNED FACILITIES.
ITEM NUMBERS 10-21: MUST BE COMPLETED FOR ALL MANNED FACILITIES.

INSTRUCTIONS FOR SPECIFIC ITEM NUMBERS
Enter the number of portable/semi-portable fire extinguishers and/or fixed fire fighting equipment on board in the appropriate spaces. The
7.
number of portable/semi-portable fire extinguishers should meet the requirements of 33 CFR 145. For location, size, and agent, use Table
33 CFR 145.05(c) and 145.10(a) to determine compliance. Deviations from the requirements of 33 CFR Part 145 should be considered
deficiencies. Enter description of deficiencies and the BSEE/OCMI determined time frame for correction in the Comments section where
applicable (see 33 CFR 140.105(c)).
○ NOTE: Fixed pertains to fixed fire suppression systems (CO2, FM-200, etc.) Firewater/hose reels are not considered fixed for this definition.
Any lifesaving equipment on an unmanned platform that is not required by 33 CFR 144.10-1 must meet the standards contained in 144.01-1
9.
through 144.01-40. Where such additional equipment is installed/located on the facility the appropriate item should be completed under the
"INSPECTION ITEM-MANNED FACILITY" section of the form.
10.
Emer. Comms. Equip. refers to emergency communication equipment.
13-15.
Enter the number of preservers/vests/buoys on board in the appropriate spaces.
17.
Personnel assigned and designated on the Station Bill.
20.
Fill in one subsection (a, b, c and d) for each piece of primary lifesaving equipment.
○ Type
Check the appropriate space.
○ Servicing
Enter the date the item was last serviced.
○ Weight Test
Enter the date of the last weight test (for davit launched equipment).
○ Operational Test
Enter the date of the last operational test (for self propelled equipment).
21.
Enter the address of the location of the required record.
• NOTE: If additional space is needed for any item, enter the applicable item number and the appropriate data in the comments section.
LIST OF OUSTANDING ITEMS/COMMENTS
• Enter description of deficiencies and the BSEE/OCMI determined time frame for correction in the Comments section where applicable (see 33 CFR
140.105(c) & (d)). Also enter a brief description of each outstanding deficiency and the proposed corrective action.
• Enter comments as appropriate. Attach additional pages as necessary.
OWNER'S/OPERATOR'S ACKNOWLEDGMENT
• Enter name, title, and signature/date of owner's/operator's representative acknowledging the particulars of the inspection.
An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number.
The Coast Guard estimates that the average burden for this report is 1.5 hours. You may submit any comments concerning the accuracy of this burden
estimate or any suggestions for reducing the burden to: Commandant (CG-CVC), U.S. Coast Guard, Stop 7501, 2703 Martin Luther King Jr. Ave, SE,
Washington D.C. 20593-7501 or Office of Management and Budget, Paperwork Reduction Project (1625-0044), Washington, DC 20503.
Privacy Act Statement
Authority: 43 U.S.C. §1333, 1348, 1350, 1356 authorize the collection of this information.
Purpose: The Coast Guard, Bureau of Safety and Environmental Enforcement, and the facility owner or operator will use this information to conduct a safety
inspection on a Fixed OCS (Outer Continental Shelf) Facility.
Routine Uses: The information will be used by and disclosed to Coast Guard personnel and contractors or other agents who need the information to assist in
activities related to Fixed OCS Facilities. Any external disclosures of data within this record will be made in accordance with DHS/USCG-013, United States
Coast Guard Marine Information for Safety and Law Enforcement, 74 Federal Register 30305, June 25, 2009.
Disclosure: Furnishing this information is mandatory; failure to furnish the requested information may result in appropriate enforcement measures by the
agency conducting the inspection, and possible restrictions on the operation of the facility.

CG-5432 (04/20)

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