Note: The checklist and accompanying guidance notes are updated frequently.
Please consult the Transport Canada website or Marine Safety office for
the most up-to-date copy.
| OWNERSHIP PARTICULARS: |
| Name: Give name of owner and/or operator of vessel. |
| Address: Indicate mailing address AND principal place of residence
if different. |
| Include telephone number, facsimile number and electronic mail address
if available. |
| File number: For the use of TC only. |
| VESSEL PARTICULARS: |
| Name: Registered name if available. |
| Home Port: Home port and offical number if available. |
| Builder/Year/Custom or Series: Custom – purpose built one-off
vessel. Series – stock production boat. Include builder &
year built. |
| Length/Beam/Depth: Fill in appropriate vessel particulars. |
| Gross Tonnage: Gross tonnage if available and circle appropriate
deck description. |
| Construction Material – Hull: Circle as many as needed to best
describe material. (ie, wood and grp if sandwiched) |
| Construction Material – SS: Circle as many as needed to best
describe material. (ie, wood and grp if sandwiched) |
| Propulsion No. 1: Circle appropriately. |
| Type/ID No.: Please give manufacture name and/or brief description
with units identifing number. (ie, serial no.) |
| Propulsion No. 2: Circle appropriately. |
| Type/ID No.: Please give manufacture name and/or brief description
with units identifing number. (ie, serial no.) |
| Auxillary Propulsion : Circle appropriatly (ie, Generator Set, Father
& Son Diesel, Diesel Electric) |
| Type/ID No.: Please give manufacture name and/or brief description
with units identifing number. (ie, serial no.) |
| Voyage Classification: List voyage classification. (ie, home trade,
inland waters, minor waters) |
| Voyage Restrictions: List any restrictions listed on the certificate. |
| Weather Restrictions: List any weather restrictions listed on the
certificate. (ie, max. wind speed, max. wave height) |
| Other Restrictions: List any additional restrictions not listed
above. |
| Maximum Permissible – Load in kg/lbs & Power in kW/hp provide
if readily available. |
| Maximum Compliment: Maximum number of passengers & crew. |
| Crewing Requirements/Certificate: List any if information is readily
available. |
| LIFESAVING EQUIPMENT: |
| Life Raft(s) (Type & Particulars): List number of life raft(s)
on board. List brand name, type, carring capacity & insp. date. |
| Life Jacket(s) (Type & Particulars): List number of life jacket(s)
on board. List brand name, type & specify Adult or Child. |
| Life Buoy(s) (Type & Particulars): List number of life rings
on board. |
| Distress Signals (Type & Particulars): List number of and type.
(ie, Parachute Flares, Star Flares, Hand-held Flares, Smoke Signals) |
| FIREFIGHTING EQUIPMENT: |
| Portable Extinguisher: Number of each different type. |
| Fixed Extinguisher: Circle appropriate extinguishing agent type. |
| Fire Pump: Is the pump a dedicated fire pump or duel purpose with
bilge pump? |
| Circle appropriate and give type and ID number. |
| INSPECTION PARTICULARS: |
| Type of Inspection: Circle type of inspection being conducted. |
| Plans Available: Are there any formal plans available for the vessel
in question? |
| Inspection Location: Where is the inspection being conducted, and
date inspection was conducted. |
| Inspector: Name and home TC office. |
| Previous Inspection Date: Date previous inspection was completed
and list if previous inspection is available. |
| Have modifications been made since last inspection/spot check?:
Compare previous inspection report and comment accordingly. |
| Any significant hull deterioration?: In the professional opinion
of the inspector, does the hull show any detoriation. (ie, rust or
rot) |
| If YES then describe. TC inspector may have to re-inspect with reference
to the First/Periodic Inspection. |
| If YES Transport Canada Marine Safety to be informed before vessel
returned to service. |
