REPORT OF ACTION TAKEN TO THE NOTIFYING AUTHORITY
In accordance with the provision of paragraph 3.7.3 of
Procedures for Port State Control (resolution A.1185(33))
(by telefax/email and/or mail)
1 To: (Name) ……………………………………………………………………………………………….
(Position) …………………………………………………………………………………………………….
(Authority) …………………………………………………………………………………………………..
Telephone ………………………………… Telefax/email ………………………………
Date: ………………………………………..
2 From: (Name) ………………………………………………………………………………………………
(Position) ………………………………………………………………………………………………………..
(Authority) ………………………………………………………………………………………………………
Telephone ………………………………… Telefax/email ………………………………
3 Name of ship ………………………………………………………………………………………………….
4 Call sign ……………………………………………… 5 IMO number ……………………..
6 Port of inspection ……………………………………………………………………………………………
7 Date of inspection …………………………………………………………………………………………..
8 Action taken
a) Deficiencies b) Action taken
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9 Next port …………………………………………….. (Date) ……………………………………….
10 Supporting documentation No Yes (See attached)
Signature ……………………………….