FORMAT FOR THE REPORT OF CONTRAVENTION OF MARPOL (article 6)
PROCEDURES FOR PORT STATE CONTROL
(Resolution A.1185(33))
(Issuing authority) Copy to: Master
(Address)
(Telephone)
(Telefax)
(Email)
1 Reporting country …………………………………………………………………………………………
2 Name of ship ………………………………………………………………………………………………..
3 Flag of ship …………………………………………………………………………………………………..
4 Type of ship ………………………………………………………………………………………………….
5 Call sign ………………………………………. 6 IMO number …………………………….
7 Gross tonnage ……………………………… 8 Deadweight ……………………………..
(where appropriate)
9 Year of build ………………………………… 10 Classification society ………………..
11 Date of incident …………………………….. 12 Place of incident ………………………
13 Date of investigation ……………………………………………………………………………………..
14 In case of contravention of discharge provisions, a report may be completed in
addition to a port State report on deficiencies. This report should be in accordance with parts 2
and 3 of appendix 3 and/or parts 2 and 3 of appendix 4, as applicable, and should be
supplemented by documents such as:
.1 a statement by the observer of the pollution;
.2 the appropriate information listed under section 1 of part 3 of appendices 3
and 4 to the Procedures; the statement should include considerations which
lead the observer to conclude that none of any other possible pollution
sources is in fact the source;
.3 statements concerning the sampling procedures both of the slick and on
board; these should include location where and time when samples were
taken, identity of person(s) taking the samples and receipts identifying the
persons having custody and receiving transfer of the samples;
.4 reports of analyses of samples taken of the slick and on board; the reports
should include the results of the analyses, a description of the method
employed, reference to or copies of scientific documentation attesting to the
accuracy and validity of the method employed and names of persons
performing the analyses and their experience;
.5 if applicable, a statement by the PSCO on board together with the PSCO’s
rank and organization;
.6 statements by persons being questioned;
.7 statements by witnesses;
.8 photographs of the slick; and
.9 copies or printouts of relevant pages of Oil/Cargo Record Books, logbooks,
discharge recordings, etc.
Name and title (duly authorized contravention investigation official)
……………………………………………………………………………………………………….
……………………………………………………………………………………………………….
……………………………………………………………………………………………………….
……………………………………………………………………………………………………….
Signature