Record all vessel identification and positional data accurately. This information is critical for regulatory traceability and environmental monitoring.
Vessel Name
IMO Number
Vessel Call Sign
Flag State
Voyage Number
Discharge Operation Start Date/Time (UTC)
Discharge Operation End Date/Time (UTC)
Current Port or Location
Next Port of Call
Water Depth at Discharge Location (meters)
Is vessel at anchor?
Anchor Position (Lat/Long)
Vessel Speed During Discharge (knots)
Is Dynamic Positioning (DP) system active?
DP System Status and Environmental Conditions
Sea State (Beaufort Scale)
Force 0 (Calm)
Force 1 (Light Air)
Force 2 (Light Breeze)
Force 3 (Gentle Breeze)
Force 4 (Moderate Breeze)
Force 5 (Fresh Breeze)
Force 6 (Strong Breeze)
Force 7 (Near Gale)
Force 8 (Gale)
Force 9 (Strong Gale)
Force 10 (Storm)
Force 11 (Violent Storm)
Force 12 (Hurricane)
Wind Direction and Speed
Visibility Conditions
Is vessel within designated MARPOL Special Area?
Special Area Name and Discharge Restrictions
Document all discharge parameters with precision. Include source tank identification, measured volumes, and calculated flow rates. Use the table for multi-source discharges.
Discharge Type Category
Bilge Water (Oily Water)
Ballast Water
Graywater (Sewage/Galley)
Bilge Water (Non-Oily)
Other Engine Room Effluent
Bilge Water Source Tank ID
Ballast Water Tank ID(s)
Graywater Source System
Non-Oily Bilge Source
Describe Other Effluent Type and Source
Multi-Source Discharge Log (if applicable)
Tank ID | Start Level (m³) | End Level (m³) | Calculated Volume (m³) | Flow Rate (m³/h) | Discharge Method | ||
|---|---|---|---|---|---|---|---|
A | B | C | D | E | F | ||
1 | BT-1P | 15.2 | 8.5 | 6.7 | 2.8 | Overboard via OWS | |
2 | 0 | 0 | 0 | 0 | |||
3 | 0 | ||||||
4 | 0 | ||||||
5 | 0 | ||||||
6 | 0 | ||||||
7 | 0 | ||||||
8 | 0 | ||||||
9 | 0 | ||||||
10 | 0 |
Total Discharge Volume (m³)
Average Flow Rate (m³/hour)
Peak Flow Rate (m³/hour)
Was flow rate continuously monitored during discharge?
Flow Rate Monitoring Method and Equipment Used
Explain intermittent monitoring procedure
Was discharge conducted through approved overboard discharge valve?
Alternative Discharge Arrangement Details
Last Discharge from Same Source (UTC)
Was holding tank completely emptied?
Remaining Volume in Tank (m³)
Complete comprehensive system verification before, during, and after discharge operations. Record all critical parameters and any system alarms or malfunctions.
Primary Treatment System Used
Oily Water Separator (OWS)
Bilge Water Treatment System (BWTS)
Ballast Water Treatment System (BWMS)
Sewage Treatment Plant (STP)
Membrane Filtration Unit
Coalescer/Filter Unit
Other Treatment System
OWS Manufacturer and Model
BWTS Manufacturer and Model
BWMS Manufacturer and Model
STP Manufacturer and Model
Membrane System Specifications
Filter/Coalescer Specifications
Describe Treatment System Specifications
Was system pre-operational check completed within 24 hours?
Pre-Operational Check Date/Time
Reason for Delayed or Missed Pre-Operational Check
Critical System Parameters During Discharge
Below Normal | Normal Range | Above Normal | Critical High | Not Applicable | |
|---|---|---|---|---|---|
System inlet pressure (bar) | |||||
System outlet pressure (bar) | |||||
Operating temperature (°C) | |||||
Flow rate through system (m³/h) | |||||
Oil content monitor reading (ppm) | |||||
System running hours | |||||
Power consumption (kW) |
Did oil content monitor (OCM) or equivalent sensor trigger any alarms?
Alarm Details and Response Actions
Was automatic stopping device tested functional before discharge?
Automatic Stopping Device Status and Manual Override Procedures
Were any filters, coalescers, or membranes replaced before this discharge?
Filter/Membrane Replacement Log
Component ID | Type | Replacement Date | Running Hours at Replacement | Condition Found | ||
|---|---|---|---|---|---|---|
A | B | C | D | E | ||
1 | Filter-01 | 25 micron | 6/15/2025 | 1250 | Clogged | |
2 | 0 | |||||
3 | ||||||
4 | ||||||
5 | ||||||
6 | ||||||
7 | ||||||
8 | ||||||
9 | ||||||
10 |
Any system leaks, abnormal vibrations, or unusual noises observed?
System Anomaly Description and Immediate Actions
System Running Hours Since Last Major Overhaul
Is system due for scheduled maintenance within next 7 days?
Scheduled Maintenance Details and Operational Impact
Verify all territorial water classifications and environmental regulatory requirements. This section determines discharge legality and required restrictions.
Territorial Water Classification at Discharge Location
International Waters (>200nm from baseline)
Exclusive Economic Zone (EEZ, 24-200nm)
Contiguous Zone (24nm)
Territorial Sea (12nm)
Archipelagic Waters
Port/Internal Waters
Distance from Nearest Land (nm)
Distance from Nearest Land (nm)
Distance from Nearest Land (nm)
Distance from Nearest Land (nm)
Archipelagic Baseline Reference
Port Authority Discharge Permit Reference
Is discharge area designated as Particularly Sensitive Sea Area (PSSA)?
PSSA Name and Additional Restrictions
Is discharge area within Regional Seas Programme jurisdiction?
Regional Seas Programme Details and Local Regulations
Applicable MARPOL Annexes for This Discharge
Annex I (Oil Pollution)
Annex II (Noxious Liquid Substances)
Annex IV (Sewage)
Annex V (Garbage)
Annex VI (Air Pollution)
Other Regional Instruments
Has vessel received any recent Port State Control (PSC) deficiencies related to discharge systems?
PSC Deficiency Details and Corrective Actions
Are there any active local restrictions or temporary prohibited zones?
Restriction Details and Regulatory Authority
Was shore reception facility availability considered before discharge?
Shore Facility Contact and Availability Status
Is vessel equipped with Shipboard Oil Pollution Emergency Plan (SOPEP)?
SOPEP Reference and Last Review Date
Additional Environmental Considerations or Observations
Final verification and authorization section. All entries must be reviewed for accuracy before sign-off. Digital signatures confirm compliance with environmental regulations and company policies.
Chief Engineer Full Name
Chief Engineer License/Certificate Number
Chief Engineer Certificate Expiry Date
Chief Engineer has reviewed all discharge parameters for regulatory compliance?
Compliance Review Deficiencies and Corrective Actions
Environmental Officer (or Designated Person) Full Name
Environmental Officer Certificate/Training Reference
Environmental Officer verified Oil Record Book entry completeness?
Record Book Deficiencies and Correction Plan
Were any deviations from standard discharge procedures observed?
Deviation Details and Justification
Chief Engineer Comments and Operational Notes
Environmental Officer Comments and Compliance Notes
Chief Engineer Digital Signature
Environmental Officer Digital Signature
Final Sign-Off Timestamp (UTC)
Has this discharge been entered in the vessel's official Oil Record Book (Part I) or equivalent log?
Oil Record Book Entry Page Number
Attach Supporting Documentation (OCM printouts, system logs, photos)
To configure an element, select it on the form.