Comprehensive Safety Compliance Form for Ship-to-Ship & Shore-to-Ship Fuel Bunkering Operations

1. Section 1: Vessel & Fuel Barge Identifiers - Pre-Transfer Verification

This section captures all identification and positioning data for both the receiving vessel and supplying fuel barge. Accurate documentation is critical for incident response and regulatory compliance. All fields marked mandatory must be completed before bunkering commencement.

 

Receiving Vessel Official Name

Vessel IMO Number

Vessel Flag State

Vessel Position (Latitude)

Vessel Position (Longitude)

Fuel Barge/Supply Vessel Official Name

Barge Registration Number

Barge Flag State

Barge Position (Latitude)

Barge Position (Longitude)

Distance Between Vessel and Barge (meters)

Is the distance within safe bunkering range (typically 20-40 meters)?

 

Confirm mooring arrangement type (e.g., alongside, stern-to)

 

Explain deviation and additional safety measures implemented

Harbor Officer Full Name

Harbor Officer License/ID Number

Vessel Captain Full Name

Captain License Number

Barge Master Full Name

Barge Master License Number

Primary VHF Channel for Operations

Emergency Contact Number (Port Authority)

Has a pre-bunkering safety meeting been conducted with all parties?

 

Meeting completion timestamp

 

CRITICAL: Bunkering MUST NOT commence without safety meeting. Document reason for deviation and obtain immediate authorization.

Is this the first bunkering operation between these two vessels?

 

Describe additional compatibility checks and familiarization procedures performed

2. Section 2: Fuel Grade, Quantity & Transfer Rate Specifications - Technical Parameters

Accurate fuel specifications are essential to prevent engine damage, ensure regulatory compliance, and maintain safety throughout transfer. All measurements must be cross-verified between vessel and barge.

 

Fuel Grade/Type to be transferred

 

Specify alternative fuel type and safety data sheet reference

Fuel Sulfur Content (% m/m)

Does sulfur content comply with designated Emission Control Area (ECA) requirements?

 

Document justification for non-compliance and special permits obtained

Total Quantity Ordered (Metric Tons)

Quantity Currently Onboard Vessel Before Bunkering (Metric Tons)

Vessel's Maximum Tank Capacity (Metric Tons)

Calculated Safe Filling Limit (95% of capacity)

Will final quantity exceed 85% of tank capacity?

 

Describe enhanced monitoring protocol for high-capacity transfer

Agreed Transfer Rate (Cubic Meters per Hour)

Maximum Allowable Pressure at Manifold (bar)

Fuel Temperature at Barge Manifold (°C)

Has fuel compatibility testing been completed and approved?

 

Compatibility test reference number

 

CRITICAL: Document why testing was not performed and risk mitigation measures

Has the vessel received and acknowledged the Bunkering Checklist and Safety Data Sheet?

 

Document communication breakdown and corrective actions taken

Select all applicable pre-transfer documentation received

Rate the overall quality of pre-transfer communication and documentation exchange

3. Section 3: Spill Containment & Emergency Cut-Off Inspection - Environmental Protection & Emergency Systems

This section verifies all spill prevention and emergency shutdown measures are in place and functional. Any deficiency identified must be corrected before transfer operations commence. Environmental protection is paramount.

 

Is primary containment boom fully deployed and encircling both vessels?

 

Total boom length deployed (meters)

 

CRITICAL: Explain why boom is not deployed and describe alternative containment measures

Has boom integrity been visually inspected for tears, damage, or improper connections?

 

Describe boom defects and corrective actions required

Quantity of absorbent pads/pillows on standby (units)

Quantity of dispersant available (liters)

Is Emergency Shutdown (ESD) system operational and tested within last 24 hours?

 

Last ESD system test timestamp

 

CRITICAL: Describe ESD system fault and why operation is proceeding despite failure

Are ESD pull-cord stations clearly marked and accessible at both vessel and barge?

 

Identify missing or inaccessible stations and immediate corrective actions

ESD System Type (e.g., pneumatic, electric, hydraulic)

Has a dedicated emergency communication protocol been established and tested?

 

Emergency stop signal phrase/code word

 

Document communication plan deficiency and immediate remedy

Current Wind Speed (knots)

Sea State (Beaufort scale)

Visibility Conditions (km)

Are current weather conditions within safe bunkering parameters?

 

Document weather-related risks and special precautions implemented

Is there a support/tug boat on standby for emergency response?

 

Support vessel name and call sign

4. Section 4: Pumping Logs & Pressure Safety Checks - Real-Time Monitoring & Control

Continuous monitoring during fuel transfer is mandatory. Log readings at 30-minute intervals or as required by local regulations. Any deviation from specified parameters requires immediate corrective action and documentation.

 

Pumping Operations Commencement Time

Initial Pressure Reading at Manifold (bar)

Initial Flow Rate (m³/hour)

Continuous Monitoring Log - Record Every 30 Minutes

Time

Pressure at Manifold (bar)

Flow Rate (m³/hr)

Fuel Temperature (°C)

Tank Level (%)

Operator Initials

Remarks/Abnormalities

A
B
C
D
E
F
G
1
8:00 AM
2.5
145
45
21.3
JS
Commenced pumping
2
8:30 AM
2.6
148
46
32.7
JS
Stable parameters
3
 
 
 
 
 
 
 
4
 
 
 
 
 
 
 
5
 
 
 
 
 
 
 
6
 
 
 
 
 
 
 
7
 
 
 
 
 
 
 
8
 
 
 
 
 
 
 
9
 
 
 
 
 
 
 
10
 
 
 
 
 
 
 

Were any pressure readings at or above 90% of maximum allowable pressure?

 

Document pressure spike events, causes, and corrective actions taken

Was flow rate reduced or stopped at any point during transfer?

 

Explain reason for rate reduction (e.g., tank switching, pressure anomaly, emergency)

Did any leak occur at manifold, hoses, or connections during transfer?

 

CRITICAL INCIDENT REPORT: Describe leak location, quantity spilled, immediate response, and environmental impact

Were all automatic pressure relief valves tested and functional before operations?

 

Identify faulty relief valves and compensatory manual monitoring procedures

Rate the performance and reliability of monitoring equipment (1=Poor, 5=Excellent)

Pressure gauges accuracy

Flow meters calibration

Temperature sensors

Tank level indicators

Communication systems

ESD system responsiveness

Were all alarm systems (high-pressure, high-level, overflow) tested and armed?

 

List disabled alarms and manual monitoring protocols implemented

Number of times pumping was stopped for tank switching or other operations

Pumping Operations Completion Time

5. Section 5: Port Captain & Chief Engineer Sign-Off - Final Verification & Accountability

Final verification ensures all operational parameters have been met, safety systems remain intact, and both vessel and barge are secured. This section formalizes accountability and closes the operational loop. Digital signatures are legally binding.

 

Has the fuel transfer been completed successfully without any safety incidents?

 

Document all incidents, near-misses, and lessons learned

Final Quantity Received (Metric Tons) - As per BDN

Quantity Discrepancy from ordered amount (Metric Tons)

Is the quantity discrepancy within acceptable tolerance (±0.5%)?

 

Explain significant discrepancy and investigations conducted

Have all manifold valves been closed, locked, and sealed?

 

Identify which valves remain open and justification

Have all hoses been disconnected and blank flanges fitted?

 

Document incomplete disconnection and planned completion time

Is the Bunker Delivery Note (BDN) fully completed and signed by both parties?

 

Document BDN discrepancies and resolution status

Has fuel sampling been completed according to regulatory requirements?

 

Sample seal numbers and laboratory destination

 

Explain why sampling was not performed and obtain required waivers

Select all post-transfer securing actions completed

Vessel Chief Engineer Digital Signature

Chief Engineer Sign-Off Timestamp

Port Captain (or Master) Digital Signature

Port Captain Sign-Off Timestamp

Fuel Barge Master Digital Signature

Barge Master Sign-Off Timestamp

Additional Comments or Observations by Harbor Officer

Should this bunkering operation be flagged for management review or lessons learned briefing?

 

Detail specific issues or best practices that warrant management attention

Overall Safety and Operational Performance Rating for this bunkering operation

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