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)?


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?


Is this the first bunkering operation between these two vessels?


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


Fuel Sulfur Content (% m/m)

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


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?


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?


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


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?


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


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?


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


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

Has a dedicated emergency communication protocol been established and tested?


Current Wind Speed (knots)

Sea State (Beaufort scale)


Visibility Conditions (km)

Are current weather conditions within safe bunkering parameters?


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


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

8:00 AM
2.5
145
45
21.3
JS
Commenced pumping
8:30 AM
2.6
148
46
32.7
JS
Stable parameters
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

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


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


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


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


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?


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?


Final Quantity Received (Metric Tons) - As per BDN

Quantity Discrepancy from ordered amount (Metric Tons)

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


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


Have all hoses been disconnected and blank flanges fitted?


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


Has fuel sampling been completed according to regulatory requirements?


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?


Overall Safety and Operational Performance Rating for this bunkering operation

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