Form CG-5432 Fixed OCS Facility Inspection Report

U.S. DEPARTMENT OF
HOMELAND SECURITY
U.S. COAST GUARD
CG-5432 (Rev. 06/04)

FIXED OCS FACILITY INSPECTION REPORT
(INSTRUCTIONS ON REVERSE)

Facility Name
OCS Area/Block

Manned
MMS Lease No.

Person in Charge

Unmanned

OMB NUMBER
1625-0044
Exp.Date: 11/30/2011

Number of Persons on Board

Operator(s)

Owner(s)

Name and Address

Name and Address

Facility Telephone
INSPECTION ITEMS-ALL FACILITIES

Def.

Cor.

Out

1. Workplace Safety 33 CFR PART 142
2. Rails/Guards/Grating 33 CFR 143.110
3. Personnel Landings 33 CFR 143.105
4. Means of Escape 33 CFR 143.101
primarysecondary5. Helo Deck Perimeter 33 CFR 143.110
6. Lights/Warning Devices 33 CFR 143.15
7. Firefighting Equip 33 CFR 145:
portable___________semi-portable__________fixed______________locationsizeagentINSPECTION ITEMS-UNMANNED FACILITIES
8. Lifesaving Equipment 33 CFR 144.10-1
9. Other Lifesaving Equipment 33 CFR 144.10
INSPECTION ITEMS-MANNED FACILITIES
10. Emer. Comms. Equip. 33 CFR 144.01-40
11. Station Bill 33 CFR 146.130
12. Emergency Drills 33 CFR 146.125
conducted monthlyrecord keeping
13. Life Preservers 33 CFR 144.01-20
number:___________equipmentmarkingsstowage14. Work Vests 33 CFR 146.20
number:___________separate stowage15. Ringbuoys 33 CFR 144.01-25
number:___________equipmentmarkingsstowage16. General Alarm System 33 CFR 146.105
markings 33 CFR 146.13517. Manning of Survival Craft 33 CFR 146.120
18. First Aid Kit 33 CFR 144.01-30

(See Instructions)

INSPECTION ITEM

Def.

Cor.

Out

20. Lifesaving Appliances 33 CFR Part 144
a. Type:
Lifefloat____ Liferaft____ Lifeboat___
approval number_________________
location
condition
equipment/markings
servicing (date ________________)
launching devices
weight test (date ________________)
operational test (date ______________)
b. Type:
Lifefloat____ Liferaft____ Lifeboat___
approval number_________________
location
condition
equipment/markings
servicing (date ________________)
launching devices
weight test (date ________________)
operational test (date ______________)
c. Type:
Lifefloat____ Liferaft____ Lifeboat___
approval number_________________
location
condition
equipment/markings
servicing (date ________________)
launching devices
weight test (date ________________)
operational test (date ______________)
d. Type:
Lifefloat____ Liferaft____ Lifeboat___
approval number_________________
location
condition
equipment/markings
servicing (date ________________)
launching devices
weight test (date ________________)
operational test (date ______________)
21. Personnel Record Location 33 CFR 141.35

19. Litter 33 CFR 144.01-35
LIST OF OUTSTANDING ITEMS/COMMENTS (Attach additional pages as necessary)

NAME

FACILITY OWNER'S OR OPERATOR'S ACKNOWLEDGEMENT
TITLE
SIGNATURE

DATE

Reset

INSTRUCTIONS
General
Facility Name..............Enter official facility name/designation.
Manned/Unmanned ....Check the space which indicates facility status at the time of the inspection.
Persons on Board.......Enter number of persons on board on the day of the inspection.
Person in Charge .......Enter the full name of the person in charge.
Operator .....................Fill in name and address of company operating the facility.
Owner.........................Fill in name and address of leaseholder or operating partner.
OCS Area/Block .........Enter standard OCS area abbreviation and block number.
Facility Telephone ......Enter telephone number if so equipped.
Inspection Items
Def.
-Refers to the total number of deficiencies per item found during this inspection.
Cor.
-Refers to the number of deficiencies per item that were corrected this inspection.
Out.
-Refers to number of deficiencies per item remaining outstanding/uncorrected.
Enter the number of deficiencies found, the number of deficiencies corrected, and the number of deficiencies
that remain outstanding for each item in the appropriate box (Cor. + Out. = Def.)
Enter N/A for any item that is not applicable.
ITEM NUMBERS 1 THROUGH 7 MUST BE COMPLETED FOR ALL FACILITIES, BOTH MANNED AND
UNMANNED
ITEMS NUMBERS 8 AND 9 MUST BE COMPLETED FOR ALL UNMANNED FACILITIES.
ITEM NUMBERS 10 THROUGH 21 MUST BE COMPLETED FOR ALL MANNED FACILITIES.
Instructions for Specific Item Numbers
7 ...............Enter the number of portable/semi-portable fire extinguishers and/or fixed firefighting
equipment on board in the appropriate spaces. For location, size, and agent-use Table 33
CFR 145.10(a) to determine compliance. Deviations from the requirements of 33 CFR Part 145
should be considered deficiencies. Enter description of deficiencies and the OCMI determined
time frame for correction in the Comments section where applicable (see 33 CFR 140.105(c)).
9 ...............Any lifesaving equipment on an unmanned platform that is not required by 33 CFR 144.10-1
must meet the standards contained in 144.01-1 through 144.01-40. Where such additional
equipment is installed/located on the facility the appropriate item should be completed
under the INSPECTION ITEM-MANNED FACILITY section of the form.
10 .............Emer. Comms. Equip.-refers to emergency communication equipment.
13, 14, 15 .Number-enter the number of preservers/vests/buoys on board in the appropriate spaces.
20 .............Fill in one subsection (a, b, c and d) for each piece of primary lifesaving equipment.
type-check the appropriate space.
servicing-enter the date the item was last serviced.
weight/- (for davit launched equipment) enter the date of the last test.
operational test-for self propelled equipment enter the date of the last test.
Enter description of deficiencies and the OCMI determined time frame for correction in the
Comments section where applicable (see 33 CFR 140.105(c)).
21 .............Personnel Record Location-enter the address of the location of the required record.
If additional space is needed for any item, enter the applicable item number and the appropriate data in
the comments section.
List of Outstanding Items/Comments
Enter a brief description of each outstanding deficiency and the proposed corrective action.
Enter comments as appropriate. Attach additional pages as necessary.
Owner’s/Operator’s Acknowledgement
Enter name, title, and signature/date of owner’s/operator’s representative acknowledging the particulars
of the inspection.
An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it
displays a valid OMB control number.
The Coast Guard estimates that the average burden for this report is 1.5 hours. You may submit any comments
concerning the accuracy of this burden estimate or any suggestions for reducing the burden to: Commandant (CG543), U.S. Coast Guard, 2100 2nd St., SW, Stop 7581, Washington D.C. 20593-7581 or Office of Management and Budget,
Paperwork Reduction Project (1625-0044), Washington, DC 20503.