Safety checklist

OMB Control No. 0648-0593

Expiration Date: 11/30/2015

Southeast Fisheries Observer Programs - Panama City
Pre-Trip Safety Check
OBS TRIP ID_____________

DATE ____________

VESSEL NAME __________________

VESSEL #_______________

Life Saving Equipment (circle Y for yes or N for no)
CGVSE
Safety Examination Decal? Y / N
Decal #________________

Date of Expiration: ___ / ____

Vessel Distance Rating: ____ NM

EPIRB
EPIRB present? Y / N
Stowed in a float-free location? Y / N
EPIRB Registration Expiration Date: ___/_____
Hydrostatic Release Exp. Date: ___ / _____ / NA

EPIRB Category: I / II
Registered To: ______________________
Battery Expiration Date: __ / ____

FLARES
3 of any flare required for operations <3nm offshore
3 Parachute, 6 Hand & 3 Smoke required for operations >3nm offshore
Record flare expiration dates:
Hand: ___ / ____
Hand: ___ / ____
Hand: ___ / ____
Hand: ___ / ____
Hand: ___ / ____
Hand: ___ / ____

Smoke: ___ / ____
Smoke: ___ / ____
Smoke: ___ / ____

Parachute: ___ / ____
Parachute: ___ / ____
Parachute: ___ / ____

PFDs AND IMMERSION SUITS (not including observer equipment)
Personal Floatation Device for each POB? Y / N

# of PFDs ____

Immersion suit for each POB*? Y / N
*required in federal waters above 32 N latitude

# of Immersion Suits ____

11-2012

FIRE FIGHTING EQUIPMENT
Vessels <26 ft require 1 B-I unless equipped with an outboard in certain conditions
Vessels >26 ft but <40 ft require 2 B-I or 1 B-II
Vessels >40 ft but <65 ft require 3 B-I or 1 B-II & 1 B-I
Location
1 __________________
2 __________________
3 __________________

Type
_____
_____
_____

STATION BILLS posted? Y / N

Service Date
___________
___________
___________

ONBOARD DRILLS logged? Y / N

LIFE RAFTS AND RINGS
Orange ring buoy with line attached? Y / N
Rigid life float? Y / N (>12nm but <20nm until 2015)
Inflatable life raft? Y / N
Capacity for all POB? Y / N
Life raft Capacity ______
Raft Repack Date ___ / ______
Hydrostatic Release Exp. Date: ___ / _____
Life raft configured correctly*? Y / N
*Please take picture of configuration

5
Hydrostatic release 
expiration date 

5 Fabrication Marks Present? Y / N
Upper Fabrication mark towards rope? Y / N

Please provide signatures to verify that a safety check was
conducted and that the information above is accurate.
Observer: ________________________________ Date: ____/_____/_____
Owner/Operator: __________________________ Date: ____/_____/_____

11-2012