CG-5432 (06/16) Fixed OCS Facility Inspection Report

DEPARTMENT OF HOMELAND SECURITY

U.S. Coast Guard
FIXED OCS FACILITY INSPECTION REPORT
Manned
Number of Per­
Unmanned sons on Board

Facility Name

OCS Area/Block

Person in Charge

Operator(s)

Owner(s)

Facility Telephone

Name and
Address:

Name and
Address:

INSPECTION ITEMS-ALL FACILITIES
1. Workplace Safety 33 CFR PART 142

Def.

Cor.

Out

INSPECTION ITEM

OMB Number: 1625-0044
Exp. Date: 08/31/2018
Lease No.

Def.

Cor.

Out

20. Lifesaving Appliances 33 CFR Part 144

2. Rails/Guards/Grating 33 CFR 143.110(a) & (c)

a. Type:

3. Personnel Landings 33 CFR 143.105

approval number:

4. Means of Escape 33 CFR 143.101

location:

primary (number of)

condition:

secondary (number of)

equipment/markings:

5. Helo Deck Perimeter 33 CFR 143.110(b)
6. Lights/Warning Devices 33 CFR 143.15

servicing date:

7. Firefighting Equip 33 CFR 145:

launching devices:

portable:

weight test date:

semi-portable:

operation test date:

fixed:

b. Type:

location:

approval number:

size:

location:

agent:

condition:

INSPECTION ITEMS-UNMANNED FACILITIES

equipment/markings:

8. Lifesaving Equipment 33 CFR 144.10-1
9. Other Lifesaving Equipment 33 CFR 144.10-10

(See instructions)

INSPECTION ITEMS-MANNED FACILITIES

servicing date:
launching devices:
weight test date:

10. Emer. Comms. Equip. 33 CFR 144.01-40
11. Station Bill 33 CFR 146.130

operation test date:

12. Emergency Drills 33 CFR 146.125

c. Type:

conducted monthly

approval number:

record keeping

location:
condition:

13. Life Preservers 33 CFR 144.01-20
number:

equipment/markings:

equipment:

servicing date:

markings:

launching devices:

stowage:

weight test date:

14. Work Vests 33 CFR 146.20

operation test date:

number:

d. Type:

stowage:

approval number:

15. Ringbuoys 33 CFR 144.01-25

location:

number:

condition:

equipment:

equipment/markings:

markings:

servicing date:

stowage:
16. General Alarm System 33 CFR 146.105 markings 33 CFR
146.135
17. Manning of Survival Craft 33 CFR 146.120

launching devices:
weigh test date:
operation test date:

18. First Aid Kit 33 CFR 144.01-30

21. Personnel Record Locations 33 CFR 141.35

19. Litter 33 CFR 144.01-35

LIST OF OUTSTANDING ITEMS/COMMENTS (Attach additional pages as necessary)

NAME

CG-5432 (06/16)

TITLE

FACILITY OWNER'S OR OPERATOR'S ACKNOWLEDGEMENT
SIGNATURE

DATE

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General
Facility Name
Manned/Unmanned

INSTRUCTIONS
Enter official facility name/designation.
Check the space which indicates facility status at the time of the inspection. A new self-inspection form shall be
completed when a facility changes status.
Enter number of persons on board on the day of the inspection.
Enter the full name of the person in charge.
Fill in name and address of company operating the facility.
Fill in name and address of leaseholder or operating partner.
Enter standard OCS area abbreviation and block number.
Enter telephone number if so equipped.

Persons on Board
Person in Charge
Operator
Owner
OCS Area/Block
Facility Telephone
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 fire fighting equipment on board in the appropriate
spaces. The number of portable/semi-portable fire extinguishers should meet the requirements of 33 CFR 145. For location,
size, and agent - use Table 33 CFR 145.05(c) and 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 BSEE/OCMI determined time
frame for correction in the Comments section where applicable (see 33 CFR 140.105(c)).
NOTE: fixed pertains to fixed fire suppression systems (CO2, FM-200, etc.)
firewater/hose reels are not considered fixed for this definition.
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.
17
******
20

Personnel assigned and designated on the Station Bill.
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 test

(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 BSEE/OCMI determined time frame for correction in the Comments section
where applicable (see 33 CFR 140.105(c) & (d)).
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 (CG-CVC), U.S. Coast Guard, Stop 7501, 2703 Martin Luther King Jr. Ave, SE,
Washington D.C. 20593-7501 or Office of Management and Budget, Paperwork Reduction Project (1625-0044), Washington, DC 20503.
Privacy Act Statement
Authority: 43 U.S.C. §1333, 1348, 1350, 1356 authorize the collection of this information.
Purpose: The Coast Guard, Bureau of Safety and Environmental Enforcement, and the facility owner or operator will use this information to conduct a safety
inspection on a Fixed OCS (Outer Continental Shelf) Facility.
Routine Uses: The information will be used by and disclosed to Coast Guard personnel and contractors or other agents who need the information to assist in
activities related to Fixed OCS Facilities. Any external disclosures of data within this record will be made in accordance with DHS/USCG-013, United States
Coast Guard Marine Information for Safety and Law Enforcement, 74 Federal Register 30305, June 25, 2009.
Disclosure: Furnishing this information is mandatory; failure to furnish the requested information may result in appropriate enforcement measures by the
agency conducting the inspection, and possible restrictions on the operation of the facility.

CG-5432 (06/16)

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