CG-5437A Port State Control Report of Inspection

U.S. DEPARTMENT OF
HOMELAND SECURITY
U.S. COAST GUARD
CG-5437A Rev. (1/11)

U.S. COAST GUARD
PORT STATE CONTROL REPORT OF INSPECTION
FORM A (CG-5437A)
INSTRUCTIONS

The Port State Control Report of Inspection - FORM A is intended to provide documentation to the various parties
associated with a foreign vessel and other port States on the outcome of an International Ship & Port Facility Security (ISPS)
Code compliance verification examination and/or Port State Control (PSC) safety examination conducted by the U.S. Coast
Guard. A Report of Inspection - FORM A shall be completed for all ISPS & PSC exams.
General
1) All dates should be in the mm/dd/yyyy format and all times are to be local.
2) As MISLE Activities should be created before conducting the exam, ensure the MISLE Activity number is indicated in
the MISLE Activity number box in the upper right corner of the form.
Block 2 – List the current name of the ship. If the vessel recently changed its name, add the previous ship’s name in
parentheses, e.g. (Ex: OLD NAME).
Block 3 – Spell out Flag Administration, do not use 2 letter country code.
Block 4 – See list of ship types.
Block 7 – Use Gross Tons ITC per International Tonnage Convention Certificate. If the vessel also has Gross Register
Tonnage or National Tonnage, include this information in parentheses, e.g. (Nat. Tonnage 482) or (GRT 314).
Block 8 – Only applies to oil tankers, use value shown on IOPP Certificate.
Block 12 – The Recognized Organization (RO) and/or Recognized Security Organization (RSO) should be listed here. If not
enough room to list, make note on bottom of form.
Block 13 – This section shall be completed regardless if the inspection date is the same as the detention date.
Block 14 – Include the full address for the ship management information. For ISM Document of Compliance (DOC)
Company, see definition in SOLAS Regulation IX/1.2.
Block 15a – List ALL certificates that are related to deficiencies that are grounds for detention (e.g. If the vessel is detained
for deficiencies with the lifeboat, list the Safety Equipment Certificate, if detained for poor access control or poor control of
restricted areas, list the International Ship Security Certificate, if detained for both safety and security, list all relevant
certificates).
Block 15d – Dates of last survey relative to the listed certificate must be listed as they are critical for CG-5432 to determine
whether a RO or RSO should be associated with the detention. This directly impacts vessel targeting. If no annual dates are
indicated on the relevant certificate, use the survey date in which the certificate was based on (usually located on the first
page).
Block 16 – If checked “yes”, complete FORM B (CG-5437B). Provide copies to the vessel, flag State and/or RO/RSO only
after the Master or vessel representative and the PSCO have signed the forms.
Block 17 – In the event of a detention, expulsion or denial of entry; provide a copy (fax or email) of Forms A and B to the
flag State, owner/operator/charterer, RO and RSO as applicable after the supervisor has reviewed and signed the forms.
Include the scanned forms in MISLE under the Documents tab and email them to CG-5432 at [email protected] with the
return receipt option checked. Include a comment in the email if more than one major control action was applied (i.e.
detained, expelled, denied entry). Also specify the number of CG detentions the vessel has had over the last 12 months.

U.S. Dept. of Homeland Security, USCG, CG-5437A (Rev. 1/11)

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MISLE Activity Number

Port State Control Report of Inspection- Form A*

U.S. DEPARTMENT OF
HOMELAND SECURITY
U.S. COAST GUARD
CG-5437A Rev. (1/11)

In accordance with IMO Port State Control Procedures [Resolution A.787(19), as
amended by Resolution A.882(21)] and the International Ship & Port Facility
Security (ISPS) Code

1. Reporting Country: United States of America

2. Name of Ship:

3. Flag of Ship:

4. Ship Type IMO Code:

6. IMO Number:

7. Gross Tonnage:

9. Yr. of Build:

10. Date of Inspection:

12. Classification Society:

Exam Type

5. Call Sign:
8. Deadweight (where applicable):

11. Place of Inspection:

13. Detention Info **: a) Date/Time Imposed:
b) Date/Time Released:

14. Ship Management Information (include address):
Charterer:
ISM DOC Company w/IMO Company #:
Owner w/IMO Company #:

Operator w/IMO Company #:

15. Relevant Certificates/Documents**:
a) Name

b) Issuing Authority

c) Dates of Issue and Expiry

1)
2)
3)
4)
5)
d) Information on last intermediate or annual survey/audit**
Date
Surveying/Auditing Authority

Place

1)
2)
3)
4)
5)
Check all applicable for 16-19 below:
16. Deficiencies Identified:

No

Yes (If yes see Form B (CG-5437B))

17. Major Control Action:

No

Detention

Expulsion

Denial of Entry: For

Safety

Security

18. Priority:

NPV

ISPS I

ISPS II

ISPS III

Random

MODU

PI

PII

19. Drills Conducted?

No

Fire Drill

Abandon Ship Drill

ISPS/Security Related Drill

Copy provided to:
(Printed name of Master/Vessel representative)

(Signature)

Name of PSCO:
(Printed name of duly authorized PSCO of reporting authority)

Issuing Unit Name and Address:

Copies forwarded to:
Check as appropriate
Agent
Flag State
Recognized Organization
Recognized Security Organization
Ship Management

(Signature)

Reviewed by Supervisor:
(print name, sign and date)

* This inspection report has been issued solely for the purposes of informing the master and other port States that an inspection by the USCG has taken place.
This inspection report shall not be construed as a seaworthiness certificate in excess of certificates the ship is required to carry.

** To be completed in the event of a detention.
U.S. Dept. of Homeland Security, USCG, CG-5437A (Rev. 4/11)

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Page 3 of CG-5437A

Appeal Procedures
(Reference: Title 46, Code of Federal Regulations, Subpart 1.03)
Any person directly affected by a decision or wishing to dispute the validity of a PSC action or their association with an
IMO reportable control action should follow the appeal procedures contained in 46 CFR 1.03 and as outlined below:
Detentions (Safety and/or Security) not related with RO/RSO/Charterer
1) Appeals must be submitted in writing within 30 days after the decision or action being appealed was made. The
appeal must contain a description of the decision or action appealed and the reason why the decision or action should
be set aside or revised.
2) All IMO reportable control action appeals must be submitted first to the cognizant Officer in Charge of Marine
Inspection (OCMI) for reconsideration. The issuing unit’s name/address is located in the bottom left corner of the
Form A.
3) If not satisfied by the decision or action of an OCMI after requesting reconsideration, a formal appeal of that
decision or action may be made within 30 days, via the office of the cognizant OCMI, to the District Commander of the
district in which the office of the cognizant OCMI is located.
4) If not satisfied by the District Commander’s decision or action on appeal, a formal appeal of that decision or action
may be made within 30 days, via the office of the cognizant District Commander to Commandant (CG-543).
5)

Commandant (CG-543) is final agency action on the appeal.

RO/RSO/Charterer Related Detentions (Safety and Security)
1) Any RO/RSO/Charterer wishing to dispute their association with a detention must make their appeal in writing
within 30 days after the last administrative action is taken by the Coast Guard DIRECTLY to Commandant (CG-5432)
at the following address:
United States Coast Guard Headquarters

COMMANDANT (CG-5432)

Attn: Foreign and Offshore Vessel Compliance Division

nd
2100 2 Street SW Stop 7581

Washington, DC 20593-7581

Or

Email: [email protected]

U.S. COAST GUARD PORT STATE CONTROL
For information on the U.S. Coast Guard’s Port State Control (PSC) Program, you may visit our website at:
http://homeport.uscg.mil/psc

U.S. Dept. of Homeland Security, USCG, CG-5437A (Rev. 1/11)

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