International Convention on Load Lines, 1966
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Record of Conditions of Assignment
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Name of
ship.........................................................................................................................
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Port of
registry......................................................................................................................
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Nationality..............................................................................................................................
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Distinctive number or
letters.................................................................................................
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Shipbuilders..........................................................................................................................
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Yard
number.........................................................................................................................
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Date of
construction/conversion...........................................................................................
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Freeboard assigned as a ship of
Type.................................................................................
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Classification........................................................................................................................
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Date and place of initial
survey.............................................................................................
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A plan of suitable size may be
attached to this Report in preference to sketches on this page.
Disposition and
dimensions of superstructures, trunks, deckhouses, machinery casings; extent of
bulwarks, guard rails and wood sheathing on exposed deck, to be inserted in the diagrams
and tables following; together with positions of hatchways, gangways and other means for
the protection of the crew; cargo ports, bow and stern doors, sidescuttles, scuppers,
ventilators, air pipes, companionways, and other items that would affect the
seaworthiness of the ship.
Doorways in superstructures, exposed machinery casings and deckhouses protecting
openings if freeboard and superstructure decks (Regulations 12, 17 and 18)
Location
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Ref. No.
on sketch or plan
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Number and
size of openings
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Height of
sills
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Closing appliances
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Type and
material
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Number of
clips
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In forecastle
bulkhead
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In bridge forward
bulkhead
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In bridge after
bulkhead
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In raised
quarter-deck bulkhead
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In poop
bulkhead
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In exposed machinery
casings on freeboard or raised quarter-decks
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In
exposed machinery casings on superstructure decks
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In
machinery casings within superstructures or deckhouses on freeboard
deck
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In
deckhouses in Position 1 enclosing openings leading below freeboard
deck
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In
deckhouses in Position 2 enclosing openings leading within enclosed
superstructures or below freeboard deck
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In
exposed pump-room casings
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Hatchways at positions 1 and 2 closed by portable covers and secured weathertight by
tarpaulins and battening devices (Regulation 15)
Position and Reference No. on sketch or plan
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Dimensions of clear opening at top of coaming
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Height of
coamings above deck
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PORTABLE BEAMS
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Number
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Spacing
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b
1 × t
f
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D × t
w
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b
2 × t
f
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Bearing surface
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Means of securing each beam
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PORTABLE COVERS
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Material
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Thickness
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Direction fitted
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Bearing surgace
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Spacing
of cleats
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TARPAULINS
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No. of layers
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Material
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Means of securing each section of covers:
Are wood covers fitted with galvanized end bands?
Hatchways at positions 1 and 2 closed by weathertight covers of steel (or other
equivalent material) fitted with gaskets and clamping devices (Regulation 16)
Position and Reference No. on sketch or plan
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Dimensions of clear opening at top of
coaming
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Height of coamings above deck
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Type of cover or patent name
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Material
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Machinery space openings and miscellaneous openings in freeboard and superstructure
decks (Regulations 17 and 18)
Positions and Reference No. on sketch or plan
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Dimensions
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Height of
coaming
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COVER
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Material
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How attached
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Number
and spacing of toggles
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Position
and Reference No. on sketch or plan
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Dimensions
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Height
of coaming
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COVER
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Number
and spacing of toggles
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Ventilators on freeboard and superstructure decks (positions 1 and 2) (Regulation
19)
Deck on
which fitted
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Number
fitted
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Coaming
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Type (State patent name if any)
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Closing
appliances
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Dimensions
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height
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Air pipes on freeboard and superstructure decks (Regulation 20)
Deck on
which fitted
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Number
fitted
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Coaming
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height
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Type (State patent name if any)
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Dimensions
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Closing
appliances
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Cargo port and other similar openings (Regulation 21)
Position of
port
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Dimensions of
opening
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Distance of lower edge
from freeboard deck
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Securing
devices
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Remarks
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Scuppers, inlets and discharges (Regulation 22)
State if
scupper or discharge
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Number
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Pipe
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From
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Vertical distance above top of keel
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Number,
type and material of discharge valves
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Position
of controls
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Diameter
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Thickness
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Material
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Discharge
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Uppermost
value
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Outlet in hull
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Inboard
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S -
Scupper
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MS -
Mild steel
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SD -
Screw-down
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D - Discharge
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CS -
Cast steel
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ANR - Automatic
non-return
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GM - Gun
metal
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SD ANR - Screw-down
automatic non-return
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Any other approved material to
be designated
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Sidescuttles (Regulation 23)
Position
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Number
fitted
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Clear
glass size
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Fixed or
opening
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Material
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Type of
glass and thickness
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Standards
used and Type No.
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Frame
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Deadlight
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Indicate the vertical distance between the freeboard deck and the lower sill of the
sidescuttle positioned at the greatest vertical distance below the freeboard deck.
Freeing ports (Regulation 24)
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Length of
bulwark
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Height of
bulwark
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Number and size of
freeing ports each side
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Total area each
side
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Required area each
side
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Freeboard deck after well
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Forward well
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Superstructure deck
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State fore and aft position of each freeing port in
relation to superstructure end bulkheads
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After well
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Forward well
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Particulars of shutters, bars or rails fitted
to freeing ports
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height of lower edge of freeing port above
deck
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Protection of the crew (Regulations 25 and 26)
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State particulars of bulwarks or guard
rails on freeboard and superstructure decks:
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State details of lifelines, walkways,
gangways or underdeck passageways where required to be fitted:
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Timber deck cargo fittings (Regulation 44)
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State
particulars of uprights, sockets, lashings, guard rails and
lifelines:
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The
conditions of assignment shown on this form are a record of the arrangements
and fittings provided on the ship and are in accordance with the
requirements of the relevant regulations of the International Convention on
Load Lines, 1966.
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(Surveyor's signature)
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(Date)
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