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1、货舱进入程序检查表Cargo Hold Access Procedure Check List船名Ship sName航次Voy.日期Date作业人数No. of workers作业责任人Duty officer进入货舱的位置/名称：Position/name of Cargo Hold Access:进入的原因：Thp rQaacn whv1 n :进入工作有效期：Validity:从日期时间，至日期时间From timedate， TO timedateNoREQUIREMENT OF CARGO HOLDS ENTRY PROCEDURE/货舱进入步骤要求确认YesNo1是否经过船岸双方
2、确认要进入货舱？Ts cargo hold access agreed between ship/terniinaL2进入货舱的人员是否经过船长的授权？Is the oersonnel authorised to enter the cargo hold bv the master?3装货期间船员进入货舱是否被PCWS代表按照特定的协议所允许？Is Entry into cargo holds during cargo operation permitted by specific agreement with the PCWS ReDresentative?4是否有高级船员监督船员进入货舱？
3、I s crpw to pnt.pr c.areo ho 1 d snnprvi spd hv an off i cpr?5是否安排指定人员始终在相关货舱的上方甲板监视工作在货舱中人员的安 全,并确保货舱内有人工作时码头的装货机没有位于本货舱。Whether the designated person is stationed on deck above the cargo hold during the entire cargo operation, to watch the safety of persons working in the cargo hold and to ensure
4、that the terminal shiploader is not r)os;i t i onpd in thp hoi d.6船方能否提供最近12个月以内的货舱进入步骤训练记录？Can the ship provide the Procedure for Enter To Cargo Hold training Record on last 12 months?7船岸双方同意的通讯方式是否有效？Is the communication system between ship/terminal available?语言：电台频道： 号码：LanguageRadio ChannelTel.
5、No.8进入的货舱入口的人孔盖是否安全固定？Are the covers of man hole fully secured ?9船岸之间是否有安全通道？Whether has safe access between ship and terminal?10进入货舱的通道是否清爽和安全？Is the access to cargo hold clear and safe?11确认是否在所有货舱入口有标示“没有许可不得进入”的警告语.Is the notice “Prohibiting Entry, Without Permission“ displayed at all cargo holds
6、 entrance?12是否履行进入密闭舱室的检查步骤？ (Form SMI-0315 attached)Whether the Enclosed Space Entry Procedure carried out?进入前的大气测量Air measure before get in:读数：氧气含量%vol (21%)Figureoxygen碳氢化合物% LFL (Less than 1%)Hydrocarbon毒气PPM (specific gas and PEL)Toxic gases说明： LFL： lower flammable limit ,可燃的下限值。Note PEL： Permissible Exposure Limit (Level),允许接触限值。相关人员 related persons姓名name签名 signature备用p. S责任人：大副PIC : Chief officer监督人（安全监督员）supervisor作业人员（签字）The workers批准人（船长）Approver (capt)作业日期 Date of work年 月日备注：此表工作前由大副填写并存档。Remark: this form should be completed by c/o before action.