Authorization No.

INTERNATIONAL SAFETY MANAGEMENT (ISM CODE)

DOC–Checklist for:
Interim Certification
(For Company)
(In accordance with Part B, Section 14-Interim Certification, Paragraph 14.1 of the ISM Code)

Place Date
:
( Place of issue of Checklist) ( Day, Month, Year)

Name of Company:

Address of Company:

IMO Unique Company Identification Number:

The company operates the following types of ships: Comment in Box: Yes (X) or No (-)

Passenger Ship Chemical Tanker

Passenger High-Speed Craft Gas Carrier

Cargo High-Speed Craft Mobile Offshore Drilling Unit

Bulk Carrier Other Cargo Ship

Oil Tanker

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 Comments in box: Yes (x), No (-), or Not Applicable (NA)

Company
No. Questions Comments
Yes No

1. Interim Certification

2. Verification for issuance of an Interim DOC is carried out where:

3. The Company is newly established? (Section 14, Paragraph 14.1.1)

4. New ship types are to be added to an existing DOC? (Section 14, Paragraph
14.1.2)

5. The Company has demonstrated a developed SMS complying with the

requirements of paragraph 1.2.3 of the ISM Code? (Section 14, Paragraph
14.1)

6. Does the developed SMS cover the following documents?

7.  Description of the Company organizational structure, such as

organizational chart or an equivalent?

8.  Description for responding to emergency situations?

9.  Description of the responsibility and authority of the key

personnel, such as job description or an equivalent?

10.  Description of means of implementing the requirements of

Sections 9, 11 and 12 of the ISM Code?

11.  Documents referring to:

12. o Resources and personnel (Section 6)

13. o Development of Plans for shipboard operations (Section 7)

14. o Emergency preparedness (Section 8)

15. o Reports and analysis of non-conformities, accidents and

hazardous occurrences (Section 9)

16. o Maintenance of the ship and equipment (Section 10)

17. o Control of all documents and data (Section 11)

Additional comments:

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 Comments in box: Yes (x), No (-), or Not Applicable (NA)

Company
No. Questions Comments
Yes No

18. o Safety Internal Audits carried out by the Company

(Section 12)

19. Should the company establish a safety and environmental protection

policy?

20. Does the Company have a list of emergency situations likely to occur
in the shore based locations and on board ships?

21. Do these represented documents give guidance on how to use the

internal lines of communication in emergency situations?

22. Does the Company have plan, for implementing an SMS meeting to the
full the requirements of the ISM Code within the period of validity of
the interim DOC?

23. Do these plans include the following phases:

24.  Date of full implementation of the SMS in shore-based locations

(trial operation during at least 3 months)?

25.  Date of full implementation of the SMS on board of at least one

ship of each type operated by the Company and declared to be
entered in the DOC (trial operation during at least 3 months)?

26.  Date of internal audit of the SMS elements in the shore-based

locations?

27.  Date of internal audit of the SMS elements on board of at least

one ship of each type operated by the Company and declared to
be entered in the DOC?

28.  Date of initial audit of the Company for issuing a DOC?

29. Have the documents pertaining to the SMS been developed in a

working language or languages understood by the shore-based and
shipboard personnel?
Additional comments:

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 Company
No. Questions Comments
Yes No

30. Have been stablished a cyber security policy?

31. Have been set instructions and procedures to ensure cyber-secure operation ?

32. Have been defined levels of authority and lines of communication between, and
amongst, shore and shipboard personnel concerning cyber security?

33. Have been set procedures for internal cyber security audits and management
reviews?

34. Have been set procedures for reporting cyber-attacks, incidents and non-
conformities?

35. Have been set procedures to prepare for and respond to cyber-attacks and incidents?

Additional comments:

General comments:

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Final recommendation:

It is recommended that:

No Full Term DOC to be issued until Initial Verification will be carried out .……………………….

I have issued the Interim DOC No. at

(Place of issue of Interim DOC)
the of of .
(Day) (Month) (Year)

Valid until: of of .
(Day) (Month) (Year)

Note: Interim DOC following Interim Certification should be issued for a period not exceeding twelve (12) months in
accordance with Part B, Section 14, Paragraph 14.1 of the ISM Code

Issued at : the of of .
(Place of issue of Checklist ) (Day) (Month) (Year)

Name and Signature of duly authorized ISM-Code Auditor

By: Intermaritime Certification Services (ICS)

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