Vessel Safety Check (Vsc) - Us Coast Guard printable pdf download

VESSEL SAFETY CHECK (VSC)

Date of VSC: ____________

To be completed by a U.S. Coast Guard approved Vessel Examiner.

Decal Awarded: Yes

See the back of this form for a brief explanation of required items.

A Federal Requirements pamphlet is also available.

VESSEL INFORMATION:

Owner/Operator Name:

Registration or

_________________________________________

Documentation Number: ______________________

Owner/Operator has attended a CGAUX, USPS, State

HIN: ______________________________________

or ____________ Boating Safety Class: Yes

Length: <16

16-25

26-39

40-65

>65

Location of VSC - County: ____________ State: ____

Diesel

Sail

Other

Area of Operations: Inland

Coastal

Replaced decal was: Last Year

Outdated

First time

Type: PWC

Open

Cabin

Other

RECOMMENDED AND DISCUSSION ITEMS

VESSEL SAFETY CHECK DECAL REQUIREMENTS

(While encouraged, items below are not VSC requirements)

Item

Yes No N/A

Yes No

1. Display of Numbers

Marine Radio

2. Registration/Documentation

II.

Dewatering Device & Backup

3. Personal Flotation Devices (PFD)

III. Mounted Fire Extinguishers

4. Visual Distress Signals (VDS)

IV.

Anchor & Line for Area

5. Fire Extinguishers

First Aid and PIW Kits (**over)

6. Ventilation

VI. Inland Visual Distress Signals

7. Backfire Flame Control

VII. Capacity/Certificate of Compliance

8. Sound Producing Devices/Bell

VIII. Discussion Items: as applies

9. Navigation Lights

a. Accident Reporting - Owner Responsibility

10. Pollution Placard

b. Offshore Operations

11. MARPOL Trash Placard

c. Nautical Charts / Navigation Aids

12. Marine Sanitation Devices

d. Survival Tips / First Aid

13. Navigation Rules

e. Fueling / Fuel Management

14. State and/or Local Requirements

f. Float Plan / Weather & Sea Conditions

15. Overall Vessel Condition: as applies

g. Insurance Considerations

a. Deck Free of Hazards / Clean Bilge

h. Boating Check List

b. Electrical - Fuel Systems

i. Safe Boating Classes

c. Galley - Heating Systems

j. Maritime Domain Awarness

I certify that I have personally examined this vessel and find it meets the above requirements at the time of this Vessel Safety Check. I

am a qualified Vessel Examiner of the: CGAUX

, USPS

, State of __________________

, or _______________________

Printed Name of the Examiner ________________________________ Examiner Number _____________

Examiner Signature __________________________________ Telephone Number _____________________

Additional Comments: This is not an official boarding for law enforcement purposes. It is recommended that you correct any deficiencies noted. This

checklist is furnished for your information. There is no assumption of liability of any kind for advice given or opinions expressed in connection to this

examination. By accepting the Vessel Safety Check decal you are pledging to maintain your boat and equipment to the standard of safety exhibited

during this examination. Please remove the Vessel Safety Check decal if the boat is sold or no longer meets these requirements.

I am consenting to this Vessel Safety Check of my watercraft with full knowledge that it is provided to me as a public service on a volunteer basis

without cost, and I understand and agree that my receipt of a Vessel Safety Check shall not constitute or be construed as a warranty or guarantee

as to either the qualification, knowledge, or skills of the operator; the seaworthiness of the vessel; or the serviceability or adequacy of any

equipment on board.

Owner/Operator Signature: ________________________________________________________________ Date: _________________________

ANSC7012 (4-08) Previous edition may be used

Vessel Safety Check (Vsc) - Us Coast Guard

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