Msf 5100 Form – Fill Out and Use This PDF

MSF 5100 / REV 1121

APPLICATION FOR SURVEY AND INSPECTION

OF SHIPS AND FISHING VESSELS

For Guidance Notes (see overleaf). Complete form using BLOCK CAPITALS

1. APPLICANT DETAILS

Name		Company

Address:

Post code:

Country:

Telephone:

Fax:

E mail:

NAME AND ADDRESS OF OWNER/OPERATOR (IF DIFFERENT FROM ABOVE)

2. PARTICULARS OF SURVEY / INSPECTION APPLIED FOR

Ship Name							Ship Type
Official No							IMO No
Fishing No							Year of build
Name of contact							Telephone
Requested date and time of survey				/	/	(00:00 24h)			Fax
Where ship can be seen						E-mail
Nature of Survey / Inspection

I apply for the survey / Inspection described above and enclose a deposit £ and agree to pay any additional fees.

I am aware that the ship should be prepared ready for survey, and appropriate safety precautions taken for all areas to be surveyed, including provision of safe means of access for boarding, as outlined in the attached Health & safety Standards. I understand that Surveyors may refuse to continue with surveys is it is not safe for them to do so, and may consider charging for any time wasted.

PLEASE COMPLETE THE PAYMENT DETAILS SECTION OVERLEAF ON PAGE 3

An Executive Agency of the Department for Transport

1 / 4

MSF 5100 / REV 1121

OFFICIAL USE ONLY

The Sum of £			Has been Received Initials				Date		/	/
Cheque drawn against account of
Customer ID
Main Project No
Sub Project No
Works Order No
Receipt No
Record Deposit £
						Initials
						Date			/	/

An Executive Agency of the Department for Transport

2 / 4

MSF 5100 / REV 1121

GUIDANCE NOTES

1.When you have completed this form please send by it by email (email is our preferred method of delivery) or post to the Marine Office with the appropriate deposit / fee. You can get information on the level of fees from your local Marine Office. Additional charges will be levied for overtime, surveys abroad, waiting time and abortive time.

2.Credit/Debit Card payment via GOV.UK Pay online payment facility is our preferred payment method. You may also pay using BACS transfer quoting the vessel name as payment reference. If you pay using cheque or postal order it must be made payable to the "Maritime & Coastguard Agency". Cheques must be paid in sterling..

3.Any refunds or requests for additional fees will be made to the applicant, in whose name the account will be held.

4.Work will not start until this form has been completed, signed and the deposit / fee received

5.The Maritime and Coastguard Agency (MCA) will use your contact details to send you information about the service(s) you are applying for, as part of its functions as a government department.

The MCA may also wish to contact you to complete a short survey, to evaluate and help to improve the service(s) provided. Where an email address is provided this will be through an e survey. Where an email address is not provided, a third-party service provider, procured through Crown Commercial Services, may contact you by telephone to carry out the survey. Both surveys are optional.

Your information will be kept secure and will not be used for any other purpose without your permission.

To find out more about how the MCA looks after personal data, your rights, and how to contact our data protection officer, please go to www.gov.uk/mca

PAYMENT DETAILS (To be completed by applicant)

Please tick (☑) the appropriate box below to indicate your chosen method of payment

GOV.UK Pay (credit/debit Card Payment) ☐

BACS/CHAPS ☐

Rolling Account ☐

Survey & Inspection National Business Unit

(Covering Aberdeen / Belfast / Cardiff / Colchester / Glasgow / Hull/ Liverpool / Plymouth / Southampton / Stability Unit)

To make payment by Credit/Debit Card: CLICK HERE

If paying by BACS/CHAPS:

Sort Code: 60-70-80

Account No:10013431

Bank Name: NATWEST

Account: MCA EASTERN

IBAN: GB02NWBK60708010013431

Swift: NWBKGB2L

Contact details:

S&I National Business Unit

Crosskill House

Mill Lane

Beverley

East Yorkshire

HU17 9JB

Email: S&INationalBU@mcga.gov.uk

An Executive Agency of the Department for Transport

3 / 4

MSF 5100 / REV 1121

HEALTH AND SAFETY STANDARDS

General

•In signing the Application for Survey (MSF 5100), the owner/manager agrees to provide appropriate

safety precautions, including those described below. Maritime & Coastguard Agency (MCA) surveyors will not sign any documentation limiting the liability of the owner or operator.

•The MCA expects appropriate safety precautions to be taken when one of its surveyors attends a vessel or site for survey or inspection purposes.

•The vessel/site owner has responsibility for all activities onboard/onsite respectively and for ensuring compliance with the relevant national health and safety legislation (Merchant Shipping Act (worldwide) and Health & Safety at Work Act (UK only)).

•When conducting work overseas, the MCA expects equivalent standards to those of the UK to be provided and in addition, compliance with any local requirements.

•Guidance and information on acceptable safety arrangements onboard can be found in the Code of Safe Working Practices for Merchant Seafarers, available at https://www.gov.uk/government/organisations/maritime-and-coastguard-agency For shore side operations (including drydocks) guidance can be obtained from the Health & Safety Executive (www.hse.gov.uk).

•The MCA surveyor will make a professional judgement, including the use of a risk assessment if

appropriate, as to the health and safety arrangements provided. If the arrangements are judged to be insufficient, the surveyor will refuse to continue with the survey or inspection until such time as they have been satisfactorily addressed.

Safe Means of Access

•Provision of safe means of access on UK ships (when operating in the UK or overseas) is a legal requirement.

•On large ships the accommodation ladder or a gangway should be used; these must be fit for purpose and properly maintained. If boarding at sea, an accommodation ladder should be used where possible,

but where a safe transfer from the boat to the bottom platform cannot be provided an appropriate pilot ladder should be considered.

•Reference should be made to MGN 591 (M+F), as amended, for guidance on acceptable arrangements on smaller vessels.

•Portable ladders should only be used where no safer access is reasonably practicable; it must be fit for purpose, properly maintained and secured against movement.

Transfer Vessels

•A vessel used for any transfer to a ship underway or at anchor must be fit for purpose. In the UK the vessel must be appropriately certificated for the purpose of which it is being used (e.g. Workboat, Pilot Boat).

•If overseas, an equivalent level of safety will be expected, including compliance with any local requirements. A letter detailing minimum acceptable arrangements is available from the relevant MCA Marine Office upon request.

•The transfer will not take place if actual or forecast weather conditions are beyond the capability and/or certification of the transfer vessel throughout the expected time for the work, including return transfer time.

Access in and around Vessel

•Safe movement around a vessel or site should not be impeded by cables, hoses, waste material, work equipment, etc. Adequate ventilation and lighting should be provided in all work areas.

•Strict procedures must be in place for higher risk activities, e.g. working at height, working in enclosed/confined spaces. Further guidance can be found in the Code of Safe Working Practices for Merchant Seafarers.

•Procedures for the use of stages and staging (e.g. scaffold towers) should be according to a national industry standard and the structure must have been inspected by a competent person. Stages and staging should always be secured against movement.

An Executive Agency of the Department for Transport

4 / 4