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Ballast Water Reporting Form

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Ballast Water Reporting Form

1. Vessel Information

Vessel: Vessel Type:
Owner: IMO Number:
GT: Call Sign:
Flag: Arrival Date:
Agent: Last Port / Country:
Arrival Port: Next Port / Country:

2. Ballast Water

Total Ballast Water On-Board:
Total Ballast Water Capacity:

3. Ballast Water Tanks

Is There a Ballast Water Management Plan On-Board?
Has the Plan Been Implented?
Total Number of Tanks On-Board:
Number of Tanks In Ballast:
If 'none', go to Section 5.
Number of Tanks Exchanged:
Number of Tanks Not Exchanged:

4. Ballast Water History

Record All Tanks That Will Be De-Ballasted in Port State of Arrival.

If 'none', go to Section 5.

Ballast Water Source

Tanks / Holds Date Port or Lat. Long Volume (units) Temp (units)

Ballast Water Exchange

Choose one:
Tanks / Holds Date Endpoint Lat. Long Volume (units) % Exch. SEA Hgt.(m)

Ballast Water Discharge

Tanks / Holds Date Port or Lat. Long Volume (units) Salinity (units)
If Exchanges Were Not Conducted, State Other Control Actions Taken:
If No Other Actions Taken, State Reason Why Not:

5. IMO Ballast Water Guidelines

Are There Ballast Water Guidelines On-Board (Res.868(20))?
Resp. Officer's Name / Title:
Orkney Islands Council (OIC) logoUK Chamber of Shipping logoBritish Ports Association logoCruise Lines International Association (CLIA) logoCruise Scotland logoCruise Britain logo

Orkney Islands Council, Marine Services, Harbour Authority Building, Scapa, Orkney, KW15 1SD