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