Anda di halaman 1dari 20

2

DIREKTORAT JENDERAL PERHUBUNGAN LAUT


DIRECTORATE GENERAL OF SEA TRANSPORTATION
DIREKTORAT PERKAPALAN DAN KEPELAUTAN
DIRECTORATE OF SHIPPING AND SEAFARERS

LAPORAN PEMARIKSAAN
RECORD OF INSPECTION
PERSYARATAN PENGAWAKAN MINIMUM
REQUIREMENTS FOR SAFE MANNING
UNTUK MEMENUHI KETENTUAN DARI RESOLUSI 1047 (27) / NCVS*
TO MEET OF THE IMO RESOLUTION 1047 (27) / NCVS*

Pelabuhan Pemeriksaan : ………………………………………………..


Port Of Inspection
Tanggal Pemeriksaan : ………………………………………………..
Inspection Date

Kebangsaan Dan
Tanda Tanggal
Nama Kapal Pelabuhan Pendaftaraan Berat Kotor
Panggilan Peletakan Lunas
Name Of Ship Nationality And Port Of Gross Tonage
Call Sign Date Keel Laid
Registeratry

Jenis Kapal ** : Daerah Pelayaran ** :


Type Of Ship Trading Area

- Penumpang (Passangger) -
Semua Lautan (International)
- Kapal Barang (Cargo ) -
Kawasan Indonesia (Near Costal Voyage )
- Penangkap Ikan (Fishing) -
Lokal (Local)
- Floating Offshore -
Terbatas (Limited)
Instalation -
Pelabuhan (Port )
-
Perairan Daratan (Intersular)
-
Lain- Lain (Others)
Nama Pemilik Kapal /Pencharter Atau Keagenan ** :
Name Of Ship Of Owner /Operator / Agent …………………………………
Alamat Pemilik Perusahaan/Pencharter/ Keagenan ** :
Address Of Owner Manager/Operator/Agent
………………………………………………………………………………………………
Jenis Pemeriksaan ** :
Type Of Inspection

- Pemeriksaan Pertama (Intial Inspection)


- Pemeriksaan Tahunan (Annual Inspection)
- Pemeriksaan Tambahan (Additional Inspection)

* Hapus yang tidak perlu ** Berikan tanda √ pada yang sesuai


delete as appropiate please mark √ as appropiate

Form.01/Kplt- Pengawakan/ rev00-2018


3

LAPORAN PEMERIKSAAN PENGAWAKAN MINIMUM


RECORD OF INSPECTION FOR A MINIMUM SAFE MANNING

Silahkan Diisi Dengan Format Tertulis


Please Complete In Type Written Form

Jika Tidak Cukup Jawaban Dapat Disediakan Pada Kertas Tambahan Yang Dilampirkan
Pada
Kertas Tambahan Yang Dilampirkan Pada Form Pemeriksaan Ini.
If There Is Insufficient Space Provide Under The Questions, Answers May Be Provided On Additional
Sheets Of Paper Attached To This From Of Inspection.

1. Keterangan Pemohon
Particulars Of Applicant

(a) .Nama Lengkap Pemohon : ………………………………………..


Full Name Of Applicant

(b) .Alamat Lengkap Pemohon : ………………………………………..


Address Of Applicant

2. Data Kapal
Particulars Of Ship

a) . Nomor IMO : ………………………………….....


IMO Number

b) . Jumlah Kabin : …………………………………….


Number Of Accomodations

c) . Bahan Material Kapal : ……………………………………


Material Of Ship

d) . Galangan Pembuat : …………………………………….


Shipyard

Catatan Tambahan ( Jika Ada ) :


Additional Information ( If Any )

Form.01/Kplt- Pengawakan/ rev00-2018


4

3. Keterangan Perusahaan Yang Mengoperasikan


Particulars Of Operating Company

A. Nama Operator : …………………………………


Name Of Operator
B. Alamat Operator : …………………………………
Address Of Operating Company
C. Nomor Identifikasi Perusahaan : …………………………………
Company Identification Number

4. Daerah Pelayaran Kapal **


Trading Pattern Of Ship

(a) - Semua Lautan (International Voyage)


- Kawasan Indonesia (Near Coastal Voyage)
- Lokal (Local)
- Terbatas (Limited)
- Pelabuhan (Port)
- Perairan Daratan (Intersular)

(b) Jika Tidak Harus Dijelaskan :


If Not Please Specify

Form.01/Kplt- Pengawakan/ rev00-2018


5

5. Data Permesinan Dan Peralatan :


Machinery And Equipment Details

5.1. Permesinan
Machinery

A. Total Shaft Power Output (Kw) : ………………………………….. Kw


Total Shaft Power Output
Y N NA
B. Control Dari Anjungan : ……………………................
Bridge Control

C. Alarm Jaga Di Kamar Mesin : ……………………………......... Y N NA


Engine Room Watch Alarm

System Alarm Jaga Adalah Suatu Yang Ketika Diakifkan Memerlukan Seseorang
Yang Berjaga Di Kamar Mesin Untuk Me-Reset System Tersebut Pada Interval
Yang Teratur Sehingga Perwira Di Kamar Yang Berjaga Navigasi Tetap
Memperhatikan keselamatan Kapal.

A Watch Alarm System Is One Which, When Active Requires Person Working Alone In The
Machinery Space To Reset The System At Regular Intervals So That The Navigating Officer Of
The Watch Is Regularly Aware Of His Safety.

System Lain (Dijelaskan)


Other Systems (Please Specify)

Form.01/Kplt- Pengawakan/ rev00-2018


6

5.1.1 Sistem Peringatan Alternative Di Kamar Mesin


Alternative Engine Room Warning System

Jika Tidak Ada Alarm Di Kamar Mesin Yang Terpasang, Apakah Kapal Memiliki System
Komunikasi Seperti Berikut Ini :
If No Engine Room Alarm Is Fifted, Does The Vessel Have Any One Of The Following Communication
System :
Y N NA
a) System Talk Back Antara Kamar Mesin Dan Anjungan …………..
Fixed Talk Back System Between Engine Room And Wheel House

b) Walkie – Talkie Portable Yang Ada Dikamar Mesin ………………….. Y N NA


Portable Walkie – Talkie At Engine Room Entarence
and wheelhouse

c) Sistem Paging Dapat Dioperasikan Dari Anjungan Dan Efektif Y N NA


Di Kamar Mesin……………………………………………………………
Paging System Operatable From Wheelhouse And Effective In Engine Room.

d) Lampu Indicator Peringatan Di Kamar Mesin Dengan Tombol


Di Kamar Mesin…………………………………………………………… Y N NA
Warning Indicating Lights In Wheelhouse With Push Button
Operated Switch At Engine Room Enterance.
e) Lampu Peringatan Indicator Di Anjungan Dengan Lampu Infra Red
Yang Dioperasikan Dengan Switch Pada Pintu Masuk
Kamar Mesin ……………………………………………………………… Y N NA
Warning Indicating Lights In Wheelhouse With Infra Red Light
Operated Switches At Engine Room Entances

f) Sistem Lain (Dijelaskan)


Other Systems (Please Specify)

Form.01/Kplt- Pengawakan/ rev00-2018


7

5.2 Peralatan Mooring


Mooring Equipment

Pengaturan Mooring (Pemetaan Mooring Dijelaskan Dalam Gambar) :


Mooring Arrangement (Describe With Picture)

a) Jumlah Bolder : ……………………………….


Number Of Boulard

b) Konvensional (Perpindahan Mooring Ke Bitts Setelah


Diikat Henti )……………………………………………… Y N NA
Convensional (Moorings Transferred To Bitts After Being
Stopped Off)

c) Tali Mooring Berada Permanen Di Winch Drum ………. Y N NA


Mooring Lines Permanently Carried On Powered Drums

5.3 Keadaan Yang Tidak Biasa Yang Berkibat Pada Awak Kapal
Unusual Features That Effect To Ship’s Crew (If Any)

Form.01/Kplt- Pengawakan/ rev00-2018


8

6. Key Operations
Key Operations

6.1. Susunan Awak Kapal Yang Merupakan Kunci Penting Kegiatan Untuk
Penugasan Sumber Daya Manusia Di Atas Kapal. Silahkan Isi Tabel Berikut
Ini Dengan Kebutuhan Kapal Secara Komprehensif.

The Key Operations Below Are Identified As Operations That Are Critical To The
Deployment Of Human Resources On The Ship. Please Complete The Following
Questions In The Most Comprehensive Of Manner.

Bagian Dek Jumlah Bagian Mesin Jumlah


Deck Department Number Engine Department Number
Nakhoda Kepala Kamar Mesin
Master Chief Engineer
Perwira Deck Perwira Mesin
Deck Officer Engine Officer
Rating Rating
Rating Rating

Catatan : Diisi Jumlah Awak Kapal Sesuai Dengan Gross Tonnage,


Note Daerah Pelayaran Dan Daya Mesin Kapal.
Please Complete The Following Table With The Number Of Ship’s Crew
Concerning With The Ship’s Gross Tonnage, Trading Area With Output
Power.

6.2. Bernavigasidengan Aman Dan Berdinas Jaga Di Kamar Mesin Sesuai Dengan
Konvensi STCW VIII/2 Yang Diamendemen Dan Perawatan Rutin Peralatan
Dan Permesinan.

Maintain Safe International And Engineering Watches Accordance With Regulation VII/2
Of The 1978 STCW Convention, As Amended, And Also The Routine Maintenance Of
Machinery And Equipment.

Jaga Navigasi Jumlah Bagian Mesin Jumlah


Navigational Watches Number Engine Department Number
Perwira Deck Perwira Mesin
Deck Officer Engine Officer
Rating Rating
Rating Rating

Catatan : Diisi Menurut Jumlah Awak Jaga Mnavigasi Dan Jaga Mesin
Sesuai Dengan Gross Tonnage, Daerah Pelayaran Dan Daya
Mesinkapal.
Please Complete The Following Table With The Number Of Ship’s
Crew Concerning With The Ship’s Gross Tonnage, Trading Area With
Output Power.

Form.01/Kplt- Pengawakan/ rev00-2018


9

6.2. 1 Dinas Jaga Navigasi


Navigational Watch

a) Sistem Jaga Yang Akan Diadopsi **


Which Watch System Will Be Adopted

1. Sistem Tiga Dinas Jaga Yang Dengan “4 On 8 0ff”,Melibatkan


Periode 4 Jam Jaga Yang Diikuti Dengan 8 Jam Lepas Dinas
Jaga.

Three Watch System Known As “4 On 8 0ff”, This Involves A Period Of 4


Hours On Watched Followed By 8 Hour Watch. .

2. Sistem Tiga Dinas Jaga Dikenal Dengan “6 On 6 Off”,


Merupakan Dinas Jaga Yang Melelahkan Yang Melibatkan 6
Jam Jaga Diikuti Dengan 6 Jam Lepas Jaga. Kecuali Untuk Kapal
Yang Sangat Kecil, Sistem Dua – Jaga Tidak Dapat Diterima .

Two Watch System Known As “6 On 6 Off”. This Is Very Tiring Rota


Involving Hours On Watch Followed By 6 Hours Off Watch. Execept For
Very Small Vessel, Two – Watch System Will Not Normally Accept.

Y N
(b) Apakah Nakhoda Berdinas Jaga ? …………………………
Will The Master Undertake A Navigational Watch

Kecuali Kapal Dengan Ukuran Yang Terbatas, Ketentuan Kualifikasi Perwira


Dek Untuk Menyakinkan Bahwa Nakhoda Tidak Perlu Melaksanakan Dinas
Jaga Dengan Mengadopsi Sistem Tiga – Dinas Jaga.

Except In Ship Of Unlimited Size, The Provision Of Qualified Deck Officers To


Ensure That It Is Not Necessary For The Master To Keep Regular Watches By
Adopting A Three – Watch System.

Jika Tidak Melaksanakan Dinas Jaga, Maka Harus Dijelaskan


If Not Conduct Navigational Watch, Have To Clarify

Form.01/Kplt- Pengawakan/ rev00-2018


10

Y N
(c) Apakah Nakhoda Melaksanakan Pemanduan Sendiri ………………
Will Be Master Required To Undertake His/Her Own Pilotage

Jika Melaksanakan Pemanduan Sendiri , Maka Harus Dijelaskan


If Conduct The His/Her Own Pilotage, Have To Clarify

6.2.2. Dinas Jaga Permesinan


Engineering Watch

a) Apakah Kapal Beroperasi Dengan Sistem UMS ? ………………… Y N


Is The Ship Operating Under UMS Mode

Jika Tidak, Apakah Sistem Dinas Jaga Sesuai Dengan Pilihan Di Bawah Ini ?
If Not, What Watch System Will Be Adopted

1. Sistem Tigs Dinas Jaga Yang Dengan “ 4 0n 8 Off “, Melibatkan


Periode 4 Jam Jaga Yang Diikuti Dengan 8 Jam Lepas Dinas Jaga.
Three Watch System Known As “4 On 8 Off, This Involves A Period Of 4
Hours On Watched Followed By 8 Hours Watch.

2. Sistem Tiga Dinas Jaga Dikenal Dengan “ 6 On 6 “ , Merupakan Dinas


Jaga Yang Melelahkan Yang Melibatkan 6 Jam Jaga Diikuti Dengan 6
Jam Lepas Jaga.Jaga Yang Melelahkan Yang Melibatkan 6 Jam Jaga
Diikuti Dengan 6 Jam Lepas Jaga. Kecuali Untuk Kapal Yang Sangat Kecil,
sistem dua – Jaga Tidak Dapat Diterima.
Two Watch System Known As “ 6 On 6 Off ”,This Is Very Tiring Rota Involving 6 Hours
On Watch Followed By 6 Hours Off Watch. Except For Very Small Vessel,Two- Watch
System Will Not Normally Accept.

Silahkan jelaskan jika ada keterangan lain :


Others, Please Specify

Form.01/Kplt- Pengawakan/ rev00-2018


11

(b) Apakah KKM Mendapat Tugas Jaga ? Y N


Will The Chief Engineer Undertake A Watch

Kecuali Kapal Dengan Tenaga Propulsi Yang Terbatas Atau Beroperasi Dengan Ketentuan
UMS, Ketentuan Perwira Kamar Mesin Memastikan Bahwa KKM Tidak Perlu Mendapat
Tugas Jaga Rutin Dengan Mengadopsi Sistem 3 Dinas Jaga.
Execept In Ships Of Limited Propulsion Power Or Operating Under Limited Propulsion Power Or
Operating Under Provisions For Unattended Machinery Spaces, The Provision Of Qualified Engineer
Officers To Ensure That It Is Not Ecessary for the Chief Engineer to keep regular watches by adopting a
three-watch system.

(a) Apakah seluruh ruang mesin dicakupi dengan sistem Y N NA


Sistem deteksi kebakaran ** …………………………..............
are all machinery spaces covered by a fire detection system ?

(b) Apakah seluruh ruang mesin dicakupi oleh sistem Y N NA


alarm bilga? ** ………………………………………………….
are all machinery spaces covered by a bilge alarm system ?

6.3. Mooring Dan Unmooring Kapal


Mooring And Unmooring The Vessel

Detail Persyaratan Pengawakan Pada Saat Beban Kerja Yang Besar Disaat Kegiatan
Mooring Atau Unmooring
Details Of Manning Requirements For Peak Workload Situation During Mooring Or Unmooring
Operations :

Stasiun Depan Station Belakang


Forward Station Aft Station
Perwira
Officer
Rating
Ratings

Jumlah Perwira Dan Rating Di Ruang Kemudi Selam Operasi Mooring Dan
Unmooring
Number Of Officers And Ratings In The Wheelhouse During Mooring Or Unmooring Operations :

Mooring Unmooring
Mooring Unmooring
Perwira
Officer
Rating
Ratings

Form.01/Kplt- Pengawakan/ rev00-2018


12

Apakah Rating Dianjungan Perlu Membantu Kegiatan Mooring


Setelah Selesai Bertugas Pada Kemudi ? …………………................... Y N
Does The Rating In The Wheelhouse Require To Go On Deck To Assist With
The Mooring Operaions After “Finish With The Wheel’’ ?

Sistem Lain (Dijelaskan)


Other Systems ( Please Specify )

7. Pencegahan Kelehan Pada Awak Kapal


Prevention Of Crew Fatigue

Bagaimana Pengaturan Dinas Jaga Bagi Perwira Dan Rating Selama Kapal Memasuki
Atau Meninggalkan Pelabuhan, Periode Standby ?
What Are The Watchkeeping Arrangaments For Officers And Ratings During Entering Or Leaving
Port,Stand – By Periods ?

A. Ruang Kemudi :
Wheel House

B. Kamar Mesin :
Engine Room

Form.01/Kplt- Pengawakan/ rev00-2018


13

c. Berapa Jumlah Jam Istirahat :


How Many Hours Of Scheduled Rest For

Petugas Jaga Petugas Jaga


Watchkeepers Watchkeepers
Hari Mingguan Hari Mingguan
Days Week Day Week
Perwira
Officers
Rating
Ratings
 Jawaban Dalam Ukuran Jam
answer in hours

D. Dinas Jaga Dan Kerja Harian :


Watchkeepers & Day Workers

Petugas Jaga Pekerja Harian


Watchkeepers Day Workers
Perwira
Officers
Rating
Ratings
 Jawaban Dalam Ukuran Jam
Answer In Hours

Minimum Jam Isirahat Tidak Kurang Dari 10 Jam Pada Periode 24 Jam Dan
77 Jam Pada Setiap Periode 7 Hari. Jam Istirahat Dapat Dibagi 2 Kali, Yang
Pertama Sekurang Kurangnya 6 Jam Dan Jarak Antara Interval Tidak Lebih
Dari 14jam.

Minimum Hours Of Rest Shall Not Be Less Than 10 Hours In Any 24-Hours Period; And
77 Hours In Any Seven- Day Period. Hours Of Rest Maybe Divided Into More Than Two
Periods, One Of Which Shall Be At Least Six Hours In Length,And The Interval Between
Consecutive Periods Of Rest Shall Not Exceed 14 Hour.

Pelaku Dinas Jaga Dan Pekerja Harian Termask Mereka Yang Melaksanakan
Pekerjaaan Perwatan Rutin ( Seperti Latihan Keadaan Darurat, Pemeriksaan
Peralatan Dll ) Setelah Melaksanakan Tugas Jaga Normal. Jumlah Jam
Istirahat Setiap Minggu Mungkin Tidak Akan Sama Dengan Jam Istirahat
Per Hari Dikalikan Tujuh.

Watchkeepers & Day Workers Include Those Who Are Required To Carry Out Routine
Maintenance Duties ( Such As Emergency Drills, Equipment Checks Etc.) After Their
Normal Watchkeeping Duties.The Number Of Resting Hours Per Week May Not Be Equal
To Rest Hours Per Day Multiplied By Seven.

Form.01/Kplt- Pengawakan/ rev00-2018


14

8. Skala Pengawakan Yang Diajukan


propose Manning Scale

8.1 Perwira
Officers

Catatan Hasil Pemeriksaan Keselamatan Pengawakan Atas Nama Kapal. Jumlah Perwira
Pengawakan Dek Dan Perwira Kamar Mesin Yang Bersertifikat Sesuai Dengan Peraturan
Pelayaran Niaga.

Record Of Result The Safe Manning Inspection Of The Above Ship. The Number Of Certificated Deck
And Engineer Officers Are Contained In Merchant Shipping Act.
OFFICER ATURAN STCW JUMLAH KETERANGAN
Deck Officer Class 1 ( Master ) II/2
Deck Officer Class 2 II/2
Deck Officer Class 3 II/I
Between
Ship Powered By Main Propulsion Machinery 3,000 Kw
750 Kw &
Of Or More
3,000 Kw
Engineer Officer Class 1 III/2 III/3 JUMLAH KETERANGAN
Engineer Officer Class III/2 III/3
Engineer Officer Class III/1
Electro- Technical Officer III/6

Apakah Ada Electro –Technical Officer ? ……………………………………….


Y N
Will An Electro –Technical Officer Be Carried ?

Jika Tidak, Tugas Electro – Technical Akan Ditangani …………… Y N


Oleh Setidaknya 2 ( Dua ) Orang Mesin Diatas Kapal.
If Not, Electro- Technical Officer’s Duty Will Be Covered By At Least Two
(2) Engineers On Board ?

8.2 Rating
Ratings
Aturan
Ratings Nomor
STCW
(A) Able Seafarer Deck II/5
(B) Rating Forming Part Of A Navigation Watch II/4
(C) Other Deck Ratings VI/1
(D) Able Seafarer Engine III/5
(E) Rating Forming Part Of A Engineering Watch III/4
(F) Other Engine Room Ratings VI/1
(G) Electro Technical Ratings III/7

Form.01/Kplt- Pengawakan/ rev00-2018


15

Y N
Apakah Juru Masak Yang Dberkualifikasi Dan Bekerja Full Time ? ………………
Will A Fill Time Qualified Cook Be Carried ?

Jika Tidak, Bagaimana Tugas Masak Dilaksanakan. Jelaskan Pada Tabel Dibawah Ini.
If Not,How Will The Cooking Duties Be Covered. Describe In The Table Below.

Mulai Tanggal 1 Januari 2010 Konvensi STCW Amandemen 2010 Akan Mulai Diberlakukan.
Pelaut Yang Melaksanakan Tugas Mooring Dan Unmooring Seperti Yang Diarahkan Oleh Perwira
Jaga, Menyediakan Dukungan Pada Cargo Operations, Mengoperasikan Peralatan Dek Dan
Permesinan, Melaksanakan Marlinspike Dan Pekerjaan Kanvas,Melaksanakan Perawatan Dek ;
Dan Pengamatan Bahan Bahan Bakar, Bilges Dan Ballast Operation, Pengoperasian Peralatan
Mesin,Mengoperasikan Peralatan Listrik Dan Perawatn Peralatan Listrik Dan Perawatan Di
Kamar Mesin Harus Memiliki Sertifikat Able Seafarer Deck.(II/5) Atau Able Seafarer Engine
(III/5).

On Seafarer 1 January 2017, The 2010 – Amandended STCW Convention Will Be Fully Implemented.
Seafarers Perform Mooring And Unmooring Operations As Directed By The Officer Of The Watch,
Provide Support In Cargo Operations, Operate Deck Equipment And Machinery, Perform Marlinspike
And Canvass Work,Perform Deck Maintenance ; And Seafarers Oversee Fuel, Bilge And Ballast
Operations, Operae Equipment And Machinery, Operate Electrical Equipment And Maintain Engine
Room Machinery And Spaces Must Hold An Appropriate Certificate For Able Seafarer Deck (Reg. II/5)
Or Able Seafarer Engine (Reg. III/5),Respectively.

Amandemen Konvensi STCW 2010 Diberlakukan Tanggal 1 January 2017, Sebagai Phase
Implementasi Atas Ketentuan Tersebut. Selama Periode Transisi 5 (Lima Tahun ), Selain
Rating Dek Dan Rating Yang Merupakan Bagian Dari Dinas Jaga Navigasi Dengan
Pelatihan Yang Relevan Akan Tetap Dapat Diterima Untuk Dapat Melaksanakan Tugas
Mooring Dan Unmooring Yang Diarahkan Oleh Perwira Jaga. Memberikan Pada Cargo
Operations, Dukungan Mengoperasikan Peralatan Dek Dan Permesinan,Melaksanakan

Form.01/Kplt- Pengawakan/ rev00-2018


16

Marlinspike Dan Pekerjaan Kanvas, Melaksanakan Perawatan Dek ; Dan Rating Kamar
Mesin Lainnya Dan
Rating Yang Melaksanakan Dinas Jagapermesinan Dengan Pelatihan Yang Relevan Akan Dapat
Meneruskan Dinas Jaga Pengamatan Bahan Bakar, Bilgest Dan Ballast Operation, Pengoperasian Peralatan
Mesin, Mengoperasikan Peralatan Listrik Dan Perawatan Peralatan Listrik Dan Perawatan Dikamar Mesin
Dengan Bekerja Sebagai 31 Desember 2016. Tetapi Bagaimanapun Setelah Januari 2017 Seluruh Pelaut
Harus Memenuhi Ketentuan Standar STCW 2010.

The 2010-Amended STCW Convention Came Into Force On 1 January 2012. However, There Is A Five
Year Transitional Period, Other Deck Ratings And Rating Forming Part Of A Navigational Watch With
Relevant Training Will Continue To Be Accepted For Perform Mooring And Unmooring Operation As
Directed By The Officer Of The Wath Provide Support In Cargo Operations, Operate Deck Equipment
Andmachinery, Perform Merlinspike And Canvass Work, Perform Deck Maintenance; Ad Other Engine
Room Ratings And Rating Forming Of An Engineering Wath With Relevan Training Will Continue To Be
In Accmepted For Oversee Fuel, Bilge An Ballast Peration, Operate Equipment And Machinery, Operate
Electrical Equipment And Maintain Engine Room Machinery And Spaces Until 31 December 2016.
However After January 2017, All Seaferersare Requiredto Meet STCW 2010 Sandards.

9. Rencana Dan Dokumen Terlampir Pada Surat Permohonan


Plants And Documents Submitted With This Application

JENIS DOKUMEN/ SERTIFIKAT


Y N NA
NO Document / Certificate
Copy Laporan Pemeriksaan
1
Copy Of Certificate Of Survey
Salinan Rencana Mooring Dan Peralatan
2 Copy Of Mooring And Equipment
Salinan Serifikat UMS
3
Copy Of UMS Certificate

Salinan DOC (ISM)


4
Copy Of Document Of Compliance (ISM)

Salinan Rencana Evakuasi (Khusus Kapal


5
Penumpang )
Copy Of Evacuation Plan (Passanger Ships Only )

Salinan Sertifikat Keselamatan


6
Copy Of Ship’s Safety Construction Certificate

Salinan Sertifikat Klas


7
Copyof Class Certificate

10. Standar Gaji Pelaut Serta Tunjangan Lain- Lain Per Bulan
Seaman Wages Allowance Standard On Board As Per Month

Jabatan
Gaji Pokok Lain- Lain Total
1 Rank
Basic Wages Allowance Total
Nakhoda
2 Master

Form.01/Kplt- Pengawakan/ rev00-2018


17

Kepala Kamar Mesin


3 Chief Engineer
Mualim I
Perwira
4 Chief Officer

Mualim 2
2nd Officer
Deck
Mualim 3
5 Deck
3rd Officer
Officer
Mualim 4
4th Officer

Masinis 1
1st Engineer

Masinis 2
Perwira Mesin 2nd Engineer
6 Engineer
Officer Masinis 3
3rd Engineer

Masinis 4
4th Engineer

Bosun / Mandor
7
Boatswain

Dek
8 Rating
Rating Dek

Engine Rating
9 Rating Kamar
Mesin

Lain – Lain
10
Others

Keterangan
remarks

Form.01/Kplt- Pengawakan/ rev00-2018


18

11. Pengingat
Reminder

Sesuai Dengan Aturan I/14 Konvensi STCW, Perusahaan Bertanggung Jawab Untuk Memastikan
Kapal Diawaki Dengan Dokumen Pengawakan Minimum Oleh Pelaut Yang Berkualifikasi,
Bersertifikat Dan Sehat Secara Medis. Persyaratan Sejenis Juga Disebutkan Paragraph 6
ISM Code.Sesuai Dengan Persyaratan Tersebut DITKAPEL Meminta Kepada Seluruh
Perusahaan Untuk Menerapkan Dokumen Keselamatan

Pengawakan Untuk Menunjukkan Pengawakan Yang Sesuai Dengan Kapalnya Dengan


Menerapkan Aturan IMO A.1047 (27)

In Accordance With Regulation I/14 Of The STCW Convention, The Company Is Responsible For
Ensuring Tha Tthe Ship Is Manned In Compliance With The Safe Manning Document By Properly
Qualified, Certificate And Medically Fit Seaferers. Similar Requirements Are Also Laid Down In
Paragraph 6 Of The International Safety Management (ISM) Code. In Line With These
Requirements, The Directorate Of Seaferers And Shipping Requires The Company To Apply For A
Safe Manning Document Proposing The Appropriate Level Of Manning That They Consider The
Vessel Willvrequire Taking Into Consideration The IMO Resolution A.1047 (27) – “Principles Of
Minimum Safe Manning”.

12. Deklarasi
Declaration

Dengan Ini Saya Menyatakan, Dengan Pengetahuan Yang Saya Punya, Keterangan
Berikut Ini Adalah Benar Dan Pengaturan Kerja Memungkinkan Untuk
Memberikan Jam Istirahat Yang Cukup Untuk Menghindari Fatiq, Dan
Perlengkapan Dan Permesinan Yang Terpasang Diatas Kapal Akan Dirawat Dengan
Sebagaimana Mestinya. Keselamatan Pengawakan Minimum Ditujukan Untuk
Keselamatan Pengoperasian Kapal Untuk Keamanannya, Perlindungan Linkungan
Maritime Dan Untuk Menghadapi Keadaan Darurat Telah Sesuai Dengan
Persyaratan Yang Ada Sesuai Dengan Jam Kerja Para Pelaut, Sperti Yang Tertulis
Pada Convensi STCW 1978 Yang Diamandemen, Juga Persyaratan Pada Resolusi
IMO A.1047 (27)
I Certify That, To The Best Of My Knowledge The Particulars Given In This Application Are True
In Correct, And That The Working Arrangement Allow For Sufficient Rest Periods To Avoid
Fatigue Will Implemented, And The Machinery And Equipment Fitted On Board Are And Will Be
Maintened In Proper Working Order. The Proposed Minimum Safe Manning For The Vessel’s
Safe Operation For Its Security, For Protection Of The Environment, And For Dealing With
Emergency Situations Has Been Complied Talking Into Account The Requirements Regarding
Hours Of Rest Of Watchkeeping Seafarers, As Prescribed By The STCW Convention 1978, As
Amended, As Well As The Requirements Of IMO Resolution A.1047(27).

Tanda Tangan
Signed :
( On Behalf Of Owners )

Name : …………………………………………

Position : …………………………………………
Form.01/Kplt- Pengawakan/ rev00-2018
19

Untuk klarifikasi permohonan ini dapat menghubungi :


For Clarification Of Any Points Arising From This Application The Marine Department May Contact :

Name : …………………………………………

Telephone : …………………………………………

E-Mail : …………………………………………

Fax : …………………………………………

Date : …………………………………………

12. Resume hasil pemeriksaan


inspection resume

pener

Penerbitan Sertifikat Keselamatan Pengawakan Disetujui – Tidak Disetujui *


Issued Safe Manning Certificate Approved – Not Approved To

Tanggal Signed
Date Tanda Tangan
MASTER

OWNER / AGENT

INSPECTOR

PEJABAT STRUKTURAL

.......................,………………………………………………

Form.01/Kplt- Pengawakan/ rev00-2018


Marine Inspector/Mustering Officer
20

LAMPIRAN 1 FOTO FOTO

Form.01/Kplt- Pengawakan/ rev00-2018


21

LAMPIRAN 2 FOTO FOTO

Form.01/Kplt- Pengawakan/ rev00-2018