■ 선박안전법 시행규칙 [별지 제79호서식] <개정 2018. 11. 20.>
항만국통제점검보고서 FORM A REPORT OF INSPECTION IN ACCORDANCE WITH THE MEMORANDUM OF UNDERSTANDING ON PORT STATE CONTROL IN THE ASIA-PACIFIC REGION1)
(reporting authority) Ministry of Oceans and Fisheries, Republic of Korea (address) Sejong Government Complex, 94, Dasom-2ro, Sejong, Republic of Korea (telephone) +82-44-200-5815 (telefax) +82-44-200-5848 (e-mail address) psckorea@korea.kr	Copy to: master head office PSCO If ship is detained, copy to: flag State IMO recognized organization, if applicable
1	name of reporting authority	REPUBLIC OF KOREA	2	name of ship
3	flag of ship		4	type of ship		5a	call sign		5b MMSI number
6	IMO number		7	gross tonnage		8	deadweight (where applicable)
9	date keel laid		10	date of inspection		11	place of inspection
12	classification society		13	date of release from detention2)
14a	IMO company number		14b particulars of company
15	name and signature of master to certify that the information under 14b is correct:
	name		signature
16	details of ship certificates
a title		b issuing authority		c date of issue and expiry
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
d information on last intermediate or annual survey
	date		surveying authority		place
1
2
3
4
5
17	deficiencies	□ no	□ yes (see attached FORM B)
18	ship detained	□ no	□ yes3)
19	supporting documentation	□ no	□ yes (see annex)
issuing office			name
			(duly authorized PSCO of reporting authority)
telephone
telefax				signature
* This report must be retained on board for period of two years and must be available for consultation by Port State Control Officers at all times. * If the owner of a ship objects to the detention of a vessel, he will have a right of appeal against a detention within 90days from date of detention.
1)	This inspection report has been issued solely for the purpose of informing the master and other port State that an inspection by the port State, mentioned in the heading, has taken place. This inspection report cannot be construed as a seaworthiness certificate in excess of the certificates the ship is required to carry.
2)	To be completed in the event of a detention.
3)	Masters and companies are advised that detailed information on a detention may be subject to future publication.
210mm×297mm(백상지 80g/㎡)

FORM B REPORT OF INSPECTION IN ACCORDANCE WITH THE MEMORANDUM OF UNDERSTANDING ON PORT STATE CONTROL IN THE ASIA-PACIFIC REGION1)
(reporting authority) Ministry of Oceans and Fisheries, Republic of Korea (address) Sejong Government Complex, 94, Dasom-2ro, Sejong, Republic of Korea (telephone) +82-44-200-5815 (telefax) +82-44-200-5848 (e-mail address) psckorea@korea.kr																		Copy to: master head office PSCO If ship is detained, copy to: flag State IMO recognized organization, if applicable
2		name of ship											6		IMO number
10		date of inspection											11		place of inspection
20 number						21 code				nature of deficiency 4)				convention 5) reference							22 action taken 6)			23 responsible RO 5)
Page :																name
																(duly authorized PSCO of reporting authority)
																signature
4)	This inspection was not a full survey and deficiencies listed may not be exhaustive. In the event of a detention, it is recommended that full survey is carried out and all deficiencies are rectified before an application for re-inspection is made.
5)	To be completed in the event of a detention.
6)	Applicable Deficiency Action Codes (see reverse side of copy) to be entered.

(reverse side of Form B)
	codes for action taken
	code
	Deficiency action code
	10	Deficiency rectified
	15	Rectify deficiency at next port
	16	Rectify deficiency within 14 days
	17	Rectify deficiency before departure
	18	Rectify deficiency within 3 months
	30	Detainable deficiency
	46	Rectify detainable deficiency at agreed repair port
	48	As in the agreed flag state condition
	49	As in the agreed rectification action plan
	99	Other (specify in clear text)
	PSC inspection action code (tick as applicable)
	26	Competent security authority informed			□
	27	Ship expelled in security grounds			□
	40	Next port informed			□
	50	Flag State/consul informed			□
	55	Flag State/consulted			□
	70	Recognized organization informed			□
	85	Investigation of contravention of discharge provisions (MARPOL)			□
	151	ILO informed			□
	152	Seafarers’ organization informed			□
	155	Ship owner representative informed			□