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U.S. DEPARTMENT OF HOMELAND SECURITY U.S. COAST GUARD CG-5432 (Rev. 06/04) Facility Name OCS Area/Block Person in Charge Facility Telephone INSPECTION ITEMS-ALL FACILITIES 1. Workplace Safety 33 CFR PART 142

FIXED OCS FACILITY INSPECTION REPORT
(INSTRUCTIONS ON REVERSE)
Manned MMS Lease No. Operator(s) Name and Address Unmanned

OMB NUMBER 1625-0044

Number of Persons on Board Owner(s) Name and Address

Def.

Cor.

Out

INSPECTION ITEM 20. Lifesaving Appliances 33 CFR Part 144 a. Type: Lifefloat____ Liferaft____ Lifeboat___ approval number_________________ location condition equipment/markings servicing (date ________________) launching devices weight test (date ________________) operational test (date ______________) b. Type: Lifefloat____ Liferaft____ Lifeboat___ approval number_________________ location condition equipment/markings servicing (date ________________) launching devices weight test (date ________________) operational test (date ______________) c. Type: Lifefloat____ Liferaft____ Lifeboat___ approval number_________________ location condition equipment/markings servicing (date ________________) launching devices weight test (date ________________) operational test (date ______________) d. Type: Lifefloat____ Liferaft____ Lifeboat___ approval number_________________ location condition equipment/markings servicing (date ________________) launching devices weight test (date ________________) operational test (date ______________) 21. Personnel Record Location 33 CFR 141.35

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2. Rails/Guards/Grating 33 CFR 143.110 3. Personnel Landings 33 CFR 143.105 4. Means of Escape 33 CFR 143.101 primarysecondary5. Helo Deck Perimeter 33 CFR 143.110 6. Lights/Warning Devices 33 CFR 143.15 7. Firefighting Equip 33 CFR 145: portable___________semi-portable__________fixed______________locationsizeagentINSPECTION ITEMS-UNMANNED FACILITIES 8. Lifesaving Equipment 33 CFR 144.10-1 9. Other Lifesaving Equipment 33 CFR 144.10 INSPECTION ITEMS-MANNED FACILITIES 10. Emer. Comms. Equip. 33 CFR 144.01-40 11. Station Bill 33 CFR 146.130 12. Emergency Drills 33 CFR 146.125 conducted monthlyrecord keeping 13. Life Preservers 33 CFR 144.01-20 number:___________equipmentmarkingsstowage14. Work Vests 33 CFR 146.20 number:___________separate stowage15. Ringbuoys 33 CFR 144.01-25 number:___________equipmentmarkingsstowage16. General Alarm System 33 CFR 146.105 markings 33 CFR 146.13517. Manning of Survival Craft 33 CFR 146.120 18. First Aid Kit 33 CFR 144.01-30 19. Litter 33 CFR 144.01-35 (See Instructions)

LIST OF OUTSTANDING ITEMS/COMMENTS (Attach additional pages as necessary)

NAME

FACILITY OWNER'S OR OPERATOR'S ACKNOWLEDGEMENT TITLE SIGNATURE

DATE

Reset

INSTRUCTIONS
General Facility Name..............Enter official facility name/designation. Manned/Unmanned ....Check the space which indicates facility status at the time of the inspection. Persons on Board.......Enter number of persons on board on the day of the inspection. Person in Charge .......Enter the full name of the person in charge. Operator .....................Fill in name and address of company operating the facility. Owner.........................Fill in name and address of leaseholder or operating partner. OCS Area/Block .........Enter standard OCS area abbreviation and block number. Facility Telephone ......Enter telephone number if so equipped. Inspection Items Def. -Refers to the total number of deficiencies per item found during this inspection. Cor. -Refers to the number of deficiencies per item that were corrected this inspection. Out. -Refers to number of deficiencies per item remaining outstanding/uncorrected. Enter the number of deficiencies found, the number of deficiencies corrected, and the number of deficiencies that remain outstanding for each item in the appropriate box (Cor. + Out. = Def.) Enter N/A for any item that is not applicable. ITEM NUMBERS 1 THROUGH 7 MUST BE COMPLETED FOR ALL FACILITIES, BOTH MANNED AND UNMANNED ITEMS NUMBERS 8 AND 9 MUST BE COMPLETED FOR ALL UNMANNED FACILITIES. ITEM NUMBERS 10 THROUGH 21 MUST BE COMPLETED FOR ALL MANNED FACILITIES. Instructions for Specific Item Numbers 7 ...............Enter the number of portable/semi-portable fire extinguishers and/or fixed firefighting equipment on board in the appropriate spaces. For location, size, and agent-use Table 33 CFR 145.10(a) to determine compliance. Deviations from the requirements of 33 CFR Part 145 should be considered deficiencies. Enter description of deficiencies and the OCMI determined time frame for correction in the Comments section where applicable (see 33 CFR 140.105(c)). 9 ...............Any lifesaving equipment on an unmanned platform that is not required by 33 CFR 144.10-1 must meet the standards contained in 144.01-1 through 144.01-40. Where such additional equipment is installed/located on the facility the appropriate item should be completed under the INSPECTION ITEM-MANNED FACILITY section of the form. 10 .............Emer. Comms. Equip.-refers to emergency communication equipment. 13, 14, 15 .Number-enter the number of preservers/vests/buoys on board in the appropriate spaces. 20 .............Fill in one subsection (a, b, c and d) for each piece of primary lifesaving equipment. type-check the appropriate space. servicing-enter the date the item was last serviced. weight/- (for davit launched equipment) enter the date of the last test. operational test-for self propelled equipment enter the date of the last test. Enter description of deficiencies and the OCMI determined time frame for correction in the Comments section where applicable (see 33 CFR 140.105(c)). 21 .............Personnel Record Location-enter the address of the location of the required record. If additional space is needed for any item, enter the applicable item number and the appropriate data in the comments section. List of Outstanding Items/Comments Enter a brief description of each outstanding deficiency and the proposed corrective action. Enter comments as appropriate. Attach additional pages as necessary. Owner's/Operator's Acknowledgement Enter name, title, and signature/date of owner's/operator's representative acknowledging the particulars of the inspection.
An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number. The Coast Guard estimates that the average burden for this report is 3.7 hours. You may submit any comments concerning the accuracy of this burden estimate or any suggestions for reducing the burden to: Commandant (Gnd MOC), U.S. Coast Guard, 2100 2 St., SW, Washington D.C. 20593-0001 or Office of Management and Budget, Paperwork Reduction Project (1625-0044), Washington, DC 20503.