Vessel:_______________ Dept._________________ Voy._______________ Date:________________

Item	Maintenance records	Remark

Remark: Item - Number of Voyage Maintenance plan or Superintendent Order.

Officer in Charge___________________________ Chief of Dept.__________________________

Note: To be completed every voyage and filed in both office's file and ship's file.

To retain for 5 years.

Issue date: 03.11.2003/Rev. 00 PBO-TD02-F03 Page: 1/1

FULFILLMENT RECORDS OF PLANNED MAINTENANCE

QSMS PBO-TD02-F03 Rev. No.00

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