1. Check list
ISM Code
DOC

2. ISM Code Certification
Document to be used for reporting the audit of the company ( DOC )
Company
Type of audit :
Initial
Periodical
Renewal
Additional
DOC issued on :
Ship’s types cover by the DOC :
Expiring date : N°
Department audited
Contacted person and position 1 2 3 4
Conclusions of the audit : Individual non-conformity report must be attached to this document
Report N°
Place :
Date :
Auditor name and signature :

3. ISM Code Certification
Document to be used for reporting the audit of the company ( DOC )
1) Status of the pending non-conformity (ies)
2) New Non-conformity (ies) issued during the present audit
3) Suggestions from auditees to improve the SMS

4. ISM Code Certification
Check list to be used during the audit of the company ( DOC ).
This document must be attached to the report.
Par.
of the
code
Element of the ISM Code
Department
audited
Rem. N° 1 2 3 4 1
Objectives
The objectives of the ISM C ode and SMS are understood by the
management and key personnel 2
Safety & Environmental Policy
The health, safety & environmental protection policies are signed
by the company’s chief executive or other senior executive officer
The safety & environmental protection policies are reviewed at
regular intervals
The safety & environmental protection policies are posted in
the offices
All ships of the fleet have been involved

5. ISM Code Certification
Check list to be used during the audit of the company ( DOC ).
This document must be attached to the report.
Par.
of the
code
Element of the ISM Code
Department
audited
Rem. N° 1 2 3 4 3
Company Responsibilities and Authority
The owner has reported to the Administration and to the Society
the entity responsible for the operation of the ships
The Administration has been provided with the name, address,
telephone, fax and telex numbers of the company
Responsibility, authority and interrelation of key persons managing,
performing and verifying work relating and affecting the SMS are
defined and documented
An updated company organizational chart is available
The updated telephone numbers of the DPA(s) and their back up
are available to the interested persons ashore and on board
The following activities are subcontracted to :
(use bottom part of this page if necessary)
The company maintains the subcontracted activities under control
( specify the system adopted - use bottom part of this page
if necessary )
Responsibility and authority of masters, chief engineers and
other shipboard key persons are defined and documented
A procedure has been established to provide the DPA(s) the
possibility to ask for resources and shore based support to
the company’s management

6. ISM Code Certification
Check list to be used during the audit of the company ( DOC ).
This document must be attached to the report.
Par.
of the
code
Element of the ISM Code
Department
audited
Rem. N° 1 2 3 4 4
Designated person (s) - DPA
There are designated by :
And the number of them are :
(use bottom part of this page if necessary)
The DPA (s) belong to the company staff
The organization of the company ensure direct assess to the
highest management level
The continuous availability of the DPA (s) is ensured
The results of safety and antipollution audits and inspections
are reported to the DPA (s)
Requests from ships for resources and shore based support
are supervised by the DPA (s)s

7. ISM Code Certification
Check list to be used during the audit of the company ( DOC ).
This document must be attached to the report.
Par.
of the
code
Element of the ISM Code
Department
audited
Rem. N° 1 2 3 4 5
Master’s Responsibility and authority
The master’s role in the implementation of the safety and
environmental protection policy of the company is clearly defined
The elements of IMO resolution A.443 (XI) are incorporated in
the SMS
The policy is correctly implemented
(provisions of the SMS are followed)
Documentation of the specific duties delegated to the officers
under the master’s command are provided to the master by
the company
Appropriate orders and instructions are issued
(standing orders, night orders, etc)
The master reviews the SMS and reports to the company any
deficiency ( e.g. the review is made during safety meetings)
The company shore based management system allows
for the master’s overriding authority and responsibility
The crew is motivated ( e.g. by the means of meetings with the
crew, instruction of the crewmembers at embarkation, etc)

8. ISM Code Certification
Check list to be used during the audit of the company ( DOC ).
This document must be attached to the report.
Par.
of the
code
Element of the ISM Code
Department
audited
Rem. N° 1 2 3 4 6
Resources & Personnel
Crew is selected by the company/by the manning agent……….
Criteria are fixed to ensure that seafarers are qualified (STCW)
and medically fit periodically and at embarkation
Ship’s officers are employees of the company
Ship’s crew are employees of the company
Information, appraisal and qualification records of shipboard
personnel are available
Each person employed on board is in possession of a medical
examination certificate attesting the medical fitness for duty
(place of examination and validity no more than two years)
Drug and alcohol tests file is provided
Performance bonus to the shipboard personnel has been
assigned last year
Vessel and duties introduction and familiarization training is
Accordance with section A-I/6 of the STCW Code for on-coming
officers and crew are documented
Familiarization procedures exist (e.g. overlapping, tutorial training,
written handing over procedures, briefing at embarkation,…..
concerning safety and operational aspects
Adequate understanding of rules & codes for the personnel
involved in the SMS is ensured. Any training required is identified
Senior officers read and understand the SMS manual and
other communications from the company
Shipboard working language has been established
( knowledge of English is required for senior officers)

9. ISM Code Certification
Check list to be used during the audit of the company ( DOC ).
This document must be attached to the report.
Par.
of the
code
Element of the ISM Code
Department
audited
Rem. N° 1 2 3 4 7
Development of Pans for Shipboard operation
A procedure exists for the preparation of plans and instructions
for keyboard operations
A master’s port arrival/departure safety check list incorporating
pre-established company policy guidelines for go/no go situations
and reporting requirements for the master is included in the SMS 8
Emergency preparedness
The emergency plans are periodically reviewed, updated and
amended
The emergency plans are approved by the Administration
The identification of the emergency situations is made
from previous experience and from analysis of accidents
and near misses
The maritime regulation requirement for weekly emergency drills
and training sessions as well as for lowering of each lifeboat
to the water every 3 months are complied with
SOPE (or VRP) approved plans are available for each ship
(company contact is always available, office organization
is foreseen)

10. ISM Code Certification
Check list to be used during the audit of the company ( DOC ).
This document must be attached to the report.
Par.
of the
code
Element of the ISM Code
Department
audited
Rem. N° 1 2 3 4 9
Report & Analysis of Non-conformities,
Accidents & Hazardous Occurrences
Procedures exist for the reporting & analysis of Non-conformities,
Accidents & Hazardous Occurrences
Procedures exist for the implementation of corrective action
(e.g. request of corrective action from company with copy to DPA
and verification during the next internal audit)
Procedures exist for immediately reporting Port State detention
to the Administration
The communication and reporting procedures specified in the
SMS documents have been adopted
Communications and reports are filed
The following ships had accidents or occurred in hazardous situations
since the previous audit :

11. ISM Code Certification
Check list to be used during the audit of the company ( DOC ).
This document must be attached to the report.
Par.
of the
code
Element of the ISM Code
Department
audited
Rem. N° 1 2 3 4 10
Maintenance of the Ship and Equipment
The maintenance system includes systematic plans and actions
designed to address all those items and systems covered by class
and statutory survey
Records of inspections and maintenance are available.
Communications from ships concerning the implementation of
corrective action are filed
Intervals for maintenance and inspections are established and
observed
Periodic functional tests of the stand-by arrangements, equipment
and systems that are not in continuous use are carried out
Communication is given to the concerned DPA of non-conformities
with possible causes
Evaluation is made if corrective action is to be taken by the crew
or if support from shore is needed
Date of last company’s inspections to the ships
Ship name : Date :

12. ISM Code Certification
Check list to be used during the audit of the company ( DOC ).
This document must be attached to the report.
Par.
of the
code
Element of the ISM Code
Department
audited
Rem. N° 1 2 3 4 11
Documentation
The updated SMS documents ( SMS manual, Company manual
and Circular letters) are available as specified by
the relevant distribution list
Periodic verification of the documents kept in files is foressen
Obsolete documents are disposed of
A list of valid circular letters is available
Mandatory rules, regulations and the relevant list are available
Applicable codes, guidelines, standards and the relevant list
are available
The IMO resolution A.443(XI)- Decision of the shipmasters with
regard to Maritime Safety and Marine Environmental Protection-
is available
The IMO resolution A.742(18)- Procedures for the control of
Operational Requirements related to the Safety of ships and
Pollution Prevention- is available
The following documents and relevant index are available:
Manual, drawings & user’s manuals. Manuals, documents &
Instructions requested by compulsory requirements
The following records are maintained and properly filed:
Master/chief engineer reports at signing off,
Inspection and maintenance reports
Fuel and lube oil analysis reports
Spare parts and material supply
Work list
Correspondence with ships
Ship’s certificates are in due course of validity (have been examined)
Ship name : Date :

13. ISM Code Certification
Check list to be used during the audit of the company ( DOC ).
This document must be attached to the report.
Par.
of the
code
Element of the ISM Code
Department
audited
Rem. N° 1 2 3 4 12
Company Verification, Review and Evaluation
Internal audits are conducted by the company at least annually on
each department as well as on each vessel to verify compliance
of the SMS to the stated objectives of the ISM Code
The auditors belong to the company’s staff or to
an external organization
The audit report is handed over to the person responsible for
the area involved
The responsible of the area involved, when the agreed corrective
actions are implemented, communicates it to the auditor
The audits are performed on the basis of a check list
Both for the audit report and for requiring corrective action,
appropriate forms are foreseen
A review of the adequacy of the SMS is carried out annually by
the company management. The minutes of the review meeting
are available
Date of the last office’s audit
Department : Date :
Date of the last ship’s audit
Ship : Date :