CpNG HdA XA HQICHU NGHlA VI$T NAM Doc lap - Tw do - Hanh phuc

THONG TITQuy djnh ve bao cao va dieu tra tai nan hang hai

CONG THONG TIN QIENTUCHiWf HQ

DENte: ' ^...........Ngay:X0^.(2OU.

Thong tur so 01/2020ATT-BGTVT ngay 20 thang 01 ham 2020 cua Bo tnrong Bp Giao thong van tai quy dinh vh bao cao va diiu tra tai nan hang hai, co hieu lire

ke tir ngay 15 thang 3 nam 2020, dupe sura doi, bo sung bod:Thong tu so 34/2020/TT-BGTVT ngay 23 thang 12 nam 2020 cua Bo

tnrong Bp Giao thong van tai sua doi, bo sung mpt so dieu cua cac Thong tu quy dinh vh che dp bao cao dinh ky trong linh vuc hang hai, co hieu lire ke tu ngay 15 thang 02 nam 2021.

Can cit Bo lugt Hang hai Viet Nam so 95/2015/QH13 ngay 25 thang 11 nam

o

2015;Can cic Bo ludt ve cac tieu chudn va khuyen nghi qude te doi vai hoat dong

y * 9 r r

dieu tra tai nan hodc su co hang hai cua To chuc Hang hai quoc te (IMO);Can cu Nghi dinh so 12/2017/ND-CP ngay 10 thang 02 nam 2017 cua

Chinh phu quy dinh chuc ndng, nhiem vu, quyen hqn va co cdu to chuc cua BpGiao thong van tai;

Theo de nghi cua Vu truong Vu An todn giao thong va Cue truong Cue Hang hai Viet Nam;

Bo truong Bp Giao thong van tai ban hanh Thong tu quy dinh ve bao cao vd dieu tra tai nan hang hai.1

Chirong IQUY DINH CHUNG

Dieu 1. Pham vi dieu chinhThong tu nay quy dinh ve bao cao va dieu tra tai nan hang hai.

1 Thfing tu so 34/2020/TT-BGTVT sOra doi, b6 sung mpt s6 di£u ciia cic Thong tu quy dinh ve ch£ b&o cdo dinh ky trong linh vuc h&ng hai, c6 c3n cii ban hAnh nhu sau:

“C5n ctrNghf ctfnh so 12/2017/ND-CP ngay 10 thang 12 nam 2017 cua Chinh phu quy dinh chuc ndng nhi$m vy, quyen hqn vd ccf cdu td chuc cua Bq Giao thong vdn tai;

Can cuNghf dinh so 09/2019/ND-CP ngay 24 thdng 01 nam 2019 cua Chinh phu quy dink ve che dg bdo cao cua co quan hanh chinh nhd nude;

Theo di nghi cua Chdnh Vdn phdng Bq vd Cue truong Cqc Hang hai Vi$t Nam;Bq truong Bq Giao thong vqn tai ban hanh Thong tu sua ddi, bo sung mgt so dieu cua ede Thdng tu quy

dinh vi che d$ bdo cdo dinh ky trong linh vqc hang hai. ”

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Dieu 2. Boi tirang ap dung^9 r

1. Thong tir nay ap dung doi voi ca quan, to chuc, ca nhan co lien quan den bao cao va dieu tra tai nan hang hai trong cac tnrdng hop sau day:

a) Tai nan hang hai lien quan den tau bien Viet Nam;b) Tai nan hang hai lien quan den tau bien nuac ngoai khi boat dong tai:

vung nuac cang bien, vung noi thuy va lanh hai ciia Viet Nam; vung dac quyin kinh te cua Viet Nam trong truang hop tai nan do co lien quan den tau thuyin Viet Nam, cac cong trinh, thiet bi ngoai khai cua Viet Nam hoac gay 6 nhilm moi truang.

2. Cac quy dinh cua Thong tu nay cung dugc ap dung &k dilu tra tai nan xay ra doi vdi tau cong vu, thuy phi ca trong cac vung nude cang bien Viet Nam; phuong tien thuy noi dia mang cdp VR- SB, kho chua n6i, gian di dong trong cac vung nude cang bien Viet Nam va tren vung bien Viet Nam.

Dieu 3. Giai thich tir ngir1. Tai nan hang hai la su kien lien quan true tiep den hoat dong cua tau bien

gay ra mot trong nhung hau qua sau: lam chet ngudi, mit tich, bi thuang nang; lam cho tau bien dam va; hu hong nghiem trong den cdu true tau; lam cho tau mat tich, chim dam, mac can, mat kha nang dieu dong; lam hu hong ket cau ha tang hang hai hoac gay 6 nhiem moi truang nghiem trong.

Tai nan hang hai khong bao gom nhung hanh vi co y gay thiet hai doi vdi con ngudi, tau bi&i, kit ciu ha tang hang hai hoac moi tnrdng.

2. Su cd hang hai la su viec xay ra lien quan true tiep den hoat dong cua tau biin ma khong phai la tai nan hang hai dugc quy dinh tai khoan 1 Biiu nay gay nguy hiem hoac neu khong dugc khic phuc se gay nguy hiem cho an toan cua tau con ngudi hoac moi trudng.

Dieu 4. Phan loai mire do tai nan hang hai1. Tai nan hang hai dac biet nghiem trong la tai nan hang hai gay ra mot

trong cac thiet hai dudi day:a) Lam chet hoac mit tich ngudi;b) Lam tau bien bi chim dam hoac mat tich;

— !.

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c) Lam tran ra moi trudng tu 100 tin dau trd len hoac tir 50 tin hoa chit dochai trd len;

d) Lam ngung tre giao thong tren luong hang hai tir 48 gid trd len.2. Tai nan hang hai nghiem trong la tai nan hang hai khong thuoc cac trudng

hgp quy dinh tai khoan 1 Dieu nay va gay ra mot trong cac thiet hai dudi day:a) Lam tau bien bi chay, no, mic can tir 24 gid trd len, lam hu hong ket ciu

cua tau Mi hudng den kha nang di bien cua tau;

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b) Lam tran ra moi tnrcmg tir 20 tan dhu den dudd 100 tin diu hoac tu 10 tin hoa chat den dual 50 tan hoa chit doc hai;

c) Lam ngimg tre giao thong tren luong hang hai tu 24 gia den duai 48 gia.3. Tai nan hang hai it nghiem trong la su co hang hai hoac tai nan hang hai

xay ra ngoai cac truong hop quy dinh tai khoan 1 va khoan 2 Biiu nay.Dieu 5. Trach nhiem cua thuyen trirong, chu tau, ngirdl quan ly tau,

ngiroi khai thac tau va cac to chuc, ca nhan lien quan tol tai nan hang hai1. Thuyen truong, chu tau, nguoi quan ly tau, nguoi khai thac tau va cac to

chuc, ca nhan lien quan tai tai nan hang hai co trach nhiem bao cao tai nan hang hai cho Gang vu hang hai hoac Cue Hang hai Viet Nam hoac Bo Giao thong van tai nhanh chong, chinh xac theo quy dinh tai Thong tu nay.

2. Thuyen truong cua tau bien lien quan tod tai nan hang hai co trach nhiem to chuc cuu nan nhanh chong, kip thbd va hieu qua phu hop vdi dieu kien an toan cua tau.

3. Thuyen truong, thuyen vien cua tau bien lien quan tod tai nan hang hai co trach nhiem to chuc bao ve hien truong tai nan va thiet bi ghi du lieu hanh trinh tai thdd diem xay ra tai nan hang hai va cung cap cac chung cu lien quan den tai nan hang hai cho co quan dieu tra.

4. Thuyen truong, thuyen vien cua tau bien va cac to chuc, ca nhan lien quan tod tai nan hang hai co trach nhiem cung cap thong tin day du, trung thuc va kip thdd cho co quan didu tra va hoan toan chiu trach nhiem truoc phap luat vd nhung thong tin cung cap.

5. B6i vdd tai nan hang hai gay ton that ve than the thuyen vien thi thuyen truong, chu tau, ngued su dung lao dong, ngoai nghTa vu bao cao theo quy dinh cua Thong tu nay, phai thuc hien viec khai bao tai nan lao dong hang hai theo quy dinh phap luat.

Chirong IIBAO CAO TAI N£N HANG HAI

Dieu 6. Bao cao tai nan hang hai\ * F

1. Bao cao tai nan hang hai bao gom Bao cao khan, Bao cao chi tiet, Bao cap dinh ky theo quy dinh tai cac Phu luc 1,2 va 3 ban hanh kem theo Thong tu nay.

2. Npi dung Bao cao tai nan hang hai phai trung thuc, chinh xac, dung thdd han.Bien 7. Bao cao khan1. Bao cao khan thuc hien nhu sau:a) Trong truong hop tai nan hang hai xay ra trong vung nude cang bien va

vung bien Viet Nam, thuyen truong hoac ngudd co trach nhiem cao nhat tren tau bien phai gui ngay Bao cao khin cho Gang vu hang hai nod gan nhat. Truong hop

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nhirng nguoi nay khong thuc hien duoc Bao cao khan thi chu tau hoac dai ly tan bien lien quan din tai nan co trach nhiem bao cao.

b) Gang vu hang hai noi gan nhat khi nhan duoc Bao cao khan hoac biet tin vi tai nan hang hai xay ra co trach nhiem chuyen ngay Bao cao khan hoac cac thong tin do cho cac ca quan, td chuc sau day: Gang vu hang hai duoc giao quan ly khu vuc tau xay ra tai nan; Cue Hang hai Viet Nam; Tong Cong ty Bao dam an toan hang hai, neu tai nan gay hu hong, lam mat tac dung cac thiet bi tro giup hang hai hoac anh huong den an toan hang hai cua tau thuyin; to chuc, ca nhan quan ly

hoac khai thac cac cong trinh, thiet bi neu tai nan gay hu hong, thiet hai cho cac cong trinh, thiit bi nay; Uy ban nhan dan tinh, thanh pho true thuoc Trung ucmg, neu tai nan gay ra hoac co kha nang gay ra 6 nhiem moi truong hoac ton hai den nguon loi thuy san.

2. Truong hop tai nan hang hai lien quan den tau bien Viet Nam khi boat dong trong vung bien cua qu6c gia khac, thuyin truong hoac nguoi co trach nhiem

cao nhat tren tau bien hoac chu tau phai bao cao theo yeu cau cua quoc gia ven biln noi tau bi tai nan va gui ngay Bao cao khin cho Cue Hang hai Viet Nam. N6u

tai nan thuoc loai dac biet nghiem trong, thuyen truong hoac nguoi co trach nhiem

cao nhat tren tau bien hoac chu tau phai bao cao cho co quan dai dien ngoai giaof 9 t 9 ** f

cua Viet Nam tai quoc gia ven bien noi tau bi tai nan biet de ho tro giai quyet.3. Truong hop tai nan hang hai lien quan den tau biln Viet Nam khi hoat

9 f r \ r

dong o vung bien quoc te, thuyen truong hoac nguoi co trach nhiem cao nhat tren

tau bien hoac chu tau phai gui ngay Bao cao khan cho Cue Hang hai Viet Nam.9 9 9 * \

4. Bao cao khan co the duoc chuyen true tiep hoac gui bang cac phuong

thuc thong tin lien lac phu hop.r

5. Boi voi tai nan hang hai dac biet nghiem trong, sau khi nhan duoc Bao

cao khan, Cue Hang hai Viet Nam phai bao cao ngay cho Bo Giao thong van tai.6. Cue Hang hai Viet Nam thong bao cho Chinh quyln hang hai cua quoc

gia tau mang co d6i voi tai nan hang hai xay ra trong cac truong hop quy dinh tai diem b khoan 1 Bieu 2 cua Thong tu nay.

Dieu 8. Bao cao chi tietTiep theo Bao cao khan, thuyen truong hoac nguoi co trach nhiem cao nhat

tren tau biln phai gui Bao cao chi tiet theo thbi han quy dinh duoi day:

1. Truong hop tai nan hang hai xay ra trong vung nude cang biln va vung noi thuy cua Viet Nam, Bao cao chi tilt phai gui Gang vu hang hai duoc giao quan

ly tai khu virc vung nude do trong vong 24 gid, ke tu khi tai nan xay ra.Trudng hop khong the hoan thanh Bao cao chi tiet trong vong 24 gid thi phai tien hanh

bao cao bo sung nhirng khong cham hon 48 gid ke tu khi tai nan xay ra.2. Truong hop tai nan hang hai xay ra trong lanh hai va vung dac quylnf 9 \

kinh te cua Vift Nam theo quy dinh tai diem b khoan 1 Bieu 2 cua Thong tu nay,

it , -3

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sau khi xay ra tai nan, tau vao neo dau tai vung nuac cang bien Viet Nam, Bao cao

chi tiet phai giii Gang vu hang hai duac giao quan ly tai khu vuc vung nude do

trong vong 24 gib, ke tu khi tau vao neo dau tai vi tri duac chi dinh. Truong hop

sau khi xay ra tai nan, tau khong vao neo dau tai vung nude cang bien Viet Nam, Bao cao chi tilt phai guri Cue Hang hai Viet Nam trong vbng 48 gib, ki tu khi tau

% f y

hoac thuyen vien cua tau bi nan den cang ghe dau tien.3. Truong hop tai nan hang hai lien quan den tau bien Viet Nam khi boat

9 r r » f

dong d vung bien quoc te va vung bien cua quoc gia khac, sau khi xay ra tai nan, tau vao neo dau tai vung nude cang bien Viet Nam, Bao cao chi tiet phai gui Gang

vu hang hai duoc giao quan ly tai khu vuc vung nude do trong vbng 24 gib, ke tu

khi tau vao neo dau tai vi tri duoc chi dinh. Truong hop sau khi xay ra tai nan, tau

khong vao neo dau tai vung nude cang bien Viet Nam, Bao cao chi tiet phai dugcv r y

gui Cue Hang hai Viet Nam trong vbng 48 gib, ke tit khi tau den cang ghe dau

tien.

*t>

Bieu 9. Bao cao dinh ky2Gang vu hang hai phai lap bao cao bang van ban gui Cue Hang hai Viet

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Nam va Cue Hang hai Viet Nam tong hop, lap bao cao bang van ban gui Bo Giao thong van tai ve cac tai nan hang hai, chi tilt bao cao nhu sau:

1. Ten bao cao: Bao cao dinh ky cac tai nan hang hai;2. Noi dung yeu cau bao cao: Thong tin lien quan den cac tai nan hang hai

theo quy dinh tai Phu luc 3 ban hanh kem theo Thong tu nay;3. Phuong thuc guri, nhan bao cao: Bao cao duoc the hien dudi hinh thuc

van ban giiy hoac van ban dien tu. Bao cao duoc gui den co quan nhan bao cao

bing mot trong cac phuong thuc sau: gui true tiep, qua dich vu buu chinh, fax, qua

he thbng thu dien tu, hoac cac phuong thuc khac theo quy dinh cua phap luat;4. Tdn suit bao cao: Dinh ky 6 thang va hang nam:5. Thbi han gui bao cao: Thbi han gui bao cao 6 thang: Trudc ngay 17 thang

6 hang nam, Gang vu hang hai bao cao Cue Hang hai Viet Nam. Trudc ngay 22

thang 6 hang nam, Cue Hang hai Viet Nam bao cao Bo Giao thong van tai. Bao

cao 6 thang cubi nam duoc thay the bang bao cao nam; Thbi han gui bao cao hang

nam: Trudc ngay 17 thang 12 hang nam, Gang vu hang hai bao cao Cue Hang hai Viet Nam. Trudc ngay 22 thang 12 hang nam, Cue Hang hai Viet Nam bao cao Bo

Giao thong van tai.6. Thbi gian chdt so lieu bao cao: B6i vdi bao cao dinh ky 6 thang duoc tinh

tu ngay 15 thang 12 nam trudc ky bao cao den ngay 14 thang 6 cua ky bao cao.

2 Bilu n^y dirpe sila d6i, b6 sung theo quy djnh t$i Bilu 4 cua Th6ng tu s6 34/2020/TT-BGTVT sua doi, b6 sung mpt s6 dilu cua ede Th6ng tu quy dinh ve chi d§ bdo cdo dinh trong Imh vyre hdng hdi, c6 hi$u lyre k! t£r ngdy 15 thdng02ndm 2021.

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B6i vai bao cao dinh ky hang nam tinh tir ngay 15 thang 12 nam tnrac ky bao cao din ngay 14 thang 12 cua ky bao cao;

7. Mau bao cao: Theo quy dinh tai Phu luc 3 ban hanh kem theo Thong tunay.

Chirong IIIDIEU TRA TAI NAN HANG HAI

Bieu 10. Muc dich, yeu cau dieu tra tai nan hang hai1. Bieu tra tai nan hang hai la viec xac dinh dieu kien, hoan canh, nguyen

nhan hay nhung kha nang co the la nguyen nhan gay ra tai nan hang hai nh§m co nhung bien phap huu hieu phong tranh va han che tai nan tuong tu.

2. Bieu tra tai nan hang hai khong xac dinh trach nhiem hay nghTa vu phap ly cua cac ben.

3. Tai nan hang hai phai duoc dieu tra dung quy dinh, kip thbi, toan dien vakhach quan.

Bieu 11. Cac trirong hup dieu tra tai nan hang hai1. Tai nan hang hai nghiem trong va dac biet nghiem trong phai duoc dieu tra.2. Cac tai nan hang hai it nghiem trong co the duoc dieu tra hay khong dilu

tra do Giam doc Gang vu hang hai quyet dinh. Truong hop khong dilu tra, Gang

vu hang hai phai bao cao Cue Hang hai Viet Nam.Bieu 12. To chirc dieu tra tai n^n hang hai1. Tham quyen dieu tra tai nan hang hai

s 9 X

a) Giam doc Gang vu hang hai khu vuc co trach nhiem to chuc dieu tra tai nan hang hai xay ra trong vung nude cang bien thuoc pham vi quan ly va tai nan hang hai khac do Cue trudng Cue Hang hai Viet Nam giao;

b) Trong trudng hop tai nan hang hai xay ra tai vung nude cang biln, tau9 f F /

bien lien quan den tai nan tiep tuc hanh trinh den vi tri neo dau duoc chi dinh tai vung nude cang bien khac, Cue trudng Cue Hang hai Viet Nam quyit dinh giao td

chuc dieu tra tai nan hang hai do cho Gang vu hang hai noi xay ra tai nan hoac noi tau bien neo dau. Khi tau den vi tri neo dau duoc chi dinh trong vung nude cang

bien thuoc khu vuc quan ly, Giam doc Gang vu hang hai co trach nhiem cu ngay

ngudi co chuyen mon, nghiep vu len tau kiem tra hien trudng va thu thap cac

chung cu.c) Cue trudng Cue Hang hai Viet Nam quyet dinh giao to chuc dieu tra tai

nan hang hai xay ra ngoai vung nude cang biin Viet Nam cho mot Gang vu hang hai phu hop.

2. Khi nhan duoc thong tin ve tai nan hang hai trong viing nude cang bien thuoc khu vuc quan ly, trong dieu kien cho phep, Giam die Gang vu hang hai phai cu ngudi co chuyen mon nghiep vu din ngay hien trudng xay ra tai nan hang hai

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va len tau kiem tra hien tmcmg, xem xet cac vi tri lam viec va thu thap cac chung cu can thiet cho cong tac dieu tra. Khi tien hanh cac cong viec nay, nhlt thiet phai lap bien ban va co su chung kien, xac nhan cua nguoi co tham quyen tren tau va

tranh anh huong den su van hanh an toan cua tau. Nguoi duoc cu din hien trubng

se la thanh vien cua To dieu tra tai nan hang hai duoc quy dinh tai khoan 3 Biku

nay.3. Giam doc Gang vu hang hai to chuc dieu tra tai nan hang hai co trach

nhiem ra quyet dinh thanh lap T6 dieu tra tai nan hang hai.4. Trong qua trinh dieu tra tai nan hang hai, neu phat hien co d£u hieu cku

thkih tpi pham thi Giam doc Gang vu hang hai thong bao cho co quan di§u tra co9^9 ̂ f

tham quyen va chuyen giao ho so, tai lieu, chung cu co lien quan den vu tai nan

hang hai theo yeu cau cua co quan dieu tra co tham quyen; truoc khi chuyen giao, ho so, tai lieu phai duoc sao y hoac pho to de luu lai phuc vu viec dieu tra tai nan

hang hai; viec chuyen giao ho so, tai lieu, chung cur phai duoc lap thanh bien ban ban giao.

5. B6i voi tai nan hang hai ma cac co quan khac co thuc hien di§u tra theo

tham quyen, viec dieu tra tai nan hang hai van duoc tien hanh theo quy dinh cua

Thong tu nay.6. Cue Hang hai Viet Nam thong bao cho cac chinh quyen hang hai cua

qu6c gia tau mang co ve viec dieu tra tai nan hang hai doi voi cac tau nuoc ngoai quy dinh tai khoan 1 Dieu 2 cua Thong tu nay.

7. Giam d6c Gang vu hang hai duoc tarn giu tau biln khong qua 05 ngay de

thu thap chung cu phuc vu cong tac dieu tra. Viec tam giu qua thai han tren trong9

trubng hop tai nan xay ra trong vung nuoc cang bien se do Cue trubng Cue Hang

hai Viet Nam quyet dinh tren co so de nghi cua Giam doc Gang vu hang hai, thbi gian gia han tam giu khong qua 05 ngay; trubng hop tai nan xay ra ngoai vung

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nuoc cang bien thi thbi gian gia han tam gift tau bien do Bo trubng Bo Giao thong van tai xem xet, quyet dinh tren co sb de nghi cua Cue Hang hai Viet Nam.

Dieu 13. Thoa thuan dieu tra tai n^n hang haiTrong trubng hop can thiet, Cue Hang hai Viet Nam thoa thuan dieu tra tai

nan hang hai nhu sau:1. Doi voi cac vu tai nan hang hai lien quan den tau bien nuoc ngoai, Cue

Han^ hai Viet Nam thoa thuan voi Chinh quyen hang hai cua qubc gia tau mang cb ve viec dieu tra tai nan hang hai phu hop voi dieu kien thuc tb va hoan canh, dia diem xay ra tai nan hang hai.

2. Doi voi cac vu tai nan hang hai lien quan den tau bien Viet Nam xay ra b nubc ngoai, Cue Hang hai Viet Nam thoa thuan vbi Chinh quyen hang hai cua qubc gia ven biin vi viec dieu tra tai nan hang hai phu hop vbi dieu kien thuc te

va hoan canh, dia diem xay ra tai nan hang hai.

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3. Truong hop khong thoa thuan duoc voi Chinh quyen hang hai cua quoc gia tau mang cos quoc gia ven bien, tai nan hang hai duoc tiln hanh di£u tra doc lap theo quy dinh cua Thong tu nay.

Dieu 14. To dieu tra tai n^n hang hai va thanh vien cua To dieu tra tai nan hang hai

1. To dieu tra tai nan hang haia) To dieu tra tai nan hang hai phai co To truong true tiep dieu hanh va toi

thieu phai co 01 To pho giup viec cho To truong, 01 to vien do Giam doc Gang vu hang hai quyet dinh theo tham quyen;

b) Trong truemg hop can thiet, Cue truong Cue Hang hai Viet Nam b6 sung ngubi co chuyen mon phu hop cung tham gia To dieu tra tai nan hang hai. Giam doc Gang vu hang hai can cu chi dao cua Cue truong Cue Hang hai Viet Nam de quyet dinh thanh lap To dieu tra tai nan hang hai.

2. Thanh vien To dieu tra tai nan hang hai phai dap ung cac dieu kien sau: la thuyen truong, may truong hoac ky su cac chuyen nganh dieu khien tau bien, van hanh may tau bien, khai thac may tau bien, dong tau, dien va dien tu dong tau thuy, luat hang hai hoac nganh nghi tuong duong; co thbi gian kinh nghiem thuc te voi nganh nghe da hoc toi thieu 05 nam va da qua cac khoa tap huan, b6i duong nghiep vu ve dieu tra tai nan hang hai.

Dieu 15. Nhiem vu va quyen h^n cua To dieu tra tai nstn hang hair y x >

1. Lap ke hoach dieu tra, xay dung du toan kinh phi dieu tra thuc hien dieu tra tai nan hang hai theo quy dinh cua Thong tu nay va cac quy dinh co Hen quan khac cua phap luat. Ke hoach dieu tra phai duoc Giam d6c Gang vu hang hai phe duyet. Bao cao b&ng van ban ve qua trinh dilu tra va kit qua dieu tra tai nan hang hai cho Giam doc Gang vu hang hai thanh lap T6 dieu tra tai nan hang hai.

2. Thong bao bang van ban cho thuyen truong hoac ngubi co trach nhiem cao nhat tren tau bien, chu tau va dai ly tau bien ve viec tien hanh dieu tra tai nan hang hai, Noi dung thong bao bao gom nhung thong tin chinh sau day:

a) Tai nan hang hai duoc diiu tra;b) Thbi gian va dia diim cuoc dieu tra Mt dau;

9 X

c) Ten va dia chi lien he cua To dieu tra tai nan hang hai;d) Quyen va nghla vu cua cac ben d6i voi cuoc dieu tra tai nan hang hai.3. Su dung trang bi, thiet bi edn thiet de phuc vu dieu tra tai nan hang hai.4. Yeu cau cac ben lien quan den tai nan hang hai co bien phap giu nguyen

hien truong va bao ve cac chung cu lien quan theo yeu cau cua viec dieu tra tai nan hang hai.

5. Yeu cm nhung ngubi lien quan din tai nan hang hai tubng trinh bang van

ban nhung van de hq biet ve dieu kien, hoan canh, diln biln cua tai nan hang hai va doi tuong lien quan den tai nan hang hai. Trong tnrbng hop ckn thilt, phai tham

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van nhung nguoi nay thi phai thong bao cho ho bilt tnioc ve thai gian, dia dilm

tien hanh tham van.r

6. Yeu can thuyen tnrdng, nguoi co trach nhiem lien quan cung cdp ban sao cac nhat ky cua tau, hai do khu vuc tau bi nan va cac bien ban, tai lieu ckn thiet khac ve tau va trang bi, thiet bi tren tau.

7. Yeu cau to chuc phan ckp va giam sat ky thuat tau, chu tau, dai ly tau9 9 f f

bien, to chuc thong tin hang hai, trung tam phoi hop tim kiem - cuu nan hang hai, tnmg tam dieu hanh he thong giam sat giao thong tau thuyen, bao dam an toan

hang hai, hoa tieu hang hai va co quan, to chuc, ca nhan co lien quan khac cung

cap thdng tin can thiet de phuc vu dieu tra tai nan hang hai.8. Kiem tra, thu thap ban sao cac giay to dang ky, dang kiem, bao hilm cua

tau, cac giay tor can thiet khac co lien quan va cac loai chung chi chuyen mon cua^ 9 >

thuyen vien de phuc vu dieu tra tai nan hang hai.9. Ghi am, chup anh, ghi hinh, khao sat, tnmg c£u giam dinh va thuc hien

nhung cong viec khac neu thay can thiet doi voi viec dieu tra tai nan hang hai.10. Tong hop, xac minh, phan tich, danh gia va de xudt ket luan nguyen

nhan gay ra tai nan hang hai. Trong trucmg hop ckn thilt, d§ xuit Giam doc Gang

vu hang hai quySt dinh trung cau y kiln cua to chuc phan cap va giam sat ky thuat tau hoac cac co quan chuyen mon lien quan.

11. Lap Bao cao dieu tra tai nan hang hai.12. Luu trix, bao quan ho so, tai lieu va cac vat chung co lien quan din tai

nan hang hai theo dung quy dinh.9 / >

13. To chuc dich sang tieng Anh Du thao Bao cao dieu tra tai nan, Bao cao

dieu tra tai nan doi voi cac vu tai nan hang hai dac biet nghiem trong va cac vu tai nan hang hai lien quan den tau mang co quoc tich nude ngoai.

9 > %

14. To chuc dieu tra lai tai nan hang hai theo quy dinh tai Dieu 20 cua

Thong tu nay.Dieu 16. Thcri ban dieu tra tai nan hang hai1. Doi voi tai nan hang hai xay ra trong vung nude cang bien Viet Nam thi

thdi han dilu tra khong qua 60 ngay ke tir ngay tai nan hang hai xay ra; ddi voi cac tai nan hang hai xay ra ngoai vung nude cang bien thi thdi han dieu tra khong qua 60 ngay ke tu ngay duoc giao dieu tra tai nan hang hai.

2. Trong tnrdng hop phuc tap, neu viec dieu tra tai nan hang hai khong the^ > f 9

hoan thanh theo thdi han quy dinh tai khoan 1 Dieu nay, tren co so de xuat cua To9 > r

tnrdng To dieu tra tai nan hang hai, Giam doc Gang vu hang hai phai kip thdi bao

cao bing van ban cho Cue tnrdng Cue Hang hai Viet Nam xem xet, quyet dinh gia han thdi gian di&u tra tai nan hang hai.

*€

£

•SB

10

f)ieu 17. Trinh tu* thuc hien dieu tra tai nan hang hai1. Thanh lap To dieu tra tai nan hang hai.2. Lap Ke hoach dieu tra tai nan hang hai.3. Lap du toan kinh phi dieu tra tai nan hang hai.4. Thong bao cho cac ben lien quan ve viec tien hanh dieu tra.5. Phong v£n thuyin vien, nhan chung; t6ng hop cac thong tin thu thap

dugc. Niu thiy chn thiet, co the tiSn hanh kiem tra va phong van bo sung de lam^ \ r

ro nhxmg van de con nghi van.6. Can cu quy djnh cua phap luat ve hang hai, tien hanh phan tich cac thong

tin thu thap dugc, ke ca cac ket luan giam dinh vat mau, vet tich lien quan den tai nan hang hai,

7. Lap Du thao Bao cao dieu tra tai nan hang hai gui cac ben lien quan de

gop y theo quy dinh tai Dieu 18 Thong tu nay.8. Cong b6 Bao cao dieu tra tai nan hang hai.Dieu 18. Du thao B£o cao dieu tra tai nan hang hai1. Sau khi lap Du thao Bao cao dieu tra tai nan hang hai, To dieu tra gui mot

ban Du thao cho chu tau, nguoi quan ly tau, nguoi khai thac tau co lien quan, Cue Duong thuy noi dia Viet Nam (neu tai nan xay ra co lien quan din phuong tien

thuy noi dia) va Cue Hang hai Viet Nam de gop y ve ban Du thao Bao cao. Sau

khi nhan dugc Du thao Bao cao dieu tra tai nan hang hai tu To dieu tra, Cue Hang

hai Viet Nam gui mot ban Du thao Bao cao cho Chinh quyen hang hai cua quoc

gia tau mang co de gop y (doi vdi tai nan hang hai lien quan den tau bien nuoc ngoai).

2. Chinh quyen hang hai cua quoc gia tau mang cb, chu tau, nguoi quan ly

tau, nguoi khai thac tau co lien quan khong dugc pho bien, cong bo hoac cho phep

tiep c$n Du thao Bao cao hoac bat cu phan nao cua Du thao Bao cao khi chua co^ %' f *su dong y cua To dieu tra tai nan hang hai, Giam doc Gang vu hang hai hoac Cue

Hang hai Viet Nam.3. Cham nhat 30 ngay hoac trong thdri gian thong nhat giira T6 diiu tra va

cac b6n lien quan nhung khong qua 30 ngay, ke tir ngay gui Du thao Bao cao, Chinh quyen hang hai cua quoc gia tau mang cb, chu tau, ngubi quan ly tau, nguoi khai thac tau co lien quan co y kien dong gop ve ban Du thao Bao cao. Qua thbi han tren, neu chua nhan dugc y kien dong gop, To dieu tra tien hanh trinh Bao cao dieu tra tai nan hang hai de Giam d6c Gang vu hang hai ky, cong bo Bao cao dieu tra tai nan hang hai.

Dieu 19. Bao cao dieu tra tai nan hang hai.1. Bao cao dieu tra tai nan hang hai bao gbm cac thong tin chinh sau:

11

a) Tom tat cac yeu to ca ban cua tai nan hang hai va neu r5 so ngirbi ch4t, mlt tfch, bi thuong hoac tinh trang 6 nhiem moi tnrong;

b) Thong tin vk quoc tich, chu tau, cong ty quan ly tau, khai thac tau neu

trong giay chung nhan quan ly an toan va to churc phan cap;c) Cac thong so chinh cua tau, dong ca cua tau; thong tin ve thai gian lam

viec, nghi ngai cua thuyen vien va cac cong vice da thuc hien tmac khi xay ra tai nan hang hai;

d) Mo ta chi tiet vh hoan canh xay ra tai nan hang hai;d) Phan tich, lap luan va chung minh cac yeu to dan den nguyen nhan cua

tai nan hang hai;e) Bh xuat ap dung cac bien phap nhSm phong ngua cac tai nan hang hai

tuong tir.2. To di6u tra tai nan hang hai phai gui Bao cao dieu tra tai nan hang hai tai

Chinh quyin hang hai cua qu6c gia tau mang ca, chu tau, nguoi quan ly tau, nguai khai thac tau co lien quan va Cue Hang hai Viet Nam cham nhat vao ngay ket thuc thai han dieu tra tai nan hang hai. Ban sao Bao cao dieu tra tai nan hang hai co the duac cap cho ca nhan hoac phap nhan khac co lien quan true tiep den tai nan, neu co yeu cau b^ing van ban.

3. To dieu tra tai nan hang hai phai gui mot bo ban chup ho sa (neu co yeu chu) va hai ban Bao cao dieu tra tai nan lien quan den viec dieu tra tai nan dac biet nghiem trong tai Cue Hang hai Viet Nam.

4. Boi vai tai nan hang hai nghiem trong va dac biet nghiem trong, Cue Hang hai Viet Nam co trach nhiem gui Bo Giao thong van tai va To chuc Hang hai quoc te ngay sau khi co ket luan dieu tra tai nan hang hai.

5. Bao cao dieu tra tai nan hang hai duqc Cue Hang hai Viet Nam pho bien cong khai tren Trang thong tin dien tu cua Cue Hang hai Viet Nam.

Dieu 20. Dieu tra lai tai nan hang haiTrong tnrong hap co nhung bang chung mai duac cung cip hay thu thap

dugc ma nhung bang chung nay lam thay d6i ca ban nguyen nhan cua vu tai nan

hang hai, Giam doc Gang vu hang hai quyet dinh tien hanh dieu tra lai vu tai nan do.Dieu 21. Khieu nai, to cao va giai quyet khieu nai, to cao

t r ' f \

Khieu nai, to cao (neu co) lien quan den viec dieu tra tai nan hang hai se/ \ r f r

dugc giai quyet theo quy dinh cua phap luat ve giai quyet khieu nai, to cao.Dieu 22. Kinh phi dieu tra tai nan hang haiKinh phi dieu tra cac vu tai nan hang hai thuc hien theo quy dinh cua phap luat.

12

Dieu 23. Hieu lire thi hanh3• •Thong tu nay c6 hieu lire ke tir ngay 15 thang 3 nam 2020. Bai bo Thong tu

s6 34/2015/TT-BGTVT ngay 24 thang 7 nam 2015 cua Bp tmong Bp Giao thong van tai vl bao cao va dieu tra tai nan hang hai va Thong tu so 39/2017/TT- BGTVT ngay 07 thang 11 nam 2017 sua doi, b6 sung mot so dieu cua Thong tu so 34/2015/TT-BGTVT ngay 24 thang 7 nam 2015 cua Bp truong Bp Giao thong van tai quy dinh ve bao cao va dieu tra tai nan hang hai.

Dieu 24. To chirc thuc hien1. Cue Hang hai Viet Nam co trach nhiem to chuc thuc hien Thong tu nay.2. Chanh Van phong Bp, Chinh Thanh tra Bp, cac Vu truong, Cue truong

Cue Hang hai Viet Nam, C\ic truong Cue Duong thuy npi dia Viet Nam, Thu truong cac co quan, to chuc va ca nhan lien quan chiu trach nhiem thi hanh Thong tu nay./.

B0 GIAO THONG VAN TAI XAC THy'C VAN BAN HOP NHAT

Ha Noi, ngay £U. thang d nam 2021

triTOng /

S6: 05 /VBHN-BGTVT

Ned nMn:- Van ph6ng Chinh phu (de d&ng Cong bao);- C6ng Thong tin di^n tv CKinh phu;.- Cong Thong tin di$n tv Bp GTVT (de d5ng tai); ll^j -Lvu: VT, PC (02). o

Va&

|*uyen Van The

3Di6u 5 va Di&u 6 cila Th6ng tir s6 34/2020/TT-BGTVT siia d6i, bo sung mpt s6 dieu cua ede Th6ng tu quy djnh vi ch4 d$ bdo cdo djnh ky trong Imh v\rc hdng hdi, c6 hi|u l\rc k4 tir ngdy 15 thing 02 nSm 2021 quy djnh nhv sau:

"D/iu 5. £>/Ju khoin thi httnhThdng tu nay cd hi$u l{ec thi hanh hi tit ng<ty IS thdng 02 n5m 2021.Diiu 6. TS chuc thpc hi$nChanh Van phong B$, Ch6nh Thanh tra Bq, ede truong Cy.c truong Cue Hang hai Vi$t Nam, Gidm

d6c Cdng vu hdng hai, Thu truong ede co quan, don v; vd cd nhdn c6 lien quan chfu trdch nhi?m thi hanh Thdng tunay".

13

Phu luc 1 • •Annex No. 1

(Ban hank kem theo Thong tie sd 01/TT-BGTVTngay 20 thong 01 nam 2020 cua Bq tne&ng Bq Giao thong vgn tai)

Ca quan nhan bao cdo: Cdng vu hang hai...................Maritime Administration of

bAo cao khAnReceiving agency

URGENTREPORTTAI NAN HANG HAi ON A MARINE ACCIDENT

Ten tau ....Losii tauType of ship

Ho hi£uShip's name Call sign

...... Cang dangk^....Port of Registry...Qu6c tjch..............

...Qu6c tich....Nationality

Thuyen b§, ke ca thuy&i truong....Ship‘s crew, including the MasterNationalityKich thucfc tau (L x B x H)..........Ship’s dimentionsTong dung tfch (GT)...................Gross tonnageLoai tai nan.................................Accident’s typeVitrixayratalnem: Vido..........Position of occurrence Latitude

Bia diem.....Location

Thai tiSt biln khi xay ra tai nan:Marine weather at/around moment of the occurrence

- Huong va sue gio....... .Wind's direction andforce

- Tinh trang mat bikn.....Sea state

- Tamhhin xa................Visibility v*'';

Then tilt bien khi bao cao:Marine weather at moment of reporting

- Hudng va clp gio........Wind's direction and force

- Tinh trang mat bien......Sea state

- Tim nhin xa................

So IMOIMO Number

....Trpng tdi toan phin, mua he (MT)Summer deadweight....Ngay, gio xay ra tai nan..............Date and local time of occurrence................................Kinh dp......

Longitude

VisibilityThiet hai so bp doi vdi tau minh:Estimated damage to own ship

- Ve ngudi:........Human life

- Ve tau, trang bi.Damage to ship and equipment

- Ve hang hoa:.......................Damage to cargoes

Thiet hai so bp doi vdi ede ben khac, neu biet:Estimated damage to others, if known

- Ve ngudi:...

chit; mat tich; ,bi thuonginjureddead missed

chet; mat tich; bi thuong

14

injuredmisseddeadHuman life- Ve tau, trang bi

Damage to ship and equipment- VS hang hoa:....................................................

Damage to cargoes- Ve c6ng trinh, thiet bi:.....................................

Damage to marine construction, equipmentH&ng hoa chd tren tau, kS ca hang nguy hiem, doc hai (neu c6):Onboard cargoes, including dangerous and harmful cargoes (if any)Ten cang ghe ISn cu6i;.................................ngay, gi5 roi cang.....Last port of call Date, time of departureTen cang tdi:....... ......................................... ngay, gior dir kien dSnNext port of call Date, ETACac yeu chi h§ trgf da phdt di tu tau.........Dispatched assistance requiredChe yeu diu da dugc dap umg...................Assistance renderedHilm nguy doi vdi nguai, tau, moi tnrbngDangers to human, ship, environmentTen, dia chi lien lac cua:Name, address of

- Chii phuong tien hay Nguai khai thac tau:Shipowner or Shij) operator

+ TSn day du;....................................Full name

+ Dia chi:..........................................Address:

+ Di?nthoai:.....................................Telephone number

+ So Fax:..........................................Telefax number

+ E-mail:............Email address

- Nguod bao hi4m P & I: P&IClub

+ Ten day dii:.....Full name

+ Dia chi:...........Address:

+ DiSn thoai:......Telephone number

+ S6 Fax:...........Telefax number

+ E-mail:..............Email address

- Dai ly tau tai Viet Nam:Ship’s agent in Vietnam

+ TSn day du:.......Full name

+ Dia chi:.............Address:

+ Di§n thoai:........Telephone number

+ So Fax:.............Telefax number

.1

15

+ E-mail:...............Email address

Ho ten, quoc tich cua thuyln tnrcmg: Master’s name and nationality

, ngay...... thdng......nam 20........date month year

Ten va chu ky cua nguai bao caoName and signature ofreporting person

i

I

•v

.a

16

Phu luc 2 • •Annex No. 2

(Ban hanh kem theo Thong tu so 01/TT-BGTVT ngay 20 thong 01 nam 2020 cua Bq tnc&ng Bq Giao thong van tdi)

bAo cao chi tietDETAILED REPORT

TAI NAN HANG HAI ON A MARINE ACCIDENT

M0T S6 Ll/UYSOME NOTES

1. ThuySn truang phai ky vao Bao cao nay. Tuy nhien, Chii phuong tien cung co the six dung MauThe form shall always be signed by the Master. The Shipowner may, however, also use the form2. Dung CHU' IN hoac m&y chit de dien bieu B&o cao.The form shall be filled in with CAPTIAL LETTERS/typewritter3. Bao cao nay dugc chia lam Phan chung (A) va cac phan sir dung cho tung loai tai nan cu the (tu B d4n J)

The form is divided in a general part (A) and a part which shall be used for the occurrence in question (B-J)4. Luon phai dien Phan A; hang hoa nguy hiem dugc phan loai theo Bg luat IMDG (muc 35) cung ph&i liet ke trong mpi truang hap bat kl tai nan la loai nao. Phan tu B-J dugc su dung cho tung loai tai n£in cu the.

Part A shall always be filled in; IMDG-classed goods shall always be listed regardless of accident type (item 35) Part B-J shall be filled in for the accident/occurrence in question.

5. Tren tau biln Viet Nam phai luon san co bieu Bao cao nay. Tau nude ngoai do Dai ly cua tau cung cdp.

This form should always be available onboard the Vietnamese vessels. For foreign vessels it should be provided with by the Local Agent.6. Bao cao nay sau khi dugc hoan thien va cac b&n trich, sao Nhat ky tau, Nhat ky dSu, Nhat ky lam hang; Danh s&ch thuy6n vien; ban sao c&c ban ghi tu dong va c&c gidy tor lien quan khac dugc trinh cho:

The completedform and extracts of the log books, copies or extracts of oil record or cargo record book, crew list, copies of automatic records and other relevant documents shall be submitted to:

- Gang vu hang hai co lien quan trong thcri han nhu sau:- The relevant Maritime Administration within a time-limit as follows:

+ Trong vong 24 gid ke tir khi tai nan xay ra, n4u tai nan x&y ra trong vung nude cang bien hoac khu vuc hang hai d Viet Nam;

+ 24 hours from the moment of occurrence, if the accident occurred within a Port waters or navigable areas in Viet Nam;

+ Trong vdng 24 gid kl tir khi ddn c&ng bien Viet Nam, ndu tai nan xay ra ngo&i pham vi vung nude c&ng biln va sau khi x&y ra tai nan tau ghd vao mot cang biln Viet Nam.

+ 24 hours from the moment of arrival at a Vietnamese port, if the accident occurred outside the Port waters and after the occurrence the vessel in question called at the port.- Cue Hang hai Viet Nam (So 8 Pham Hung, Cau Gidy, Ha N6i, Viet Nam - Fax:

84.4.37683058) trong vdng 48 gid ke tir khi den cang gh6 dau tien ngoai Viet Nam ndu tai nan xay ra trong cac vimg biln Viet Nam va sau khi xay ra tai nan, tau dugc phep tiep tuc hanh trinh.

- The Viet Nam Maritime Administration (No. 8 Pham Hung road, Cau Giay district, Ha Noi, Viet Nam; Fax: 84.24.37683058) within 48 hours from the moment of arrival at first port outside the Viet Nam, if the accident occurred in Vietnamese waters and after the occurrence the vessel in question was permitted to continue the voyage;

17

- Cue Hang hai Viet Nam (So 8 Pham Hung, Chi Giay, Ha N§i,Viet Nam - Fax: 84.24.37683058) trong vong 48 gifr ke tu khi din cang bien nude ngo&i, nlu tai nan lien quan din tau bien Viet Nam va xay ra ngoai pham vi c&c vung biln Viet Nam.

- The Viet Nam Maritime Administration ((No. 8 Pham Hung road, Cau Giay district, Ha Noi, Viet Nam; Fax: 84.24.37683058) within 48 hours from the moment of arrival at first foreign port, if a Vietnamese vessel involved in the accident occurred outside the Vietnamese waters.7. Bao c&o phai dugc dien day du cac noi dung theo yen clu, vi du:

The form must be completely filled in as requested, for example:a) Trong trudng hop dam va thi ph&i diln phln A va B;

In case of collision, both A and B shall be filled inb) Trong trudng hop h6ng m&y gay ra dam va thi phai diln phin A, B va F

If engine failure has caused the collision, A, B and F shall be filled in

y f r f

Ngoai ra, can tham kh&o mot so tu vung tieng Anh lien quan den c£c muc phai khai bao b trang sau.

TERMS WHICH SHALL BE USED

Items 29, 30 and 31 Type of cargo Empty BallastDry cargo-general cargo-container Bulk (ore, coal, grain, etc)Oil - oil products Gas (LPG, LNG)

Liquid chemicalsPassenger(also ferries)Fish and fish productsRefrigerated cargoCarsTrailersUnknown

Item 40

Type of waters/fairways Ship activities

Laid upAt the workshop At quay At anchor At the cargo buoy Drilling workAt an installation (oil terminal, etc)Arrival to portDeparture from portAt seaFishingSea surveyDredgingIce breaking

At quay, in dock, etc Within the harbor area Channel, river, buoyaged fairway Narrow fairway (along the coast) Traffic separation zone Coastal waters Outer coastal waters Open seaOil exploration area Other

Item 41Main activities on board Storage Drilling

18

Handling of fishing equipmentTrawlingDredgingSea surveyNormal sea voyage (routine work)IcebreakingOther (indicate what)

Maintenance/repair in machinery spaces Other maintenance work Cleaning/preparation or similar of cargo holds/tanksMooring/Preparation for departureAnchor handling/anchoringSafety drills/trainingTestsStationary

Item 45

Type of accident

An accident at sea may include several occurrences. In such cases the occurrences in question shall be recovered in chronological order.EXAMPLEAn engine failure causes collision and the ship capsized.This is recorded: engine failure - collision - capsizing

19

BAO CAO CHI TTET TAI N^N HANG HAIDetailed report on a Maritime accident

A. PHAN CHUNG (Dicn trong tit ca c^c tnrjmg h^p)A. GENERAL PART (To be filled in for atl types of accidents)

Qu6c tjch Nationality

i TSntlu Ship's name

HO hi$u Signal letters

Clng dSngky Port of registry

Nam hodn cli, neu c6 Year of rebuilt, if possible

2 Lo^it&uShip's type

Nam d6ngYear of built

V§t li^u d6ng Material

TolnphanGross

MUAHfiSUMMER

MUADONGWINTER

3 Dung TTnh Trong tdi Mdn nude Draught

Trgngtai Mdn nude Draughtrich Net Dwt Dwt.

TonnageCdc kfch I Chi^udlithude I Length Dimensio

Chilu rOngBreadth

SisnxulttgiMake

C6ng suit miy (kW)Engine power

Miy chinh Main Engine

Logi4Type

nsCaquan Dluphinphin clp clp Class Class

designation

Clp di bangIce class

Bio hieu thin Cong ty bio hiem Insurance company

5 P&ItiuHull insurance

CkCTHdNG S6 CUA TAU I

Lin ki€m tra phin cap gin nhit, dja dilm vithdi gianLatest Class inspection, Place and date

KhiemkhuyetDeficiencies□ C6 □ Khdng YesNo

Neu ly do cua cic khilm khuyetIndicate the reason for the deficiencies

6SHIP’S DATA

Lin kilm tra PSC gin nhit, dja diem vi thdigianLatest PSC inspection, Place and date

Khiem khuyet7Dtficitndts

□ C6 □ Khdng YesNo

Lin kilm tra ginnhlt cic thilt bj cdu sinh vi curu hoi Latest control of fire and life-saving equipment

do thuyln b$by the crew

doPSCObyPSCOdo ca quan phin cap by the class

9 Tiu cd diy ddi khdng?Has the ship double bottom below the cargo spaces

□ Cd □ Khdng YesNo

Lin Idn di gin nhitLatest docking

D)a dilm vi thdi gian Place and date

Tinh trying cua diy ddi cua tiu t$i lan Idn di gin nhit.The quality of ship’s bottom at the latest docking

9

x»

20

Lan ddy tdu sinhgSn ship’s bottom

hamh^ng cargo spaces

10 k6t chd hdng cargo tanks

k£t ballast ballast tanks

nhltLatestcleaningofNgiyDate

C6 giitridln Valid until

C6 giitridenValid until

Giay chiing nh$n dang ky tiu bilnCertificate of Registry

ll Giay chiing nh£n an toki T^tukhach Safety certificates Passenger ship

Ng&yDate

Gi&y chvmg nh|in an toin tiuikh^chPassenger ship safety certificates

KetcauConstructionNgdyDate

Trang thiet bj Equipment Ngiy Date

V§n chuyen khf hod 16ng Transport of liquefied gas

V6 tuy4n di$n V6 tuyen di§n thoai Radiotelephonyb^o

RadiotelegraphyNg4yDate

Ng^yDateGlAYCHtJNG

cm V§n chuydn hoi chdt 16ng "Transport of liquid chemicals

Giiy chiing nh|tn miim triiExemption certificate

NgiyDate

CUAtAu

Giiy chiing nh§n IOPP ciia tiuh^ng kh6IOPP Dry cargo ships

B6 curu sinh Liferaftski4m tra djnh ky hdng nSm annual inspection

Ng&ySHIP’S

CERTIFICATESDate

Giay chiing nh|n IOPP ciia t&u Cdc gidy chiing nh§n kh^cOther certificate

Ng4yDatedau

IOPP tankersQudc giaNational

QuocteInternational

Vd tuy£n tim phuongRadio direction

Bing dO i$chDeviation table

LabintirGiiy CN mgn Magnetic compass

Ngiy thingkho finding Ngiy thingLoad line datedate

Khu vyc boat d$ng theo cic Giiy chiing nhinTrade area according to Certificates

12

21

So l§nh d6m bu6ng lii Night orderbook bridge

Nh$t ky’ di^u dOng bu6ng Idi Enginesmanoeuvres book bridge

13 Nh$ttyddu Oil record

Duy tri trSntdu

Nh|tlq?tiu Ship log

Bitn nMp Rough draft

Nh§t ky VT£) Radio log

Khdc

book □ book □book□ □ □□□cm Nhfrkjdilu

d§ng mdy Manoeuvres log engine

SonhftkjtriicWorking hour log

S6 nh$tpMt thu6c Dispensary

Onboar Nh^tkybudng mdy Engine room log

Bdn nhdpRough draft

Khdng ghiNo recording

ch£ptr£n dis

kept □ □tAu bookO log

RECORDING ON BOARD

book □ □O

Bieu d0ngManoeuvre ingrecordingdiagram

14 Tvr dOng ghiAutomatic recording

Hu6ngCourserecordingdiagram

Bdng ghi d$ sduEcho soundingrecordingdiagram

HOpden“Blackbox”

Khdng ghi No recording

by □ □□ □ □ThuydntruongMaster

is GCN Djnh bi6n anto&n t6i thidu Minimum crew decision Ngay Date

Cic sy quanboongMates

TongTotal

Cdc sy quan mdy Engineers

VTBWirelessoperator

Thuy thu Deck crew

Thgrmdy Engine crew

Nhttng ngudri khdc Other personnel

S6 thuyln vidn theo16GCNCrew numberaccording to decision

thuy£:nVltN/hAnh

KHACH

Thuydn vidn tr6n tduluc tai nanManning on board at the accident

17

Tat cd thuydn vi6n c6 duqc ddng ky vd thdng bdo cho caquan ddng ky thuy^n viSn hay khong?Were all signed on and reported to the register of seafarers C6D KhdngD YesNo

S6 hdnh khdchNumber of passengers

18 S6 thuyen vienNumber of crew

MANNING/PASSENGERS

N6u rO sao l^i gidm s6 thuyen viSn, n£u c6Indicate why the crew was reduced, if applicable

19

22

TuoiTiycca On watch Ngiy Date

Chiic Thin gian di bi6n vdi chiic danh quan Time at sea as officer

Thfri gian di biSn vdi ch4c danh hi^n t^i Time at sea in present rank

GCN KM nflng chuySn m6nCertificates of competence

Ng&y ISn t4u d^m nhi^m chiic danh hi$n tal Entered the rank onboard datedanh Age

Rank

ThuyentnrfmgMaster

20

21 S? quan tr\rc ca boongWatchkeeping officer deckS? quan true ca bu6ngmdyEngineer on watch or on duty

22

nAng lvcCUATHUYEN

VIEN Cdc thuy&i viSn tr\rc ca Nhi$m vy duyc giao Work assignment

Thbi gian di bien Time at seakh^c

CREWCOMPETENCY Other crew members

on duty23 NhirtrSn

Ditto

C6 mi6n trir nio tieu chuSn chuy6n m6n khfing? Was there an exemption for the qualification?YesNo N6u rQ miln trir Indicate which

□ C6 □ Khdng

SO GlO LAM VI$C TRlTOC KHI xAy RA TAI NAN WORKING HOURS BEFORE THE ACCIDENT

So gib da tryc khi tai n$n xdy

H$ THONG TRVCCA WATCH SYSTEM

24tieng trubc Last 24 hours

48tieng trade Last 48 hours

Tuiintrade Last week

raHours on watch when the accident occurred

giOlam viJcWORKING HOURS25 Thuyfin tradng

Master □ th6ng tryc 2 ca Two watch system

26 Sy quan boong Mate □ th6ng tryc 3 ca

Three watch system

23

27 Sy quan m&y Engineer PKMc

OtherCdc thuy^n vifin tr\rcca khdcOther crew members on duty

28□ Kh6ng c6

No watch system

Tr<?ng liiQmg ghi theo tin h§ m6t Weights shall be given in metric tonnes

Loai h^ng hod chd trong chuyen tnn^c Type of cargo the voyage before

29 Lo^i h^ng hod tren tdu Type of cargo on borad

PhSn b6 h2mg hoi (lo^i vd trgng lupng trongcdc him hdng/trSn boong)Cargo location (type and weight in cargo holds/on deck)Kim theo so db xep hdngAttach a cargo plan

Him/KitHold/Tank

Ham/KdtHold/Tank

Him/KitHold/Tank

Him/KitHold/Tank

Him/KitHold/Tank

30 Him/KitHold/Tank

HSm/KitHold/Tank

S6 S6 . s6 S6 S6 S6 S6TiNHTR^NG HANG HOA

CARGO CONDITION

No No No No No No NoLo?iTypetrpngllIQTlgweight

T$i nip him s6At hatch no

T^i nip him s6At hatch no

TV nip him soAt hatch no

Cic vj tri khic, nlu c6Other location of cargo, ifapplicable

31 HingtrinboongDeckcargo

SV

A

24

Logrihdngtrfinboong Type ofdeckcargotrpnglirpngweight

ChiSucao ciiahilngtrenboong Height of deck cargo

K6t TrpnglupngWeight

K6t Trpnglupng

Weight

K6t Trpnglupng

Weight

Kdt Kit Muc ti6u thy/24 gidr dibien Consumptio n per 24 hours at sea

Trpnglupng

Weight

Trpnglupng

Weight

KatsiidyngginnhatLastestfromtank no

Tank Tank Tank Tank Tank

D&ubditrem Lube oil

32

33 NudengptFreshwater

34 NudedanBallastC6 chd hdng nguy hi6m khdng?/s dangerous goods carried?□ C6 □ IChdng

N^u cd, n6u loai theo IMDG (hang hod dupe ddng gdi), lopi hang hod vk lo^i ddng gdi/chuy6n chd (k6m theo danh sdeh, so do x£phang ho^c sp d6 ede kdt)If yes, indicate IMDG-class (packaged goods) type ofgoods and type of cargo carrier/package (attach list, cargo plan or cargo tank plan)______________ ________________________ ____________ ___________________ __________________Yes No

25

35 H&ng hod dupe phSn cdch ph&hcpvft IMDG □The goods is separatedin acconrdance with code IMDG Thod thu|n Baltic □The Baltic Sea agreement

36 Hdng hod NhiSn UfaCargo Bunkers

T6ng cgng %ddy tdiTotal

Nude ngQtFresh water

NudcddnBallastTong

cOngTotal

Load in % of full load

37 Mdnnude mui Draught

M6n nude IdiDraught aft

Mdn nudegittatduDraughtamidship

M^n phdi khdMeassuredfreeboard

M^ntrdi Ty trqng nude khi dtjcStb Prt mdn

Water density at draught readingfwd

T$i luc Nghieng DO nghiOngDegrees

Ly do nghifingReason for the listkhdi List

hdnh□ Stb□ Prt

Atdeparturewas

M6men u6nvOngHoggingmoment

Chieu cao tdm Cdnh tay <36n 6ndinh Idn nhlt Maximum righting arm

M6menu6n vdngSaggingmoment

C6 ttoh todn 6n tinh kh6ng?The stability calculations are carried out □ CO □ Kh6ng

nghi£ng tinhtodnCalculated Yes NoGM

Luc bdt dau chuyOn di, hdng hod dirgechdng buOc bdiAt the start of the voyage, the cargo was secured by

Thuyen viSnCrew

ViOc chdng bupc dupe giam sdt bdiThe securing of the cargo was controlled by

38

CongnhanboeddStevedores

Neu thdi gian vd dja di6m cua Idn th\ic tOp cuu hod vd cuu sinh dupe ghi trong nh|t tduIndicate place and date for the lastestfire and life-saving drills with reference to the ship’s log

39

Dja diOmPlace

Mtic dO huln luyOnExtent of the training

TH1/CTAPctru hoA/ClTUSINH

NgdyDate

TrangPage

FIRE/UFESA VING DRILLS

26

40 Vung nu6c Type of waters

Cdc ho^it dOng cua t^u Activities of the ship

41 Cdc ho^it d§ng chinh tren t&u Main activities on board

GIO Chi^u42 SONGWAVE

SONGLUNG

SWELL

Chi£u D. CHAYCURRENT

Hudn SCrcgidStrength

T6cd0Speed

HudngDirection

HudngDirection

HudngDirectionWINDg cao cao

Direction

Height Height

cAc y£u t6 b£n ngoAiEXTERNALFACTORS

43 Tam nhln xa, hdi ly Visibility in nautical miles

MuaPrecipitati

Nhift d§ nude bi€n Sea water temperature

Lo$i Sucmg mu Fog □ Cd

Cd bang hay khdngPresence of ice □ Cd

Nhi^tdO khdng khiTypeAirontemperatureYes

□ khdng Yes□Khdng No

N4u cd, lo^i bang If yes, type of ice

No

44 LJUS□ Ban ngdy □ Bern □ Binh minh/Hodnghdn

Daylight Darkness Dawn/Dusk

45 Lo^itain^n Type of accident

D|a didm Place

GidGMT Giddjaphuofng GMT

NgdyDate Local time

46 VjtriPositionhi/hOng

DAMAGES47 Cingrdi Departure port

Ngayrdi Departure date

Thdi gian rdi Cdngdich DestinationTime

Cang den diu tidn sau tai n^nFirst port after the accident

48 Ngdyden Arrival dale

Thdi gian dinTime

27

T&u d&n cdng ddu tien sau tai n^n bSng m&y chfnh cua t&u hay khdng? Did the ship proceed to the first port using its own propeller machinery

49 □ C6 □ Khdng Yes No

50 B4o cdo hu hdng (I091 hu h6ng vi cic bi§n pMp dp dyng), ndu cd th£ thl ndu cd h$u qud, vf d\i: thdi gian bj mdt, len d6,v.v...Damage report (type of damages and measures taken) indicate if possible the consequence, e.q: lost time, docking, ect.

Thuy^n vidnCrew

T6ng s6Total

51 H^nhkhichPassengers

Nhttng ngudi khdctrdntdu Others on board

Nhiing ngudi khdc khdng d trentiu Other not on board

S6 ngudiNumber

B| thircragInjured

ofpersons

ChitDead

T6n, dja chi va nguW thSn g4n nh& cua ngudi hi chetIndicate name, address and nearest relative to the dead person

28

B. Di£n trong tnrdng fagp tai nan gay m3c can v&/ho$c dam va (Neu cfic thiet bj neu sau ddy khdng du^c lip dit trSn tiu thl viet “khong” vio c$t gh| chu)

B. To be filled in when the accident caused grounding and/or collision {If the indicated instrumnet is notinstalled on board: write “ho” in the remark column)

H2ng sin xu£t/lo$i Manufacture/type

Tinhtr^ngCondition

Dang sir d\mg luc xiy ra tai Ghi chu Remarksn^n

In use at accident53 Rada 1

Radar2

3

54 ARPAARPA

1

2

55 La bin con quay Gyro compass

1

256 Labintir

Magnectic compass1

2cActhietbphogiCiphAnhhAi57 Miy lii t\r dgng

Automatic pilot1AIDS TO NAVIGATION

2

58 BO ghi tiudng diCourse recorder

ThiOt bj bio dOng 10ch hudngCourse deviation alarm

59 Noi vdi Coupled to

60 Mdy do siu Echo-sounding device

H? vo tuyen Decca Decca navigator

61

2962 M&y hdnh h&i v$ tinh

Satellite navigator

OmegaOmega

63

64 LoranLoran

C&c thiet bj tr? giup h&nh Mi65khdcOther aids to navigation

66 BO ph4t tin hi§u suong mu Fog signal apparatus

VjtrfLocation

sSNu6cxuat Ngiy tu chlnh, du<?c d^n ho$c in Correction date, stamped or printed

Nam in Year of print

Ng&y tu chinh gan nh^t tr€n t&u Lastest correction on board

Dugc sir dyng Me xdy ra tai n^n (cd ho$c khdng)Was used at the accident (yes or no)

b&n NumberNationality

67 H&i Tyl?d6 ScaleChart

68 Danh ba d^n bienList of lights

haidOvacacanphamhanghaichochuyendidv'dinhCHARTS AND NAUTICAL PUBLICATIONS ONBOARD FOR

INTENDED VOYAGE

69 H^ng hai chi nam Sailing directions

B£ng thu^ trieu Tide tables

70

\

30

71 Bdng/b^n do ddng chiy Current maps/table

72 “CSc tin hi§u v6tuy&i”"Radiosignals"

C&c lo^ii khdcOthers

73 Neu c&c 16i trong c&c SnphSm nSutren di:<?c xem c6 Snh hiring d&n tduIndicate faults in the above-mentioned publications which are considered to effect to ship

74 Sd ngiy cua Th6ng bio h^ng hdi g4n nhStNumber and date of the lastest Ufs (NtM)

C6 nh@n dirge c£c Th6ng bdo hdng h&i thu5ng xuydn khong? Is Ufs (NtM) received regularly?

75 Ai (Jr tren bu6ng Idi?Who was on the bridge?

76 Ngudi trge ca c<5 nhi?m vy nio kh^c v&o khi v4 trude khi x4y ra tai nan kh6ng?Neu cd, thl nhi^m vy giHad anybody who belonged to the watch other duties at or before the accident? If yes, which?

THUYiNVlfiN TRENBUAnG LAlTRUttC VATAI LCCXAY RASAMVA/MACCAN

77 Ai chju trich nhi$m tren bu6ng Idi?Who was responsible on the bridge?

Thuy&i tnrdng luc dd d dSu?Where was the master?

MANNING ON THE BRIDGE A TAND BEFORE THE COLLISION/ GROUNDING

78 Ai dang dye tren budng Idi?Who were on watch on the bridge?

Nhflng ngudi liSn quan cd am hi6u vung nude ndykhdng?Were the persons concerned familiar with the the waters?

79 Hoa ti£u cd am hi4u loyi tdu ndy khdng?Was the pilot familiar with the ship type?

Cd hoa ti£u d tr£n tdu khdng?Was there a pilot on board?

80 Ai v$n hdnh ra da s6Who operated the radar

Ai v$n hdnhradasoWho operated the radar No.

Ra da s6 1 sir dyng thangxandoWhich scale was used for radar No. I

Ra da s6 2 su dyng thangt£m xando Which scale was used for radar No. 1

No.

31

Rada da du<?c sir dyng 6 ch4 d? djnh hudng n&o? How were the radars used?□ Bac th§t □ Tuong doi

North up

□ Chuy£n d§ng th§t □ Chuyin d$ng tuong d6i True motion

81

Relative motion

Ralative82 Ngudri canh gidi dung is ddu?

Where was the look-out?Ngudri canh gidi cd nhi^m vy ndo khde khdng Had the look-out other duties □ Cd □ KhdngYes NoChi rS nhi?m vy gi Indicate which

N6u idi lay, ai Id ngudri Idi?At manual steering, who was at the helm?

N^u Idi ty d0ng, ai 14 ngudri gidm sit?At use of automatica pilot, who supervies it?

83

Ddi vdi buong mdy cd ngudri tryc, ai Id ngudri tryc ca?At manual engine room, who was on watch?

N£u mdy chfnh duyc dilu khiSn td faudng Idi, ai Id ngudriv§n hdnh?At manoeuving of the main engine from the bridge, who operated?

84

B6i vdi budng mdy khdng cd ngudri tryc, ai Id ngudi tryc ca?At unattended engine room, who was on duty?

T&mnhln td bu6ng Idi cd dnh hudng gi tdi qud trinh diln bidn ede syki$n khdng?Had the visibility from the bridge any influence on the course of events?Ndu thdng tin chi tilt Give detailed information □ Cd □ Khdng Yes No

thing bu6ng Idi cd gay edn trd sy t§p trung doi vdihdnh hdi an todn khdng?Did the bridge arrangment obstructed the navigator from having fiillattention to safe navigation?□ Cd □ Khdng

Yes No(Vj tri ciia ede hdi d6, VHF,.v.v„.)(Location of charts, VHP, etc)Ndu thdng tin chi tilt Give detailed information.

85

Cdc hudng di, khodng edeh an todn.v.v... theo klhoych chuyin di cd duyc thl hi^n tren hdi d6 khdng? Was voyage plan with courses laid in the chart, safety distance, etc, established □ Cd □ Khdng

Cd tuan theo kd hoych khdng? Was the plan

followed?□ Cd □ Khdng

Yes No

86 Hdnh hai cd hi dnh hudng bdi cdc hoyt dpng giao thdng khde khdng?Was the navigation influenced by other traffic □ Cd □ Khdng

Yes No

HANH HAITRUttC KHI DAM VAMAC CA.N SAILING BEFORE THE COLLISION/GROUNDING

Yes NoCdc di£u ki£n cdu thdnh tai nyn Circumstances which contributed to the accident

87

Vj tri an todn culi edng trude khi xdy ratai nynLast safe position before the accident

88 ThdigianTime

Chi sdt. Vj tri Position

NgdyDate dokl

Log

4.

32

89 Vj trl d6 d3 dirtyc xdc djnh nhu th^ nio?How was that position fixed

Vj trf tfnh to£n dirgrc thao tic t£r vj trf xic djnh gin nhat Dead-reckonine from the lasted fixed position

T.dp kll6cdo

Tir Hudng Idi la b^n con quay/tir Steered

Hudng Idi th$t Steered true course

Hudng di Khoang cdch . Distance

L4ch hudng Drift of course

T6cd0thdrigianFromtime

th§tSailed true course

Log HudngDirectionSpeed Speed

coursegyro/magn.

90

91 C&c hudng ng3m v4 quan trSc khdc d£ th\rc hi^n All bearing and other observations taken

T6c dO blnhthudng cua tiu The ships normal speed

“Hit T6c dp trudc lie xiy ra tai n^nSpeed before the accident

92 x6c dp vko thdi di6m vaSpeed at the moment of impact

Niiam&y m4yHalf Full

Ch§m m4y slow

93 Cdc thdng tin khde Other information:L3n xAc djnh dO l^ch hudng gan nhit: Lasted deviation observation:

cActh6ngTINLlfeN

QUANDtN TlNHlEU VA

BIEUdonglCc

DAM

Cfic myc tir 93 din 107 dirQ’c dien khi tiu lien quan den dam vaItems 93 to 107 shall be filled in when the ship has been involved in a collision

94 .Khi n&o thi phdt hi$n du<?c tiu kia?When was the other ship detected?

Thdi gianTime

33

D6i tirgng dam va dirge ph&t hi$nnhir thl n^oHow was the collision object detected□ MSI thirtmg □ TrSn radar Visual□ Bang 3m hi§u By sound signal

95 VA Phirong v| v& kho3ng c3ch dugc x3c djnh nhu thl n3o?How was bearing and distance ascertained?□ Quang cy Optical bearing□ Udc luyng

Estimated

Phuong vj Kho3ngcichINFORMATION

ON SIGNALS AND MANOEUVRES AT

COLLISIONS

BearingDistance

□ TrSn radar Radar

On radar

T6cd0Speed

96 T3umlnhOwn ship’s

Dd gi3i tr3nh va Radar dirge thyc hign tr6n:Radar plotting carried out assisted by□ Gidy □ Mat d6 gidi phdn xy □ ARPA gidi Diagram Reflection plotter□ Khdng d6 •No plotting

Hu6ngCourse

ARPA

97 Nguy co va cham dugc phdt hiyn khi ndo vd nhu thS ndo?When and how was the collision risk detected?

Tdu da dieu d$ng nhu the ndo de trdnh va? What manoeuvres were made by own ship? □ Thay d6i tdc d0 □ Thay doi hudng Speed change Course change

□ Khdng 1dm glNo

98 Tdu c6 phdt tin hi£u dm thanhkhong?Did own ship gave sound signals? □ C6 □ Khong

Cdch thuc thu hut s\r chii y (VHP, ddn,v.v...)How was attention calledfor (VHP, light, etc)

Vdo luc ndo? At what time?

Yes No

99 C6 nghe thdy dm hi§u tur tdu kiakhdng Were sound signals from the other ship observed?□ CdO Khdng

Quan sdt duyc nhtag tin hi0u gl? What signals were observed?

Vdo luc ndo? At what time?

Yes No

too Tdu minh dd trung ddn/tin hi§u gl?What lights/signals were carried by own ship?

, *

34

101 E>6n/tiii hi$u quan s^t dugc tren tdu kia Lighs/signals observed on the other ship

102 Hiring v& t6c dq cua t^u kia khi Hu6ng T6cquan s^t du^rc bibg mat during Course SpeedCourse and speed of the other ship when it was observed visually

Nhttng thay d6i ve hu6ng vk t6c d$ quan s^t dugrcChanges of course and speed observed

103 Antenna Radar cua t&u kia c6 quay khdng?Was the radar antenna on the other ship moving

□ C6 □ Kh6ng □ Khdng quan sat dupeNot observed

C&c (ten quan s& dugc ciia riu kia c6 r6 khdng? Was the observed lanterns giving clear lights?

Yes No

Dieu dpng tranh va c6 bj anh hudng bdi riu khac khdng?Were any avoidance manoeuvres disturbed by the other ship?

104 Bdi tfnh chit nude By the nature of the waters

Bdi giao thdng khde By other traffic

□ C6 □ Khdng □ Cd □ Khdng□ Khdng□ Cd Yes No Yes No

Yes No

Cd bat ky sy lidn lac bfing VXD gifta cic tdu tnrdc khi xdy ratai nan khdng?Were there any radio communication between the ships before the collision?

Cd cd gdng lidn lac bang VIB khdng?Were any attempts made to take radio contact?

□ Cd □ Khdng

105 Cd lidn lac bang VTB sau ddm va Radio contact after the collision

□ Cd □ Khdng y

Yes No□ Cd □ KhdngYes No Yes No

106 Tdu kia cd tdi hay khdng?Was the other ship loaded?

□ Cd □ Khdng

T4u kia cd bj nghieng khdng? Had the other ships a list?

□ Khdng quan sat dupe Not observed

□ Cd □ Khdng □ Khdng quan sat dupe Not observedYes No Yes No

Tauddiphuong The other

107 Tdng dung tlchGross tonnage

Tdn Hd hi?u Signal letters

Loai Cdng dang ky Port of registryName Type

ship

35

Da l&m nhQng gi d£ trg giup t^u khdc sau khi dam va? What was made to assist the other ship after a collision?

108

M6 td ngSn ggn qud trinh diin bien dm svr ki?n (dieu dpng cua t&u minh, diSu dOng quan s& du?c cita tau b^n, c&c cSn trd vi§c digu d0ng, hu h6ng, thdi gian t&u ra can.v.vy Give a briefdescription ofthe course of events (own ship manoeuvres, observed manoeuvres of the other ship, obstacles for manoeuvres, damages, time when the ship came off the ground, etc.)D6i v6i tai n?n d&m va: VS l$i sor d6 mO ta cdc tlnh hu6ng t£r luc phit hi?n du<?c tiu dot phuong cho d4n thdri diem vaAt a collision: Draw preferably a sketch shewing the situation from the time when the other ship was detected to the collision moment.

109damva/mAc

C£N

COLUSION/GROUNDtNG

C. Bien trong tnrong hpp tai n^n gay chay/no C To be filled in if the accident caused fire/explosion

Chiy/nd bat dau to khu vyc nk»:Area in which the fire/explosion started □ Bu6ng miy

Machinery space

110

□ Him hang Cargo space

□ Khoang to Accommodation space

□ C&c khu vyc khde Other place

M6 ta chi ti€t nod vy chiy/nd bat ddu Describle in detail where the fire/explosion started

ill

VfTRlCHAY/DANHllta

Nod chdy tiep theoWhere did the fire develop further

112FIRE/IGNtTlON

PLACE

113 V§t Ii$u phat hoaMaterial in whichthe ignition took place □ SAn phim diu □ G§ □ V$t lif u ng3n each

OH production Wood Insulation material□ Cac v§t U?u khac, nSu rd Other, indicate what material

-• •.

36

114 Nguy6n nhSn ph^t hoi Ignition causes□ Ch&y □ Tia lira □ Cdc bh m$t n6ng □ Tyr dOng d^nh lira □ Cdc lo^i kh&c, n&u t6 Flame Spark Hot surfaces Auto-ignition Other, indicate what

US Thi£t bj b^o chdy cd du<?c lap d$t tyu noi phdthoa khdngWere fire detection installed where the fire started□ C6 □ Khdng

Neu cd, loyri n^oIf yes, what type

□ Nhi$t Heat

□ Khdi □ Lo^i kh&c, ndu rQOther type, indicate what typeomke

Yes No

115 thong bdo ch&y hoyil dOng c6 t6t khdngDid the warning system function satisfactory □ Cd □ Khdng

Neu khdng, md t& c&c khidm khuyetIf no, describe the deficiences

Yes NocAnhbAoCHAYVA THlfiT B{ ClTUHOA

Chdy dugc ph&t hi^n nhu th^ndoHow was the fire detected

117 □ Thidt bj b&o cMyFire detector

□ Ngudi □ Cdc I091 khdcPersonnel Other meansFIRE WARNING

ANDEX71NGUSHING

EQUIPMENT

Thidt bj chua chdy Tyii noi chdyco djnh Fixedfire extinguishing equipment

118 Neu cd, lo^i n^o If yes, indicate type

□ Cd □KhdngAt the accident place Yes No

119 Neu cd, logi n&o If yes, indicate type

Khu vyrc ISn c§nKhdngAdjoining area

□ Cd □

Yes No

Ndu tai nym xky ra trong c&ng, ai ngudi dang tryrc ca?If accident occurred in port, who were on watch duty?

120

chAy/n6FIRE/EXPLOSION

37

121 Vi tri cua nguiri tr\rc ca khi phdt hi$n tai n^n?Where were the persons on watch when the accident was detected?

Hudng gi6 tuong doi &nh hudng nhir the n^o?How was the relative wind direction

122 LSn gin nh^t, trade khi xky ra tai n^n, c6 ngufiri d^n khu vyc niy khdng? N^u c6, nguM ndo?When were persons at the accident place at the latest time before the accident? (Indicate, if possible, who)

C6 gi bdt blnh thudng th&i diSmd6 khdng?Wes anything abnormal at that time?

nC6 □ Khfing

Neu c6, neu r5 (vf dy nhu bdo dgng) If yes, indicate what (e.g. alarm)

123

NoYes

B5 l^m gl 46 d§p lira h^n che thi^t h^i?What was made to extinguish the fire and limit the damages?

124

Lo$ii thi6t b{ chda cMy 6£ sit dyng (c6 djoh vMio^c cim lay)What type ofextinguishing equipment was used fixed and/or portable)

125

Cac thi6t bj chtta chdy c6 boat dpng t6t khdng?Did the extinguishing equipment function satisfactorily?

□ C6 □ Khdng *No*

M61& s\r boat ddng ciia thilt bj chtta ch&y, ede khi6m khuydt,....Describle how the extinguishing equipmentfunctioned, deficiencies, etc.

126

Yes

CAc t&m ch^n lixa vi thi6t bj 46ng nhanh ho^t dOng tdtkhdng?Didfire damapers and quick shut-offarrangements junction satisfactorily?

NhQng thiet bj n4y dirge bd tri hop ly khdng? Were these suitably located

127

□ C6 □ KhdngYes No

□ C6 □ Khdng*No*

*Niu khdng, n6u cAc thiet bj hu hdng vh nguySn nhdn t^iPh^nLIf no, indicate deficient equipment and causes in Part L

Yes

i ^ j 'W • e-*

^ :•

38

D. Biln trong tnrtmg h^p tai n^n gfiy aghieng/l^t D. To befilled in if the accident has caused list/capsizing

Tot 0911 U6n quart den The accident mu concerned

□ Dich chuyen cua hftng ho4 □ R6 ri □ Nghifing \&\i do th<ri tidtx&uLeakage Violent heeling caused be heavy sea

128Shilling of cargo

with □ Tong hop cua c&c dang tr£n □ Khdng rO nguyfin nhin Combination of the above Caused unknown

□ Cic nguyfin nhfin kh&c O Other caused

HAng hod dupe b6c !£n 6 diu?Where was the cargo taken on board?

H&ng hod dirpc b6c Ifin tiu ob su gj&m sdt cua co quan chirc nfing hay c&c t6 churc kMc khdngDid the loading take place under supervision of a state authority or other institution?

□ C6 □ Khdng

129

Yes NoN^u c6, co quan n&oIf yes, indicate what authority

Tit c& cAc hfim/k<t King cd xdp d4y khdng?Were all holder/tanksfully loaded

DC6 □ Khdng

130

Yes NoHAng hoi trong him vi trdn boong dfi dupe chfing bu$c d£ phdng djeh diuydn nhu th£ nio?How was the hold and deck cargo secured against shifting?

131

T&u dfi v$n chuyin King hoi loai niy bao gid chira?Has the ship previously carried the same type of cargo Yes

□ C6 □ Khdng132No

NGHlfeNG/L^T LIST/CA PSIZING

Sau lin giim djnh khi n&ng di biin gin nhit, tiu cd hoin cii hoic thay ddi lim inh hirimg tdri dn tinh khdng?Has the ship after the latest seaworthyness survey been rebuild or altered in such a way that it influenced the stability? □ Cd □ Khdng Yes No

N4u cd, md ti cic hoin cii If yes, describe the modification

133

Tiu cd so dd xip hing cho chuyinhinh trinh hidn thdri khdng?Had the ship a cargo plan for the voyage in question?

□ Cd □ Khdng

Tiu cd dupe cAp thdng bio in tlnh duocduyit khdng?Were the ship provided with approved stability calculation?

Tiu cd duyc trang bi thiit bj thich hop di tinh toin 6n tinh khdng?Is the ship provided with an approved instrument for stability calculation

□ Cd □ Khdng

134

Yes No□ Cd □ Khdng

Yes Yes NoNoCd tinh toin 6n tinh cua tiu iuc rtri cing gin nhit khdng?Was the stability ealetdatedfor the ship's condition at the departure from the last port?

Cd tinh toin on tinh ciia tiu khi den cing dd khdng? Ditto before arrival to the unloading port

135

□ Cd □ Khdng□ Cd □ Khdng Yes NoYes No

On tinh cua tiu cd thoi mfin khdng?Was the stability satisfactory?

Chu ky l&c ngang cua tiu, giiy Indicate the rolling period in seconds

136

O Cd □ KhdngYes No

39

DS 14m gi 44 tim ra nguyfin nhSn nghiSng? (ki4m tra, doWhat was done to find out the reason for the list? (Inspections, sounding, etc)

137

N£u nguySn nhdn 1dm t£ng d$ nghiSng, n^u c6 thlIndicate, if possible, the cause of the increasing list

138

D3 l^m gidl t&u khdi nghigng ho$c 1dm cho t&u can bSng trd M?What was done to stop further list or to right the ship?

139

Vi$c nghieng tau da xiy ra nhu the nao?How did the heeling occur?

140

□ D$t ng$t Suddenly

□ Dp nghieng tang tir tir Gradually increasing

141 Neu t£u bj Igt up do <3$ nghilng tSng tir tir, khi n4o thl xAc djnh dupe tlnh the 1^ nguy cap?If the capsizing occurred with a gradually increasing list, when was it established that die situation was critical?

Neu nguy£n nhin l§t, neu c6 thlIndicate, if possible, the cause of the capsizing

142

E. Dien trong trircrag hgp tai ngn co sy ro ri E. To befilled in if the accident includes a leakage

143 Lo^iirdri Type of leakage □ B6n trong □ B§n ngoii

ExternalInternal

Noi bat ngu6nPlace where it started

Dirge ph&t hi?n nhu th^ n4o?How was it detected?

144 R6rir6r! Leakage

LEAKAGE

Ai phdt hi$n ra?Detected by whom?

Ph& hi?n khi n&o? When was it detected?

. »» ' 4\* 4 •t/

» •

40

D214m gi dS lo^i tni/h^n ch4 r6 ri?What was done to stop/minimize the leakage?

14$

146 Neu miic dO r6 ri, n£u c6 th6Indicate, if possible, the size of the leakage.

147 C&c h§u qua do r6 ri?What consequences had the leakage?

148 N€u nguy&i nhSn cua rd ri, n6u c6 th^Indicate, ifpossible, the cause of the leakage

F. Diln trong trirdug hgp tai nan Wdo hir hdng miy chfnh F. To be filled in if the accident was/caused engine failure

149 MS t& hu hing Describle the damage

Hu hong da b3t diu xdy ra 6 b$ ph§n ho$c h$ thdng nio?In which component or system did the damage initially occur?

ISO

h6ng mAyCdc th6ng s6 thu@t ciia bp ph$n/h$ thong n6i trfin? (Nhi sdn xuit, lo@i, so hi$u, tu6i,.v.v..)Technical data for component/system where the damage occurred (manufacturer, type, mark, age.etc.)

151 ENGINE FAILURE

Thdi gian ciia lln gidm dinh phan cap, kilm tra ho$c cdc cuOc kiem tra kMc?When was the component/system the latest time classed, inspected/surveyed or other wise controlled by an outside?

152

41

Hu hdng dS du^c phit hi$n nhu th4 nio? How was the damage detected?

153 Ai dS ph&t hi§n ra? By whom?

Khindo?When?

Cd ngucri trvc ca buong mdy khi hu hdng xdy rakhSng?Was the machinery space manned when the damage occurred?

154 Ai da ho$c Ian cuoi b trong buong mSy trudc khi hu hdng xdy ra?Who was, or who had last been in the machinery space before the damage occurred

*□ C6 □ KhongYes No

Nfeu dien bien cac su vi$c theo trtnh t\r thiji gian, n^u c6 th£Give, ifpossible, a description of the course ofevents in chronological order

1SS

Da lim gi de h^n che hu hdng?What was done to limit the extent of the damage?

156

157 N£u nguySn nhan hu hdng, neu cd theIndicate, ifpossible, the cause ofthe failure damage

NhOng hu hdng cd thd lien quan tdiCan the failure damage referred to□ Thi4u sdt trong ch4 d$ bdo dudng Faulty maintenance routines□ Cdc thilu sdt gidm sdt khdc:

□ bio dudng dupe thiet lip Other supervision failure

158

□ Ihi4u sdt trong h$ thSng gidm sit lure in supervision systems or instruments

□ ho$c thiet bj giim sitmaintenance routines had not been followed

□ Khdng tu&n thu cic quy trinh That established

G. Bien trong trirtmg hgp tai nan gay thiromg t$t/nhiem d$c/chet G. To be filled in if the accident caused injury/poisoning/death

BJTHUONGINJURED

NHIEMDOCPOISONED

MATHCHDISAPPEARED

CHETDEAD

BJ THtfONG/nhiEmdoc/

CHET ThuySn viSn Crew members

159

-•V , 4

42

160 1NJURY/POISONI H&nh kh£ch PassengersNG/

HEATH161 Nhung ngufri khdc tr6ntiu Other persons onboardNhttng ngudi khdc ngoM t&uPersons outside theship

162 Tai n^n/thi^t h^i phdt sinh tr\rc ti6p tircdc sy co khickhongWas the accident/damage directly caused by another

Ho$c li6n quan d^n sai s6t/t6n thdt chung/tiu dim (curu hoi, lai k6o,.v.v...)Or in connection with failure/average/shipwreck (fire extinguishing, towing, etc)

□ C6 □ KhSngYes Nooccurrence

□ C6 □ KhfingYes No

Tai n?n x4y ra lien quan den vi$c so t&n khoi td.u khdng Did the accident occur in connection with evacuation of the ship

163 N4u tai n?n trong khi l&m vi?c, xiy ra d vj tri lim vi$c nio?If a working accident, where took the work place?

□ C6 □ KhfingYes No

Ngufri bj thucng/chet c5 nhi?m v\i gi khi tai n^n xay ra? ~Which duty had the injured/dead person when the accident occurred?

164

165 Ai Ifnh 14m vice d<5? Who ordered the work?

Ai chi huy vi?c d6? Who lead the work?

166 C6 quy djnh b4o h0/an to4n d$c bi0t n4o khdng?Existed special safety/protection provisions for the work in question?

Nhtfng quy djnh n4y c6 dugc tufin thu khdng? Were these provisions followed?

□ C6 □ Khdng□ C6 □ Khdng Yes No

Yes NoNhung h? thong bio h0/an to4n cd tho4 m3n khdng? Were the safety/protection arrangements satisfactory?

□ Cd □ Khdng

Ban an toin cua t&u cd xem xdt cic di^u ki0n 14m vide trade khi x&y ra tai n?n khdng?Were the working coditions before the accident considered by the safety committee?

□ Cd □ Khdng

167

Yes No Yes NoMd t4 c4c khi£m khuydt lien quan ddn bio h0/an to4n, v41^ do t$i sao khdng duerc tu4n thu c4c quy d}nhDesrcible deficiencies concerning safety/protection, if any, and the reason why the provisions were not complied with

168

169 Ndu cd, da quydt djnh c4c bi0n ph4p gi?If yes, what measures were decided?

Ban an to4n cua t4u d4 xem xdt tai nan chua?

43

C&c bi$n phdp niy d3 du<?c ip dyng nhu the n&o Have these measures been taken

Has the accident been considered by the safety committee

□ C6 □ Khdng □ MQt ph£n Yes NoPartly

O C6 O KhdngYes No

N£u 1& mOt ph^n, n6u r5If partly, indicate which

170

N^u tai n^n xiy ra trong cac kit/khoang kin ho$c kit/khoang kin ISn c$n,n£u hing hoi/cdc thft b6n trong cic khoang n&yIf the accident occurred in or in the neighbourhood ofa tank/enclosed space, indicate then cargo/content in these space

Hing hoi/cic thfr ben trong cua chuy&n tmdc Previous cargo/content

171

M6 ti quy trinh v§ sinh, bom vh do n6ng dp khf. Ndu thdi gian su dyng cho cic cdng vifc <36Describle the procedures for cleaning, pumping and gas measuring. Indicate the time use for that work

172

D2 ip dyng phuong phip do nio nhim kiem soit lugmgWas gas measuring made in order to control the amount of

□ Khldoc Poisonous gas

173

□ Khfdlchiy Flammable gas

□ Khloxy Oxygen

Vi?c do da dugc ti£n hinh D Trade khi xiy ra tai nanGas measuring was made Before the accident Aido

174 □ Sau khi xiy ra tai n?n After the accident

Ai doBy whom By whom

Trj so do Trj s6 do Value read Value read

Nhi sin xuit vi lo^ti thidt bj do, nSu ca que thu va ngiy/thing sir dyng l&n gan nh^t Ngiy ki^m tra thilt bj g^n nh^tMeasuring instrument manufacturer and type, indicates also type of measuring dips The instrument's latest control dateused and its last date/month of use

175

176 Cic trang bj bio h§ ci nhin ci du?c su dyng khong? Was personnel protection equipment used?

□ Khdng□ C6Yes No

M6 ti cic thidt bj bio h0 di su dyng vi cic khi£m khuylt n^u cdDecrible the protection equipment used and any deficiencies, if any

177

4,i ♦

44

178 Li?u tai n§n c<3 Hen quan den hir h6ng kit cku, h$ thong vk thi4t bj cua t^u?Can the accident be related to faults in the ships' construction, arrangement or equipment? □ C6 □ Khdng

Yes NotT9 Nlu c6, n6u chi tidt

If yes, give a detailed description

180 Tinh tr^ng sure kho6 v& tinh thdn ciia ngudd bj thucmg/ch&t c61^ nguySn nh§n din d^n tai n^n ho$c l^tm cho h$u qud cua n6 trd nln nghiem trgng ban (say, chdn n^n.v.v.TJHas the physical or psychical condition ofthe injured/dead person contribute to that the accident or its consequences has been more serious (alcohol, depression, etc)□ C6 □ Khdng

Yes No181 Trong tnrfrng hgp chdt do 6m ho$c nhiixn dpc, neu thdi gian lln dugre b&c si khim g^in nhlt

In the case of death caused by sickness or poisoning, indicate the time when the person was last examined by a doctor

182 C6 diem gi d&ng luu y vd tinh tr^ng siic khod cua ngirtri trude khi bj thucmg/ch6t?Were there anything noteworthy in respect of the person's health condition before the injury/death?

183 Khi n&o phit hi$n ra ngufiri d6 bj 6nvhj thuong/nhilm dOc/ch^t?When was it detected that the person was sick/injured/poisoned/dead?

Trong tnrimg hgp bj nhiem dpc, t^ii sao chit d0c c6 trdn t^u?In the case of poisoning, why was the substance on board?□ Chit <16 dupe v$n chuyen tren t&u □ Da sii dyng trong qua trinh bio duOng □ Do ede myc dich d^c bl§t □ Khdng bilt The substance carried as cargo Was used during maintenance Procured for special purposes Unknown

184

Ngudi d6 da tidp xuc v6i chdt d$c d6 nhu thd ndo?How came the person in contact with the substance?

185

Chat d6 dupe cdt giQ tren t&u nhu th§ ndo?How was the substance stored on board?

186

Trdch nhi?m doi v6i vide cdt gitt chdt d6 trdn tdu nhuth6 ndo?How was responsible for the storage of the substance?

187

Ngudi bj thuong/ch£t c6 bidt chdt d6 khdng?Was the injured/dead person familiar with the substance□ C6 □ Khdng □ Khdng bi£t

No Do not know

Nhu thd ndo? How?

188 Cdc bao ki$n c6 dupe ddnh dlu khdng?Was the packaging marked? □ C6 □ Khdng

Yes Yes NoMo td kMi qudt qud trinh diin bidn ede sy kifnGive a comprehensive description of the course ofthe event

189

45

H. Dien trong tnrimg hgrp tai nan gfiy 6 nhiem/x& thii H. To befilled in if the accident caused pollution/discharge

Lo^i 6 nhilm {Neu rO d$c tinh ky thu^t, tinh chat cua chat thdi ra)Type ofpollution (technical and characteristic designation of the discharge substance)

190

0 nhiem x&y ra liSnquan den Did the pollution occur in connection with

□ Dim vaCollision

□ Boc/dd hlng □ Dichuyenhlng ho|c nhien li$u transfer of cargo or bunker

191 □ Nh|n nhien □ Nhln chlm ngoli bi£nDumping in open sea

□ V§ sinhlieu

Loading/unloading Bunkering Tankcleaning

□ MIc c?nGrounding

□ I4tdpCapsting

□ Hu hdngthiet bjEquipmentfailure

□ RdriLeakage

□ Clc nguyen nhan khlcOther cause

Vi|c thli c6 phli do thi&u sdt trong qul trinh v|n hlnh thifet bjtrln Hu khong?Was the discharge caused byfailty handling of equipment on board?

Neu chit thli II dlu hole hlng hoi nguy hiem, tau c6 dirge cap gily chimg nh|n cho lo«u hlng db kh6ng?If the discharge consisted ofoil or hazardous cargo, was the ship provided with a valid certificate for such cargo?

□ C6 □ Khong

191

Yes No□ C6 □ Khong6 NHIEM/

Yes NoTHAINeu s6 lining thli, litIndicate the amount discharge in litre

N£u kich thude ciia v|t dlu ho$c clc chat 16ng doc h^i khlcIndicate the size of oilslick or other liquid hazardous substance

193

POLLUTION/DISCBARGE M3 ta vi$c thli dS xly ra nhu th^ nlo

Describle how the discharge occurred194

Ai dl llm gi nhim hon chl/ngfrng vice thli hole nhim h&n chi su lan r3ng?Who was doing in order to minimize/stop the discharge or in order to limit the spreading? D3 thong bio v£ vi$c thli cho ai vl nhu the nlo?Who were notified concerning the discharge and how?

195

Blo do vi§c x! thli dldugc giiiReport on the discharge sent

196 NglyDate

Thdi gian Time

Cho NgudiguiTo By

%i'y s

46

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(Ban hanh kem theo Thong tu sd 01/TT-BGTVT ngay 20 thdng 01 ndm 2020 cua Bq trucmg B$ Giao thong vgn tdi)

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thinrag (ngtrM)

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I. Trong 36 chia ra:

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■Mit tich b/ Hang h6a:

■ Bam va

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• MSc can fzJ Chi phi sura chuu• Chdy

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• Lpt tjm

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• Tai npn khdcngdy.... thdng.... ndm 20....(Ky ten, ddng ddu)