Haw. Code R. § tit. 13, subtit. 11, pt. 1, ch. 231, subch. 5, exh. B
Each item shall meet applicable U.S. COAST GUARD, AMERICAN BOAT & YACHT COUNCIL STANDARDS AND DEPARTMENT OF LAND AND NATURAL RESOURCES ADMINSTRATIVE RULES.
| INSPECTION ITEM | PASSED | NOT PASSED | N/A | REMARKS |
| CERTIFICATE/DOCUMENT ABOARD | ||||
| REG/DOC NO. PROPERTY DISPLAYED | ||||
| MFC S SER. NO. DISPLAYED | ||||
| SAFETY EQUIPMENT | ||||
| PFD' S | ||||
| VISUAL DISTRESS SIGNAL(S) | ||||
| HORN, WHISTLE AND/OR BELL | ||||
| PLACARDS: TRASH, OIL | ||||
| FIRE EXTINGUISHER(S) | ||||
| PROPER LIGHTS | ||||
| BILGE PUMPING DEVICE | ||||
| OIL IN BILGE | ||||
| OIL ABSORBENT PADS OPERATIVE | ||||
| OTHER FUELS PROPERLY VENTED | ||||
| PROPULSION | ||||
| ENGINE ABOARD | ||||
| ENGINE OPERATIVE/APPROP. SIZE | ||||
| BACKFIRE FLAME ARRESTER | ||||
| ENGINE COMPARTMENT VENTILATED | ||||
| FUEL COMPARTMENT VENTILATED | ||||
| EXHAUST SYSTEM | ||||
| SPARS OPERATIVE | ||||
| RIGGING OPERATIVE | ||||
| APPROPRIATE SAILS ABOARD | ||||
| MARINE SANITATION DEVICE ABOARD | ||||
| HOLDING TANK - TYPE | ||||
| FLOW THROUGH | ||||
| PROPERLY INSTALLED | ||||
| ADEQUATE STEERING/RUDDER OPER. | ||||
| HULL/PROP/RUDDER CLEAN FOR USE | ||||
| ADEQUATE EXITS | ||||
| UNSECURED OPEN' GS/HULL/DECK/CAB | ||||
| RECONSTRUCTION/SURVEY/INSURA NCE | ||||
| CHAFE GEAR | ||||
| GROUND TACKLE | ||||
| GENERAL APPEARANCE | ||||
| REASONABLE CLEANLINESS | ||||
| ANIMAL ABOARD | ||||
| HOW MANY LIVING ABOARD? |
COMMENTS: ________________________________________________
___________________________________________________________
___________________________________________________________
_____________________________
I inspected the vessel described on the front of this form on _______ 20_____ at ____ (AM)
(PM) at ________________________. I have observed the vessel described on the front of this form move by its own propulsion (POWER/SAIL), at an adequate speed indicating that the vessel was in good operating condition, from _______________ to _________________, the route designated by the harbor agent for this vessel. I have personally inspected every item on the checklist on the front and reverse side of this form for the vessel described therein and (CONSIDER / DO NOT CONSIDER) it to be in good material and operating condition in accordance with the requirements contained in the Hawaii Administrative Rules, Department of Land and Natural Resources, State of Hawaii. I further certify that the vessel's length (end to end over deck: LOD) is _____ feet _____ inches; and length overall (including extension such as bowsprit: LOA) is ____ feet _____ inches.
Date signed: __________ Signature: ____________
Name typed or printed: ________________________________________
Company Name: _____________________________________________
Address: ________________________________________________
City: _________________________ State: ___________________
Zip: _____________
Contact Phone No: _______________________________________
PERMIT NO. ______________________PERMIT EXPIRATION
DATE: ___________
Haw. Code R. tit. 13, subtit. 11, pt. 1, ch. 231, subch. 5, exh. B