Form Ansc7012 "Vessel Safety Check (Vsc)"

Form ANSC7012 or the "Vessel Safety Check (vsc)" is a form issued by the United States Coast Guard.

The form was last revised in April 1, 2008 and is available for digital filing. Download an up-to-date Form ANSC7012 in PDF-format down below or look it up on the United States Coast Guard Forms website.

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VESSEL SAFETY CHECK (VSC)
Date of VSC: ____________
To be completed by a U.S. Coast Guard approved Vessel Examiner.
Decal Awarded: Yes
No
See the back of this form for a brief explanation of required items.
A Federal Requirements pamphlet is also available.
VESSEL INFORMATION:
Owner/Operator Name:
Registration or
_________________________________________
Documentation Number: ______________________
Owner/Operator has attended a CGAUX, USPS, State
HIN: ______________________________________
or ____________ Boating Safety Class: Yes
No
Length: <16
16-25
26-39
40-65
>65
Location of VSC - County: ____________ State: ____
Powered by: Gas
Diesel
Sail
Other
Area of Operations: Inland
Coastal
Replaced decal was: Last Year
Outdated
First time
Type: PWC
Open
Cabin
Other
RECOMMENDED AND DISCUSSION ITEMS
VESSEL SAFETY CHECK DECAL REQUIREMENTS
(While encouraged, items below are not VSC requirements)
Item
Item
Yes No N/A
Yes No
1. Display of Numbers
I.
Marine Radio
2. Registration/Documentation
II.
Dewatering Device & Backup
3. Personal Flotation Devices (PFD)
III. Mounted Fire Extinguishers
4. Visual Distress Signals (VDS)
IV.
Anchor & Line for Area
5. Fire Extinguishers
V.
First Aid and PIW Kits (**over)
6. Ventilation
VI. Inland Visual Distress Signals
7. Backfire Flame Control
VII. Capacity/Certificate of Compliance
8. Sound Producing Devices/Bell
VIII. Discussion Items: as applies
9. Navigation Lights
a. Accident Reporting - Owner Responsibility
10. Pollution Placard
b. Offshore Operations
11. MARPOL Trash Placard
c. Nautical Charts / Navigation Aids
12. Marine Sanitation Devices
d. Survival Tips / First Aid
13. Navigation Rules
e. Fueling / Fuel Management
14. State and/or Local Requirements
f. Float Plan / Weather & Sea Conditions
15. Overall Vessel Condition: as applies
g. Insurance Considerations
a. Deck Free of Hazards / Clean Bilge
h. Boating Check List
b. Electrical - Fuel Systems
i. Safe Boating Classes
c. Galley - Heating Systems
j. Maritime Domain Awarness
I certify that I have personally examined this vessel and find it meets the above requirements at the time of this Vessel Safety Check. I
am a qualified Vessel Examiner of the: CGAUX
, USPS
, State of __________________
, or _______________________
.
Printed Name of the Examiner ________________________________ Examiner Number _____________
Examiner Signature __________________________________ Telephone Number _____________________
Additional Comments: This is not an official boarding for law enforcement purposes. It is recommended that you correct any deficiencies noted. This
checklist is furnished for your information. There is no assumption of liability of any kind for advice given or opinions expressed in connection to this
examination. By accepting the Vessel Safety Check decal you are pledging to maintain your boat and equipment to the standard of safety exhibited
during this examination. Please remove the Vessel Safety Check decal if the boat is sold or no longer meets these requirements.
I am consenting to this Vessel Safety Check of my watercraft with full knowledge that it is provided to me as a public service on a volunteer basis
without cost, and I understand and agree that my receipt of a Vessel Safety Check shall not constitute or be construed as a warranty or guarantee
as to either the qualification, knowledge, or skills of the operator; the seaworthiness of the vessel; or the serviceability or adequacy of any
equipment on board.
Owner/Operator Signature: ________________________________________________________________ Date: _________________________
ANSC7012 (4-08) Previous edition may be used
VESSEL SAFETY CHECK (VSC)
Date of VSC: ____________
To be completed by a U.S. Coast Guard approved Vessel Examiner.
Decal Awarded: Yes
No
See the back of this form for a brief explanation of required items.
A Federal Requirements pamphlet is also available.
VESSEL INFORMATION:
Owner/Operator Name:
Registration or
_________________________________________
Documentation Number: ______________________
Owner/Operator has attended a CGAUX, USPS, State
HIN: ______________________________________
or ____________ Boating Safety Class: Yes
No
Length: <16
16-25
26-39
40-65
>65
Location of VSC - County: ____________ State: ____
Powered by: Gas
Diesel
Sail
Other
Area of Operations: Inland
Coastal
Replaced decal was: Last Year
Outdated
First time
Type: PWC
Open
Cabin
Other
RECOMMENDED AND DISCUSSION ITEMS
VESSEL SAFETY CHECK DECAL REQUIREMENTS
(While encouraged, items below are not VSC requirements)
Item
Item
Yes No N/A
Yes No
1. Display of Numbers
I.
Marine Radio
2. Registration/Documentation
II.
Dewatering Device & Backup
3. Personal Flotation Devices (PFD)
III. Mounted Fire Extinguishers
4. Visual Distress Signals (VDS)
IV.
Anchor & Line for Area
5. Fire Extinguishers
V.
First Aid and PIW Kits (**over)
6. Ventilation
VI. Inland Visual Distress Signals
7. Backfire Flame Control
VII. Capacity/Certificate of Compliance
8. Sound Producing Devices/Bell
VIII. Discussion Items: as applies
9. Navigation Lights
a. Accident Reporting - Owner Responsibility
10. Pollution Placard
b. Offshore Operations
11. MARPOL Trash Placard
c. Nautical Charts / Navigation Aids
12. Marine Sanitation Devices
d. Survival Tips / First Aid
13. Navigation Rules
e. Fueling / Fuel Management
14. State and/or Local Requirements
f. Float Plan / Weather & Sea Conditions
15. Overall Vessel Condition: as applies
g. Insurance Considerations
a. Deck Free of Hazards / Clean Bilge
h. Boating Check List
b. Electrical - Fuel Systems
i. Safe Boating Classes
c. Galley - Heating Systems
j. Maritime Domain Awarness
I certify that I have personally examined this vessel and find it meets the above requirements at the time of this Vessel Safety Check. I
am a qualified Vessel Examiner of the: CGAUX
, USPS
, State of __________________
, or _______________________
.
Printed Name of the Examiner ________________________________ Examiner Number _____________
Examiner Signature __________________________________ Telephone Number _____________________
Additional Comments: This is not an official boarding for law enforcement purposes. It is recommended that you correct any deficiencies noted. This
checklist is furnished for your information. There is no assumption of liability of any kind for advice given or opinions expressed in connection to this
examination. By accepting the Vessel Safety Check decal you are pledging to maintain your boat and equipment to the standard of safety exhibited
during this examination. Please remove the Vessel Safety Check decal if the boat is sold or no longer meets these requirements.
I am consenting to this Vessel Safety Check of my watercraft with full knowledge that it is provided to me as a public service on a volunteer basis
without cost, and I understand and agree that my receipt of a Vessel Safety Check shall not constitute or be construed as a warranty or guarantee
as to either the qualification, knowledge, or skills of the operator; the seaworthiness of the vessel; or the serviceability or adequacy of any
equipment on board.
Owner/Operator Signature: ________________________________________________________________ Date: _________________________
ANSC7012 (4-08) Previous edition may be used
Back of ANSC7012 (4/08)
❏ ❏ ❏ ❏ ❏ 8. SOUND PRODUCING DEVICES:
Brief Explanation of VSC Required Items:
To comply with Navi-
gation Rules and for distress signaling purposes all boats must carry a sound
❏ ❏ ❏ ❏ ❏ 1. NUMBERING:
producing device (whistle, horn, siren, etc.) capable of a 4-second blast au-
The boat’s registration number must be per-
dible for ½ mile. Boats larger than 39.4 ft. are also required to have a bell
manently attached to each side of the forward half of the boat characters
(see Navigation Rules.)
must be plain, vertical, block style, not less than three (3) inches high, and in
a color oontrasting with the background. A space or hyphen must separate
❏ ❏ ❏ ❏ ❏ 9. NAVIGATION LIGHTS:
All boats must be able to dis-
the letters from the numbers. Place State validation sticker according to State
play navigation lights between sunset and sunrise and in conditions of re-
policy. (e.g. FL 1234 AB or FL-4234-AB)
duced visibility. Boats 16 feet or more in length must have properly in-
❏ ❏ ❏ ❏ ❏ 2. REGISTRATION/DOCUMENTATION:
Registration
stalled, working navigation lights and an all- around anchor light capable of
being lit independently from the red/green/white “running” lights.
or Documentation papers must be on board and available. Documentation
numbers must be permanently marked on a visible part of the interior struc-
❏ ❏ ❏ ❏ ❏ 10. POLLUTION PLACARD:
Boats 26 feet and over with a
ture. The documented boat’s name and hailing Port must be displayed on the
machinery compartment must display an oily waste “pollution” placard.
exterior hull in letters not less than 4 inches in height.
❏ ❏ ❏ ❏ ❏ 11. MARPOL TRASH PLACARD:
❏ ❏ ❏ ❏ ❏ 3. PERSONAL FLOTATION DEVICES (PFDs):
Boats 26 feet and over
Ac-
in length, operating in U.S. navigable waters, must display a “MARPOL”
ceptable PFDs (also known as Life Jackets) must be U.S. Coast Guard ap-
trash placard. Oceangoing boats 40 feet and over must also have a written
proved and in good, serviceable condition. A wearable PFD of suitable size
trash disposal plan available onboard.
is required for the each person on the boat. Children must have properly
fitted PFDs designed for children. Wearable PFDs shall be “readily acces-
❏ ❏ ❏ ❏ ❏ 12. MARINE SANITATION DEVICE:
Any installed toilet
sible.” Boats 16 Feet or longer, must also have one Type IV (throwable)
must be a Coast Guard approved device. Overboard discharge outlets must
device, which shall be “immediately available.” PFDs shall NOT be stored
be capable of being sealed.
in unopened plastic packaging. For Personal Watercraft riders, the PFD must
❏ ❏ ❏ ❏ ❏ 13. NAVIGATION RULES:
be worn. An impact rating is recommended, but not required.
Boats 39.4 feet and over must have
on board a current copy of the Navigation Rules.
❏ ❏ ❏ ❏ ❏ 4. VISUAL DISTRESS SIGNALS:
Recreational boats 16
❏ ❏ ❏ ❏ ❏ 14. STATE AND LOCAL REQUIREMENTS:
feet and over used on coast waters or the Great Lakes are required to carry a
These re-
minimum of either 1) three day and three night pyrotechnic devices, 2) one
quirements must be met before the “Vessel Safety Check” decal can be
day non-pyrotechnic device (flag) and one night non-pyrotechnic device (auto
awarded. A boat must meet the requirements of the state in which it is being
SOS light) or 3) a combination of 1) and 2). Recreational boats less than 16
examined.
feet on coastal waters or the Great Lakes need only carry night visual dis-
❏ ❏ ❏ ❏ ❏ 15. OVERALL BOAT CONDITION:
As it applies to this
tress signals when operating from sunset to sunrise.
Vessel. Including, but not limited to:
It is recommended, but not required, that boats operating on inland waters
should have some means of making a suitable day and night distress signal.
a.
Deck free of hazards and clean bilge -
The boat must be
The number and type of signals is best judged by considering conditions
free from fire hazards, in good overall condition, with bilges reasonably clean
under which the boat will be operating.
and visible hull structure generally sound. The use of automobile parts on
boat engines is not acceptable. The engine horsepower must not exceed that
❏ ❏ ❏ ❏ ❏ 5. FIRE EXTINGUISHERS:
Fire extinguishers are required
shown on the capacity plate.
if one of the following conditions exists: 1) Inboard engine(s); 2) Double
bottom hulls not completely sealed or not completely filled with flotation
b.
Electrical and Fuel Systems:
The electrical system must be
materials 3) Closed living space 4) Closed stowage compartments that con-
protected by fuses or manual reset circuit breakers. Switches and fuse panels
tain flammable materials or 5) Permanently installed fuel tanks. Recreational
must be protected from rain or water spray. Wiring must be in good condi-
boats less than 26 feet, and propelled by outboard motors are NOT required
tion, properly installed and with no exposed areas or deteriorated insulation.
to have fire extinguishers unless one or more of the conditions (2-5) listed
Batteries must be secured and terminals covered to prevent accidental arc-
above applies. NOTE: Fire extinguishers must be readily accessible and
ing.. If installed, self-circling or kill switch mechanism must be in proper
verified as serviceable.
working order. All PWCs require an operating self circling or kill switch
mechanism.
Minimum number of extinguishers required
Fuel Systems - Portable fuel tanks (normally 7 gallon capacity or less)
must be constructed of non-breakable material and free of corrosion and leaks.
Boat
No Fixed
With Fixed
Length
System
System
All vents must be capable of being closed. The tank must be secured and
have a vapor-tight, leak-proof cap. Each permanent fuel tank must be prop-
Less than 26'
one B-1
0
erly ventilated.
26' to less than 40' two B-1 or one B-2
one B-1
40' to 65'
three B-1 or
two B-1 or
c.
Galley and Heating Systems -
System and fuel tanks must
one B-1 & one B-2
one B-2
be properly secured with no flammable materials nearby.
❏ ❏ ❏ ❏ ❏ 6. VENTILATION:
Boats with gasoline engines in closed com-
I - VIII. RECOMMENDED AND DISCUSSION ITEMS:
partments, built after 1 August 1980 must have a powered ventilation sys-
(Not required for the award of the “Vessel Safety Check” decal). For the
tem. Those built prior to that date must have natural or powered ventilation.
very best boaters, we recommend these additional items. Meeting these re-
Boats with closed fuel tank compartments built after 1 August 1978 must
quirements reflects your concern for Boating Safety.
meet requirements by displaying a “certificate of compliance.” Boats built
** Person in the Water (PIW) kit consists of one extra wearable PFD
before that date must have either natural or powered ventilation in the fuel
and a throwable type IV PFD w/line.
tank compartment.
❏ ❏ ❏ ❏ ❏ 7. BACKFIRE FLAME ARRESTER:
All gasoline pow-
For more information: Ask your Vessel Examiner,
ered inboard/outboard or inboard motor boats must be equipped with an
Visit http://SafetySeal.net
approved backfire flame control device.
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