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1 July 2012

Assessment of Sea Service

Marine Safety Act 2010 (Vic), Marine Safety Regulations 2012(Vic), National Standard for Commercial Vessels: Part D

Things to know before having your sea service assessed

You can use this form at anytime to have your sea service assessed by TSV to determine if you meet the sea service requirements for a certificate of competency. Alternatively, your sea time can be assessed by using the online Sea Time Calculator available at www.transportsafety.vic.gov.au

Your details (the applicant)

1. Surname Given names

2.

Date of birth (dd/mm/yyyy)

City or town of birth

State

Country

Australia or specify

3.

Gender Male Female

Height (centimetres)

Eye colour Blue Brown Green Grey Hazel

4.

Hair colour Black Blonde Brown Grey Red Bald Other (specify):

5.

Residential address Street number and name Suburb State Postcode

6.

Postal address Same as residential address OR street number and name/PO box Suburb State Postcode

7.

Mobile number Email

Daytime telephone number Same as mobile OR ( ) Fax number (if applicable) ( )

Type of certificate
8. What type of certificate of competency would you like to be assessed for? (choose all that apply) Deck Engineering Coxswain Master 5/Skipper 3 Master 4 Master 3 Telephone 1800 223 022 Fax 03 9655 6611 Email information@transportsafety.vic.gov.au Mate 4 Skipper 2 Skipper 1 Engineer class 3 MED 3 MED 2 MED 1 PO Box 2797 Melbourne VIC 3001 121 Exhibition Street, Melbourne VIC 3000
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Inland Waters Coxswain Master 5

Sea service
9. Provide details of your sea service in the table below, starting with the most recent service. If you need more space, attach a separate sheet with the details below or copy this table as needed and attach. Details of Details of service on vessel operation Details of vessel (include the split (days) between deck crew (see legend below and
insert relevant letter/s or number/s) and engine crew service)
No. of days on this vessel as deck crew No. of days on this vessel as engine crew

Name and number

Length in metres

Power (kW)

Type of engine (inboard/ outboard)

Area

Type

Duties

Date from

Date to

Total no. of days on this vessel

Totals Details of operation legend

Area U Unlimited / foreign going A Within 1000 miles of the coast B Within 100 miles of the coast C Within 15 miles of the coast D - Sheltered waters E Inland waters Type 1 Passenger 2 Non passenger 3 Fishing 4 Recreational 5 Government 6 Search and rescue Duties L In command M Watchkeeper in charge of watch at sea N Senior deckhand/boatswain P Deckhand only Q Deckhand including steering watch S In charge of machinery (non exclusive) T V W X Assistant engineer (exclusive) Assistant engineer (non-exclusive) General engineering duties only General purpose hand (deck and engine room) Y Diver only Z Duties not included above (cook, bar staff etc)

Calculating power

1 kilowatt = 1.341 horsepower (hp) Horsepower x 0.746 = kilowatts (kW)

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Declaration and signature

10. Applicant declaration and signature I declare that: I have undertaken and completed the sea service as described in this application. the particulars supplied on this application form and any attachments are true and correct. I understand it is an offence under section 305 of the Marine Safety Act 2010 (Vic) to provide any false or misleading information and that penalties apply. Signature of applicant Date

X
Attachments
There are no mandatory attachments required but if you have a fully completed ROPES manual (all tasks completed) and attach it, the overall sea service required could be reduced by up to 50 per cent.

How to lodge
Send your completed application by post to PO Box 2797 Melbourne VIC 3001.

What happens next?

TSV will assess the information you have provided. An assessment can take two-four weeks depending on complexity. After completing the assessment, TSV will provide you with a written assessment report.

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Privacy: Transport Safety Victoria (TSV) collects and holds the personal information provided in this application to assist the Director, Transport Safety (Safety Director) to administer the Marine Safety Act 2010 (Vic) and Marine Safety Regulations 2012 (Vic). TSV is committed to protecting personal information in accordance with its obligations under the Marine Safety Act 2010(Vic). The personal information provided in this application may be disclosed to other government agencies in accordance with section 306 of the Marine Safety Act 2010(Vic) and section 177 of the Transport Integration Act 2010 (Vic). It is an offence under the Marine Safety Act 2010 (Vic) to give information that is false or misleading in order to obtain or attempt to obtain a certificate. The individuals whose personal information is collected on this application have a right to seek access to this personal information and to seek correction of any error in the personal information held. All individuals whose personal information is included with this application should be informed of this fact. For more information on privacy please refer to TSV's privacy statement at www.transportsafety.vic.gov.au/privacy.

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