Dromon Bureau of Shipping Automatic Identification System (AIS) Survey

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SWP05/Form 08
Automatic Identification System (AIS) Survey

Assignment No.

Name of Ship IMO Number Flag

Type of Ship Gross Tonnage Distinctive Number of Letters

This is to confirm that the following survey has been conducted on board the above mentioned ship:

Survey Scope:

Survey Code Survey Scope Result

Survey findings:

Number Finding Due date

THIS IS TO CONFIRM:
The AIS has been tested in accordance with IMO SN/Circ.227 as amended, Resolution MSC.74(69), Annex 3 and
MSC.1/Circ.1252.

Radio Surveyor

Place of Surveyor

Surveyor started

Surveyor completed
(Radio Surveyor's Signature & Stamp)

SWP05/Form 08 Revision Initial Page 1 of 3

Dromon Bureau of Shipping Automatic Identification System (AIS) Survey
www.dromon.com

Remarks /
No. Item Reference Addressed
Comments
Installation details:
1.1 AIS transporter type:
1.2 Type approval certificate available Yes No N/A
on board[2].
1.3 Initial installation configuration Yes No N/A
report on board[2].
1.4 Drawings provided? (Antenna, AIS- Yes No N/A
arrangement and block diagram)
1.5 Main source of electrical power Yes No N/A
found in order.
1.6 Emergency source of electrical Yes No N/A
power found in order.
1.7 The capacity has been verified if Yes No N/A
the AIS is connected to a battery.
1.8 Pilot plug has been found near Yes No N/A
pilots operating position.
AIS programming (Static Information)
2.1 MMSI number has been Yes No N/A
programmed.
2.2 IMO number has been Yes No N/A
programmed.
2.3 Radio call sign has been Yes No N/A
programmed.
2.4 Name of ship has been Yes No N/A
programmed.
2.5 Type of ship has been Yes No N/A
programmed.
2.6 Ship length and beam has been Yes No N/A
programmed.
2.7 Location of GPS antenna. Yes No N/A
AIS programming (Dynamic information)
3.1 Ships position has been Yes No N/A
programmed with accuracy and
integrity status.
3.2 Time in UTC. Yes No N/A
3.3 Course over ground (COG). Yes No N/A
3.4 Speed over ground (SOG). Yes No N/A
3.5 Heading. Yes No N/A
3.6 Navigational status. Yes No N/A
3.7 Rate of turn (ROT), where Yes No N/A
available.
3.8 Angle of heel, pitch and roll, where Yes No N/A
applicable.
AIS programming (Voyage related information)
4.1 Ships draught. Yes No N/A
4.2 Type of cargo. Yes No N/A
4.3 Destination and ETA (as masters Yes No N/A
discretion).
4.4 Rout plan (optional). Yes No N/A
4.5 Short safety-related messages. Yes No N/A
Performance test using measuring instrument
5.1 Frequency measurements, AIS Yes No N/A
Ch.1 and 2, GMDSS Ch. 70.
5.2 Transmitting output, AIS Ch.1 and Yes No N/A
2, GMDSS Ch. 70
5.3 Polling information ch.70 Yes No N/A
5.4 Read data from AIS. Yes No N/A
5.5 Send data to AIS. Yes No N/A
5.6 Check AIS response to “virtual Yes No N/A
vessels”.

SWP05/Form 08 Revision Initial Page 2 of 3

Dromon Bureau of Shipping Automatic Identification System (AIS) Survey
www.dromon.com

Remarks /
No. Item Reference Addressed
Comments
5.7 Check Error log, if available and Yes No N/A
access if possible, for entries since
last test.
5.8 Check operation without external Yes No N/A
GPS by disconnecting antenna.
Performance test
6.1 Reception performance has been Yes No N/A
checked.
6.2 Reception of own signal from other Yes No N/A
ship/VTS has been confirmed.
6.3 Polling by VTS/shore installation. Yes No N/A
7 The electromagnetic interference Yes No N/A
from AIS has been observed to
other installations.
Notes:

[2] To be checked at initial survey, after installation.

Remarks

SWP05/Form 08 Revision Initial Page 3 of 3