Certificate of Inspection
Inflatable Lifejacket
Name of Vessel:
IMO Number:
Owner/Manager:
Flag:
Classification Society:
Type of Vessel:
Place of Service:
Date of Service:
Next Service:
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The equipment specified below has been inspected and serviced by qualified personnel.
Inflatable Lifejacket Details
Rows
Manufacturer
Model / Type
Serial Number
Single / Twin
Light Exp.
CO2 cartridge Type
01
02
03
04
05
06
07
08
09
10
Description of Inspection / Tests:
Rows
carried out/checked
not carried out
not applicable
Overall condition
Crutch strap
Reflective tape
Automatic emergency light
Whistle
Oral tubes
Condition of CO2 cartridges
Release mechanism
Water activated device
Water-Air tightness
Woell Marine Stamp & Signature
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Cusomer Name
First Name
Last Name
Customer E-Mail
example@example.com
Technician Name
First Name
Last Name
Technician Email
example@example.com
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