Title IP Code Amendments / Appendix

Effective Date 7/1/2024

APPENDIX

FORM OF SAFETY CERTIFICATE FOR SHIPS CARRYING INDUSTRIAL PERSONNEL

INDUSTRIAL PERSONNEL SAFETY CERTIFICATE

This Certificate shall be supplemented by a Record of Equipment for the

Industrial Personnel Safety Certificate (Form IP)

(Official seal)
(State)

Issued under the provisions of the

International Convention for the Safety of Life at Sea, 1974, as amended

under the authority of the Government of

(name of the State)

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by ____________________________________________________________
ST
(person or organization authorized)
GI
RE

Particulars of ship7
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Name of ship .........................................................................................................................

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Distinctive number or letters ..................................................................................................

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Port of registry .......................................................................................................................

Gross tonnage .......................................................................................................................

IMO number8 .........................................................................................................................

Date [dd/mm/yyyy] on which keel was laid or ship was at a similar

stage of construction or, where applicable, date on

which work for a conversion or an alteration or

modification of a major character was commenced ...............................................................

_________________________________

7 Alternatively, the particulars of the ship may be placed horizontally in boxes.

8 In accordance with the IMO Ship Identification Number Scheme adopted by the Organization by resolution
A.1117(30).

THIS IS TO CERTIFY:

1 ☐ check box, if applicable

That the ship has been surveyed in accordance with the provisions of section I/3 of the International Code of
Disclaimer Although all possible efforts have been made to ensure correctness and completeness of Information contained in this Service, KR, known as Korean Register is not
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Safety forresponsible
ShipsforCarrying Industrial Personnel as a ship to which regulations XV/3.1 or 3.4 of the Convention apply.
any errors or omissions made herein, nor held liable for any actions taken by any party as a result of information retrieved from this Service.
1 ☐ check box, if applicable

That the ship has been surveyed in accordance with the provisions of section I/3 of the International Code of
Safety for Ships Carrying Industrial Personnel as a ship to which regulations XV/3.1 or 3.4 of the Convention apply.

.1 That the survey showed that:

.1 the structure, equipment, fittings and materials of the ship and the condition thereof are in all respects
satisfactory and that the ship complies with the relevant provisions of the Code; and

.2 if fitted, the personnel transfer appliances and arrangement and the condition thereof are in all respects
satisfactory and comply with the provisions of regulation III/2 of the Code.

2 ☐ check box, if applicable

That the ship has been surveyed in accordance with the provisions of section I/3 of the International Code of
Safety for Ships Carrying Industrial Personnel as a ship to which regulations XV/3.2 or XV/3.3 of the Convention
apply.

.1 That the survey showed that:

.1 the life-saving appliances and the equipment of the lifeboats, liferafts and rescue boats were provided in
accordance with regulation IV/7 or V/7 of the Code, as applicable;

ER
.2 the ship, if permitted to carry dangerous goods, complies with the relevant provisions of regulation IV/8 or
V/8 of the Code, as applicable; and ST
GI

.3 if fitted, the personnel transfer appliances and arrangement and the condition thereof are in all respects
RE

satisfactory and comply with the provisions of regulation III/2 (except for paragraph 2.1.7) of the Code.
AN

3 This certificate is not valid for the carriage of toxic products, low-flashpoint products or acids when the total
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number of persons on board exceeds 60.

KO

This certificate is valid until .....................................................................................................

Completion date of the survey on which this certificate is based (dd/mm/yyyy): ……….....................

Issued at ......................................................................................................................

(Place of issue of certificate)

.................................

(Date of issue) (Signature of authorized official issuing the

certificate)

(Seal or stamp of the issuing authority, as appropriate)

ENDORSEMENT FOR ANNUAL, PERIODICAL AND INTERMEDIATE SURVEYS

THIS IS TO CERTIFY that, at a survey required by section I/3 of the Code, the ship was found to comply with the
relevant provisions of the Code:

Annual/Periodical* survey: Signed:.................................................................

(Signature of authorized official)

Place: …………………………………………….

Disclaimer Although all possible efforts have been made to ensure correctness and completeness of Information contained in this Service, KR, known as Korean Register is not
Date: ……………………………………………. 2 / 7
responsible for any errors or omissions made herein, nor held liable for any actions taken by any party as a result of information retrieved from this Service.
 Place: …………………………………………….

Date: …………………………………………….

(Seal or stamp of the authority, as

appropriate)

Annual/Periodical/Intermediate* survey: Signed:.................................................................

(Signature of authorized
official)

Place: …………………………………………….

Date: …………………………………………….

(Seal or stamp of the authority, as

appropriate)

Annual/Periodical/Intermediate* survey: Signed: .................................................................

(Signature of authorized
official)

Place: …………………………………………….

ER
Date: …………………………………………….
ST
(Seal or stamp of the authority, as
GI
appropriate)
RE

Annual/Periodical* survey: Signed:.................................................................

(Signature of authorized
AN

official)
RE

Place: …………………………………………….
KO

Date: …………………………………………….

(Seal or stamp of the authority, as

appropriate)

*Delete as appropriate.

ENDORSEMENT TO EXTEND THE CERTIFICATE IF VALID FOR LESS THAN FIVE YEARS
WHERE REGULATION I/14(C) OF THE CONVENTION OR 1.8.8 OF THE 2000 HSC CODE
APPLIES

The ship complies with the relevant requirements of the Convention, and this certificate shall, in accordance with
regulation I/14(c) of the Convention* or 1.8.8 of the 2000 HSC Code,* be accepted as valid until.................

Signed:
.................................................................
(Signature of authorized
official)

Place:
...................................................................

Date:
.....................................................................

Disclaimer Although all possible efforts have been made to ensure correctness and completeness of Information contained in this (Seal orknown
Service, KR, stamp ofRegister
as Korean theisauthority,
not as
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appropriate)
responsible for any errors or omissions made herein, nor held liable for any actions taken by any party as a result of information retrieved from this Service.
 Date:
.....................................................................

(Seal or stamp of the authority, as

appropriate)

ENDORSEMENT WHERE THE RENEWAL SURVEY HAS BEEN COMPLETED AND

REGULATION I/14(D) OF THE CONVENTION OR 1.8.9 OF THE 2000 HSC CODE APPLIES

The ship complies with the relevant requirements of the Convention, and this certificate shall, in accordance with
regulation I/14(d) of the Convention* or 1.8.9 of the 2000 HSC Code,* be accepted as valid until.........................................

Signed:
.................................................................
(Signature of authorized
official)

Place:
...................................................................

Date:
.....................................................................

(Seal or stamp of the authority, as

appropriate)

ER
ENDORSEMENT TO EXTEND THE VALIDITY OF THE CERTIFICATE UNTIL REACHING THE ST
PORT OF SURVEY OR FOR A PERIOD OF GRACE WHERE REGULATION I/14(E) OR
GI

I/14(F) OF THE CONVENTION OR 1.8.10 OF THE 2000 HSC CODE APPLIES

RE

This certificate shall, in accordance with regulation I/14(e)/l/14(f)* of the Convention or 1.8.10 of the 2000 HSC
AN

Code,* be accepted as valid until............................

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Signed:
.................................................................
KO

(Signature of authorized
official)

Place:
...................................................................

Date:
.....................................................................

(Seal or stamp of the authority, as

appropriate)

*Delete as appropriate.

ENDORSEMENT FOR ADVANCEMENT OF ANNIVERSARY DATE WHERE REGULATION I/14(H) OF THE

CONVENTION OR 1.8.12 OF THE 2000 HSC CODE APPLIES

In accordance with regulation I/14(h) of the Convention* or 1.8.12 of the 2000 HSC Code,* the new anniversary
date is ..............

Signed: .................................................................
(Signature of authorized
official)

Place:
...................................................................
Disclaimer Although all possible efforts have been made to ensure correctness and completeness of Information contained in this Service, KR, known as Korean Register is not
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Date:
responsible for any errors or omissions made herein, nor held liable for any actions taken by any party as a result of information retrieved from this Service.
 Place:
...................................................................

Date:
.....................................................................
(Seal or stamp of the
authority, as appropriate)

In accordance with regulation I/14(h) of the Convention* or 1.8.12 of the 2000 HSC Code,* the new anniversary
date is .........................

Signed:
.................................................................
(Signature of authorized
official)

Place:
...................................................................

Date:
.....................................................................
(Seal or stamp of the
authority, as appropriate)

*Delete as appropriate.

ER
Record of Equipment for the Industrial Personnel Safety Certificate
ST
GI
(Form IP)
RE

This Record should be permanently attached to the

AN

Industrial Personnel Safety Certificate

RE

RECORD OF EQUIPMENT FOR COMPLIANCE WITH THE

KO

INTERNATIONAL CODE OF SAFETY FOR SHIPS CARRYING

INDUSTRIAL PERSONNEL

1 Particulars of ship

Name of ship ..............................................................................................................

Distinctive number or letters ........................................................................................

Total number of persons on board

for which certified ........................................................................................................

2 Details of life-saving appliances

1 Total number of persons for which life­saving appliances

areprovided .......... ...........

Port side Starboard

side

2 Total number oflifeboats .......... ..........

2.1 Total number of persons accommodated bythem .......... ..........

2.2 Number of partially enclosedlifeboats
(SOLAS regulation III/21 or III/31, or 8.10 of the HSC
Code, as applicable, and LSA Code, section 4.5) .......... ..........
Disclaimer Although all possible efforts have been made to ensure correctness and completeness of Information contained in this Service, KR, known as Korean Register is not
2.3 Number of self­righting partially enclosedlifeboats
responsible for any errors or omissions made herein, nor held liable for any actions taken by any party as a result of information retrieved from this Service.
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(SOLAS regulation III/21 or III/31, or 8.10 of the HSC

2.2 Number of partially enclosedlifeboats
(SOLAS regulation III/21 or III/31, or 8.10 of the HSC
Code, as applicable, and LSA Code, section 4.5) .......... ..........
2.3 Number of self­righting partially enclosedlifeboats
(SOLAS regulation III/21 or III/31, or 8.10 of the HSC
Code, as applicable, and LSA Code, section 4.5) .......... ..........
2.4 Number of totally enclosedlifeboats
(SOLAS regulation III/21 or III/31, or 8.10 of the
HSC Code, as applicable, and LSA Code, sections .......... ..........
4.6)
2.5 Other lifeboats .......... ..........
2.5.1 Number .......... ..........
2.5.2 Type .......... ..........

3 Number of motor lifeboats (included in the total . . . . . . . . . . . . . . . ..

lifeboats shown above) . . . . . . . . . . . . . . . ..
3.1 Number of lifeboats fitted with searchlights

4 Number of rescue boats . . . . . . . . . . . . . . . ..

4.1 Number of boats which are included in the total lifeboats
shown above . . . . . . . . . . . . . . . ..

ER
5 Liferafts . . . . . . . . . . . . . . . ..
5.1 Those for which approved launching appliances are required ST . . . . . . . . . . . . . . . ..
5.1.1 Number of liferafts . . . . . . . . . . . . . . . ..
GI
5.1.2 Number of persons accommodated by them . . . . . . . . . . . . . . . ..
5.2 Those for which approved launching appliances are not
RE

required ................
5.2.1 Number of liferafts . . . . . . . . . . . . . . . ..
AN

5.2.2 Number of persons accommodated by them

. . . . . . . . . . . . . . . ..
RE

...............
6 Number of marine evacuation systems (MES)
KO

6.1 Persons accommodated by them

7 Buoyant apparatus
7.1 Number of apparatuses
7.2 Number of persons capable of being supported

8 Number of lifebuoys

9 Number of lifejackets (total) . . . . . . . . . . . . . . . ..

9.1 Number of adult lifejackets . . . . . . . . . . . . . . . ..
9.2 Number of child lifejackets . . . . . . . . . . . . . . . ..
9.3 Number of infant lifejackets . . . . . . . . . . . . . . . ..

10 Immersion suits . . . . . . . . . . . . . . . ..
10.1 Total number ...............
11 Number of thermal protectiveaids9 ...............

THIS IS TO CERTIFY that this Record is correct in all respects.

Issued at ....................................................................................................................
(Place of issue of the Record)

...............................
(Date of issue) Disclaimer (Signature of duly authorized official
Although all possible efforts have been made to ensure correctness and completeness of Information contained in this Service, KR, known as Korean Register is not
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responsible for any errors or omissions made herein, nor held liable for any actions taken by any party as a result of information retrieved from this Service.
issuing the Record)
Issued at ....................................................................................................................
(Place of issue of the Record)

...............................
(Date of issue) (Signature of duly authorized official
issuing the Record)

(Seal or stamp of the issuing authority, as appropriate)

____________________________

9 Excluding those required by the LSA Code, paragraphs 4.1.5.1.24, 4.4.8.31 and 5.1.2.2.13.

***

ER
ST
GI
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AN
RE
KO

Disclaimer Although all possible efforts have been made to ensure correctness and completeness of Information contained in this Service, KR, known as Korean Register is not
responsible for any errors or omissions made herein, nor held liable for any actions taken by any party as a result of information retrieved from this Service.
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