Chief Engineer’s Statement of Examination
of Surveyable Machinery Items
This form is to be used to record the results of the examination of machinery by the ship’s Chief
Engineer on ships which are not operating an approved Machinery Planned Maintenance Scheme.
Two signed copies of this statement are to be prepared. One copy of the statement is to be retained on
the ship and the other is to be presented to the Surveyor. A confirmatory survey will be carried out by
the Surveyor, at which a review of the records of examination by the Chief Engineer and a general
examination of those items to be credited will be carried out.
Refer to the Lloyd’s Register Group document The Examination of Surveyable Machinery Items by Chief
Engineers for further instructions on this arrangement and for a list of applicable machinery items.
General Details
Ship Name: IMO No:
Name of Ship Operator: Total number of Items seen:
Chief Engineer details
Name of Chief Engineer :
Chief Engineer's License Number: Chief Engineer's License Date of Expiry:
Name of Administration issuing License:
Signature Notes
Date: 1 This statement is to be presented to the Surveyors at
the time of confirmatory surveys.
Signature of Chief Engineer (named above): 2 The results of examination of machinery items by
Chief Engineers are to be recorded on the following
page.
3 After examination by the Chief Engineer, it is the
responsibility of the ship Operator to arrange for the
attendance of a Surveyor to credit such items. This is
to be at the first port where the Lloyd's Register's
exclusive Surveyors are available.
Lloyd's Register Group Limited, its affiliates and subsidiaries and their respective officers, employees or agents are,
individually and collectively, referred to in this clause as the ‘Lloyd's Register Group’. Lloyd's Register Group assumes no
responsibility and shall not be liable to any person for any loss, damage or expense caused by reliance on the information
or advice in this document or howsoever provided, unless that person has signed a contract with the relevant Lloyd's
Register Group entity for the provision of this information or advice and in that case any responsibility or liability is
exclusively on the terms and conditions set out in that contract.
Clients that arrange for items of machinery to be credited for survey based on examinations by Chief Engineers shall
indemnify and hold Lloyd’s Register Group harmless against any claim, loss, or liability including any legal costs or other
expenses relating to any negligence or omission of the Chief Engineer.
Any dispute, claim, or litigation between Lloyd’s Register Group and the Client arising from or in connection with this
application shall be subject to the exclusive jurisdiction of the English courts and will be governed by English Law.
LR2098 (2015.04)
Chief Engineer’s Statement of Examination
of Surveyable Machinery Items
Results of Examination
1. Enter the date of examination, the Lloyd’s Register machinery Master List Number and corresponding description as
shown of the Lloyd's Register Master List of Surveyable Items.
2. Enter details for each Master List item examined in a separate section. Use additional copies of this page, as necessary,
to record the results of the examination of multiple items of machinery. Attach each page to the front page signed by the
Chief Engineer.
Details of Items Examined
Date of Examination
Masterlist Number Description
Condition, as found
Repair, if any
Details of Items Examined
Date of Examination
Masterlist Number Description
Condition, as found
Repair, if any
Details of Items Examined
Date of Examination
Masterlist Number Description
Condition, as found
Repair, if any
LR2098 (2015.04)