AMBUJA CEMENTS LTD.

SHIP SECURITY PLAN

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APPENDIX 5
SECURITY INCIDENT REPORT FORM
Security Incident Report Form
Details Required Details Recorded
Date
Name of Ship
Flag
Master
Location of Ship (Lat & Long at sea, at
anchor, in port)
Port Facility Security Officer
Reporting Officer
Ship Operations (loading/discharging
cargo, bunkering, awaiting pilot etc.)
Date, time and place of incident
Brief Description of incident

Number of those involved crew, others.

Action Taken
Subsequent Action
Reported to : (as required)
CSO
Company
Local Authorities
What measures are recommended to
prevent recurrence of a similar event

___________
SSO / DATE
MANAGEMENT COMMENT:

SIGNATURE: ____________________ ____________________

CSO / DATE VICE PRESIDENT/ DATE
AMBUJA CEMENTS LTD. SHIP SECURITY PLAN

Security incident means any suspicious act or circumstance threatening the security of a ship,
including a mobile offshore drilling unit and a high-speed craft, or of a port facility or of any
ship/port interface or any ship to ship activity.
AMBUJA CEMENTS LTD. SHIP SECURITY PLAN

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APPENDIX 7

DRILL & EXERCISES LOG SHEET FORMAT

SHIPS NAME DATE

DRILL/EXERCISE

PLACE / LOCATION

VESSEL DETAILS DRAUGHT F A

CARGO BALLAST BUNKERS

COURSE SPEED

WEATHER CONDITION

MINUTES OF DRILL/EXERCISE:
AMBUJA CEMENTS LTD. SHIP SECURITY PLAN

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APPENDIX 7

DRILL & EXERCISES LOG SHEET FORMAT

Drill:- Bomb Threat Date:- 18/01/2012

Location:- Nhava Anchorage

Draft: F/A 4.21m Even keel Cargo: 2696.32 Mts

Fuel : 30.00Mts

Course: NA Speed: NA

Weather: Light Air

Minutes Of Drill:-

1630: General Alarm Sounded. All crews mustered in wheel house, Head
count taken and found all accounted for. Crew briefed of information
received from CSO at 1625hrs from that a threat had been received at
company office on telephone that a bomb had been placed on board one
of our vessel and to take appropriate measures.

1635: Security level areas raised to security level: 3. Search teams were
briefed, distributed search equipment, instructed to proceed on search
of vessel compartments and report frequently with states of same.
- CSO was informed of raising security level 3 and to inform PFSO,
BCT Panvel and other agencies accordingly, Jawahar Port control
was informed similarly.

1705: Completed through search of vessel by all three teams and

reported that no I.E.D. device or any other suspicious objects was
detected.

1709: CSO informed of completion of search and NONE FOUND report.

1712: BCT Panvel was advised to prepare for security level :3 measures
and exchange of DOS accordingly.
AMBUJA CEMENTS LTD. SHIP SECURITY PLAN

AUTHORIES INFORMED: CSO, PFSO,DG Com.Centre, Coast Guard,

Jawahar Port Control, BCT Panvel.

REVIEW COMMENTS / LESSONS LEARNT:

1. That all crew should vigilant of shore workers on board and

randomly check ID.

2. Be aware record un usual behavior, check their place of work on

board.

3. All unused compartments, lockers should always be secured by

lock/cable ties including sounding caps of FW , fuel tanks etc.

4. Immediately report to HOD and or SSO of any doubts against any

person or object.

DEBRIEFING OF CREW:

Company Recommendation explained.

AMBUJA CEMENTS LTD. SHIP SECURITY PLAN

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APPENDIX 7

DRILL & EXERCISES LOG SHEET FORMAT

* COMMENTS FROM AMBUJA SHIKHAR:

*COMMENTS FROM AMBUJA VAIBHAVA:

*COMMENTS FROM AMBUJA GAURAVA:

*COMMENTS FROM AMBUJA SHAKTI:

*COMMENTS FROM AMBUJA KEERTI:

*COMMENTS FROM AMBUJA BHAVANI:

*COMMENTS FROM AMBUJA LAKSHMI:

*COMMENTS FROM AMBUJA GAURI:

*COMMENTS FROM BCT PANVEL:

MASTER (SSO)

NAME: ________________
AMBUJA CEMENTS LTD. SHIP SECURITY PLAN

*NOTE: Comments from ships and BCT Panvel applicable when carrying out emergency exercise with
Panvel office.
 AMBUJA CEMENTS LTD. SHIP SECURITY PLAN

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APPENDIX 16
NON CONFORMITY REPORT
Ships name / Location : __________________ NCR No. : ___________
(to be filled in by the auditor)
NCR Initiator : Date of initiating NCR :
Reference of the Requirement (of ISPS Code or other Regulation) not complied with:

NON CONFORMITY :

Corrective / Preventive Action(s) suggested:

Signature: _______________ Signature :______________

Initiator SSO
CORRECTIVE / PREVENTIVE ACTION APPROVED AGREED DATE

Signature: _______________________ _______________________

CSO / DATE VICE PRESIDENT / DATE

Approved corrective action completed.

Signature: _______________________ _______________________

SSO / DATE CSO / DATE

Final Distribution of closed NCR:

AMBUJA CEMENTS LTD. SHIP SECURITY PLAN

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APPENDIX 18

RECORD OF PORTS CALLED (ATTACH DOS IF NON-COMPLIANT ISPS)

RECORD OF AT LEAST LAST 10 PORTS CALLED TO BE KEPT

Date Name of Port Called Security Level Masters

Signature
Ship Shore

The Form of a Declaration of Security between a ship and a port facility (Appendix 6) is to be
filled up as per guidelines provided in Section 3.2.5.
AMBUJA CEMENTS LTD. SHIP SECURITY PLAN

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APPENDIX 19

GANGWAY REGISTER

S.N Name, address & Tel. No. of Date/ Purpose Pass Name Date/ Signature
external workshop personnel Time of No. of ship Time
or guest or visitor. in visit Issued visited out
 AMBUJA CEMENTS LTD. SHIP SECURITY PLAN

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APPENDIX 20

KEY CONTROL REGISTER

(TO BE FILLED ONLY IN LEVEL 2 AND 3)

Date & Key for location Name & Name & Signature Purpose SSO
Time of (Restricted area) Designation Designation of person of
handing of person of person taking handing
over key handing taking over over
over Key over Key key key
AMBUJA CEMENTS LTD. SHIP SECURITY PLAN

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APPENDIX 21

SHIP SECURITY PLAN ANNUAL REVIEW

SHIP: M.V. AMBUJA ___________ DATE: __________

ISSUES RAISED CSOs COMMENT

AMBUJA CEMENTS LTD. SHIP SECURITY PLAN

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APPENDIX 21

SHIP SECURITY PLAN ANNUAL REVIEW

SHIP: M.V. AMBUJA ___________ DATE: __________

GUIDELINES FOR CARRYING OUT SSP ANNUAL REVIEW

1. Security Level is understood by everyone on board and displayed at various

locations.

2. Security training imparted regularly understood by all.

3. Periodical drills as per schedule provided in SSP is carried out.

4. Review of Ships Security Audit Findings: Last Internal & External Security Audit.

5. Review of Security incident reports.

6. Last SSP Annual Review Report, if applicable.

7. Effectiveness of existing system, procedures, instructions, forms and checks as

mentioned in the SSP.

8. Any suggestions for improvement in the SSP.

MASTER (SSO)

NAME ________________
AMBUJA CEMENTS LTD. SHIP SECURITY PLAN

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APPENDIX 23

OBSERVATIONS

COMPANY: AMBUJA CEMENTS LTD. AUDIT DATE:

SHIPSS NAME / LOCATION:

AUDITOR:

S.N. Description Remarks

Signature______________ Signature______________

NAME: NAME:

SSO Initiator