AD NO.

: 04-00
Initial Issue Date: 09-08-2017
Revision Date: 00
REPUBLIC OF THE PHILIPPINES
DEPARTMENT OF TRANSPORTATION

MARITIME INDUSTRY AUTHORITY

FORM 5: INVENTORY OF TEACHING AID

Course : ELEMENTARY FIRST AID

Name of Maritime Training Institute :

Note: Substitute textbooks and videos Self- Pre-inspection

Inspection
can be used provided they contain the Assessment evaluation
same content of the required.
To be To be accomplished To be accomplished
accomplished by STCW Office by STCW Office
by MTI Evaluator Inspector
Quantity Number At Not Not
Items Complied
Complied
Complied
Complied
Required Hand

Accomplished by : Date :
Name and Signature of
MTI’s Authorized Representative

Document Evaluator’s Comments:

Date of Evaluation
Document Evaluator’s Name & Signature

Inspector’s Comments:

Date of Evaluation
Inspector’s Name & Signature