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SMS

A

CKNO

WL

E

DG

MENT FO

R

M

BOS-FR

M

-11.900001

By

si

g

nin

g

t

h

is

for

m

,

I,

t

h

e

P

erson

S

i

g

nator

y

,

certif

y

t

h

at

I

h

a

v

e

read

t

h

e docu

m

ents

and

p

rocedures

t

h

at

are

p

resent

in

t

h

e

S

afet

y M

ana

g

e

m

ent

Sy

ste

m

(

SMS

) durin

g

t

h

e

p

eriod of

my

boardin

g.

P

osition

P

rinted

N

a

m

e

S

i

g

nature

Date

Version n

°: 01. O

rigina

l

Date

:

2

nd

January 2

01

5

.

Version Date

: N/

A

.

Va

l

id

version

on

l

y

on QM

S

site

.

Page

1

of

1

F

orm prepared by

: BOS

Deputy QH

S

E

S

Manager

.

Approved

by

: BOS

QH

S

E

S

Manager

.

Va

l

idated

by

: BOS

Qua

l

ity

R

epresentative

.

18