Exclusion Assessment Form

IACS UR E26 Section 6 (Risk-Based Exclusion)

Doc ID: TAG-OT-CRT-02
Issue Date: Feb 2026
Rev: 1.2

System/Service:
OEM/Vendor:		Physical Location:

All items must be marked ‘YES’ to justify exclusion from the vessel’s Cyber Security scope.

Functional Isolation: System compromise cannot impact propulsion, steering, power, or navigation?	YES
Network Isolation: System is air-gapped or has no logical IP link to any Category II or III systems?	YES
External Connectivity: No remote access, maintenance ports, or wireless (WiFi/4G) entry points exist?	YES
Data Flow: No critical data (NMEA, Modbus, etc.) is exchanged with systems in scope?	YES
Physical Access: Access to physical media ports (USB/RJ45) is restricted or disabled?	YES

1. Technical Lead / CSO

2. Signature & Date

1. Class / Verification Body Acceptance

2. Stamp, Signature & Date

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