Ocean Thermal Energy Conversion (OTEC) harnesses thermal energy stored at different seawater depths via power generation from a thermodynamic closed-loop cyclical system. Apart from its consistent energy generation, it could be diversified into other side industries, making OTEC an attractive and sustainable source of renewable energy. However, the process that utilises seawater as its main fluid is exposed to biofouling deposition due to unwanted growth and accumulation of biological elements on any contact surfaces, potentially affecting its efficiency and damaging equipment in the process. Considering that biofouling is an inevitable condition that may not be eliminated, a comprehensive study for assessing potential biofouling growth and deposition mechanism is a crucial step for strategizing effective biofouling management in a commercial and large-scale OTEC power plant facility. This review paper focuses on evaluating suitable biofouling assessment techniques specifically for a large-scale OTEC power plant facility. This is achieved by evaluating previous and proposed biofouling assessment techniques relevant to OTEC systems by focusing on their implementation under a realistic OTEC setup. The initial study indicated that the potential of biofouling deposition may be unavoidable in some sections in all OTEC models, despite biofouling-free design consideration. Previous OTEC biofouling studies were evaluated with reported physical and biological assessment approaches indicated the need to further improve these techniques especially in continuous and non-destructive methods. Therefore, several biofouling monitoring systems reported from other water treatment industries were considered for the OTEC systems, with findings indicated the importance of considering important OTEC operational parameters for feasible and robust biofouling monitoring systems. Two major parameters which are seawater intake flow rate and temperature variation at different seawater intake levels were evaluated under OTEC operational evaluation by considering examples of practices conducted in cooling water systems in the power plant industry. A realistic biofouling monitoring setup for mimicking continuous changes in biofouling deposition is required, in this case by side-connecting an operated OTEC power plant facility with a pilot plant setup or a side sampler. This step allows the application of proposed biofouling monitoring techniques under a realistic and uninterrupted biofouling deposition setup.