en Report on accident or incident during ship operations
 *
 

Fields marked with an asterisk (*) are required
Occurrence details
 *

 LT

  h
 
Ship’s particulars
 *







Tonnages

 t

 t

 t
Dimensions

 m

 m

 m


 *
Propulsion type means the classification of a ship according to energy used by propulsion system to propel the ship through the water






 
 
Type of casualty



 
General casualty
 *





Injuries
Lives lost
Crew
Number
Lives lost
Passenger
Number
People injured
Crew
Number
People injured
Passenger
Number
 
Location of occurrence
 * Latitude Longitude
   °  ,    °  ,  



 

 
Commercial voyage  *
 
Cargo/loading condition


 m

 m


 
Environmental pollution


 t


 t

 
External damage

 
Assistance




 
Crew / passengers



 
On watch / in charge (to be filled in only in case of marine casualty)
  Working hours (last)
  24h 48h 1 week
Master
Officer on watch
Engineer on watch
Other crew members on watch
 
Weather
(°)

(°)






(°C)
 
Reporter’s personal details

Contact information








 
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