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1、Marine Accident ReportM/V Date: Port: To: M.S.A. of the P.R.C.I, the master of M/V which arrived thisport at about (time), hereby report that myvessel was involved in a marine accident that occurred at about (ti me)in(position) ,and now submit to you thisreport attached with necessary papers and doc
2、uments of set(s).Please make an investigation and verification.Yours sincerely,Master signature)(Ship's stamp)Date:Particulars of ShipShip s nameNationalityPort of registryShip's owner/operatorAddressTel.Ship's agent/chartererAddressTel.Port of departurePort of destinationKind of cargo /
3、quantityL.O.AMolded breadthMolded depthHull materialGTNTDWT/allocationAge of shipKind of shipSummer draftF:A:Draft while the accident occurringF: A:Draft when arriving at this portF:A:Min. strokeMin. turning radiusMax? speedType of main enginePowerNumber of cargo holdsRadar typeMax.rangeBlind areaBe
4、aring errorDistance errorType of GPSType/error of gyrocompassType/error of magnetic compassOfficers on dutyNameNo. ofCertificateRangeGradeRankDuty officerDuty engineerDetails of navigation and collision avoidance(Collision)The other shipShip's namePort of registryNationalityKind of shipHull mate
5、rialShip's ownerPort of departurePort of destinationFirst sightingTimeDistanceBearing of other shipCourse of other shipSpeed of other shipSpeed of own shipPosition of own shipCourse of own shipPosition of captainMethod of observationCommunication method between two vesselsLights/shapes of own sh
6、ipLights/shapes of other shipRadar observingObserverTime of first sightingRangeDistanceBearing of first sightingSituation of both ships when sightingAction to prevent collisionOwn shipOther shipTime/distance to make avoidance/First action to be takenTime/type of making sound signalAction to prevent
7、collision afterwardOwn shipOther shipTimeActionTimeActionTime/course/speed of changingOther actions and timeVHF equipped or notAuto bell recorder equipped or notAuto course recorder equipped or notVDR equipped or notTime of collisionPlace of collisionPart of collisionOwn shipOther shipTme course of
8、own ship when collidingCollision angle of both shipsActions taken by both ships after collisionOwn shipOther shipSalvage measures and actionsDetailed Process of the AccidentSketch of the AccidentWind directionWind forceWave direction/forceCurrent directionCurrent speedTideVisibilityWeatherTemperatureNote: ship's name, time, position and track required to be markedLoss and DamageLossan
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