Maritime Incident, Grounding & Machinery Failure Report Form

Vessel Name

IMO Number

Call Sign

Flag State

Vessel Type

Year of Build

Classification Society

Registered Owner Name

Technical Manager/Operator

Hull Underwriter/P&I Club

Gross Tonnage (GT)

Deadweight Tonnage (DWT)

Overall Length (meters)

Breadth (meters)

Maximum Draft (meters)

Total Complement (All Persons on Board)

Date & Time of Incident (UTC)

Date & Time First Discovered (UTC)

Primary Incident Type

Describe the sequence from machinery failure to grounding:

Describe how grounding caused machinery failure:

Describe the complete sequence of events:

Phase of Voyage at Time of Incident

Navigation Status

Brief Narrative Summary of Incident

Geographic Position (Latitude)

Geographic Position (Longitude)

Charted Depth at Position (meters)

Actual Depth Sounding (meters)

Chart Number & Edition

Tidal Stage at Time of Incident

Height of Tide (meters above/below datum)

Environmental Conditions Assessment

(1 = Calm / Excellent, 2 = Moderate / Good, 3 = Rough / Fair, 4 = Very Rough / Poor, 5 = Severe / Extremely Poor)

True Wind Direction & Speed

Sea/Swell Direction & Height

Visibility (Nautical Miles)

Ice Conditions Present

Describe ice conditions and impact on operations:

Describe ice conditions and impact on operations:

Describe ice conditions and impact on operations:

Describe iceberg proximity and tracking:

Traffic Density in Area

Did Machinery Failure Occur?

Select ALL Machinery Systems that Failed (Check all that apply)

Main Engine Failure Details: Describe specific failure mode, symptoms, and immediate consequences:

Auxiliary Engine Failure Details: Describe specific failure mode and impact on power generation:

Steering Gear Failure Details: Describe system affected and resulting navigational limitations:

Machinery Failure Initiated (UTC)

Failure Development Pattern

Were Any Warning Alarms/Indications Observed Prior to Failure?

Describe all warning signs, alarm conditions, and timeline of pre-failure indications:

Was Machinery Operating Within Normal Parameters Before Failure?

Describe abnormal parameters observed:

Pre-Failure Machinery Operating Parameters (Last 4 Hours)

Was Vessel Due for Scheduled Maintenance on Failed System?

Scheduled Maintenance Due Date:

Last Major Overhaul Date of Failed Machinery

Summary of Maintenance History for Failed System (Last 12 Months)

Were Critical Spare Parts Available Onboard for Failed System?

Specify unavailable spares and procurement plan:

Did Crew Attempt Emergency Repairs?

Describe emergency repair actions, duration, and effectiveness:

Did Vessel Make Contact with Seabed/Obstruction?

Nature of Grounding Contact

Time of Initial Grounding Contact (UTC)

Vessel Speed Over Ground at Contact (knots)

Vessel Course Over Ground at Contact (degrees)

Engine Order at Time of Contact

Engine RPM at Time of Contact

Tide Stage at Grounding

Were Soundings Taken Immediately After Grounding?

Soundings Around Vessel After Grounding

Were Attempts Made to Refloat Immediately?

Describe refloat attempts including engine movements, ballast operations, tug assistance, and results:

Was Anchoring Attempted After Grounding?

Describe anchoring deployment, holding ground, and effectiveness:

Type of Seabed Composition

Were Underwater Obstructions (Wrecks, Pinnacles) Charted?

Describe uncharted obstruction and reported position:

Did Vessel Experience Multiple Grounding Contacts?

Describe each contact point, time interval, and damage progression:

Master's Name & License Number

Officer of the Watch (OOW) Name & Rank

Lookout(s) Name(s) & Position

Watch Condition

Was Master Present on Bridge?

Master's Location on Bridge (e.g., Conning, Chart Table)

Master's Location at Time of Incident:

Was Pilot Embarked?

Pilot Name & License Number:

Primary Means of Navigation

Last Position Fix Time (UTC)

Last Position Fix Method

Was Vessel on Planned Track?

Explain deviation from planned track and reasons:

Were All Required Aids to Navigation Operational?

Specify failed aids and impact on navigation:

Was VTS (Vessel Traffic Service) Contacted?

Provide VTS station name, contact time, and communication summary:

Were Any Navigational Warnings in Force?

List all active warnings and their relevance to the incident:

Chief Engineer's Name & License Number

Engineer Officer of the Watch (EOW) Name & Rank

Engine Room Watch Condition

Was Chief Engineer in Engine Room?

Chief Engineer's Location:

Main Engine Operational Status

Was Engine on Bridge Control?

Engine Control Location

Was Fuel Changeover in Progress?

Describe fuel changeover details, viscosities, and any operational issues:

Fuel Type in Use (ISO 8217 Grade)

Fuel Viscosity (cSt at 50°C)

Critical Machinery Parameter Status (30 Minutes Pre-Incident)

(1 = Normal, 2 = Slightly Low/High, 3 = Significantly Low/High, 4 = Critical Low/High, 5 = No Reading/Failed)

Were Any Machinery Alarms Inhibited or Bypassed?

Specify which alarms were bypassed and justification:

Last Machinery Space Inspection/Rounds (UTC)

Were Any Machinery Deficiencies Reported Before Incident?

List outstanding deficiencies and reported dates:

Was Hull Breached?

Hull Breach Details

Was There Machinery Damage Beyond the Initial Failure?

Describe secondary machinery damage caused by grounding or incident progression:

Were Ballast/Cargo Tanks Breached?

Tank Damage & Flooding

Was Rudder/Propeller Damaged?

Describe rudder/propeller damage and impact on maneuverability:

Were Deck Structures (Bulwarks, Railings) Damaged?

Describe deck structure damage:

Did Any Cargo Get Damaged?

Describe cargo damage, location, and quantity:

Watertight Integrity Status

Current Draft Forward (meters)

Current Draft Aft (meters)

Vessel List After Incident

List Direction & Approximate Angle

Is Vessel in Danger of Capsizing?

Has Class Society Been Informed of Damage?

Class Surveyor Name & Contact:

Has Any Pollution Occurred as Result of Incident?

Select ALL Pollution Types Released (Check all that apply)

Specify chemical name and quantity:

Is Quantity of Pollutant Known?

Pollution Quantity Estimates

Has Oil Spill Trajectory Been Modeled?

Describe trajectory direction, speed, and predicted shoreline impact:

Are Pollution Containment Measures Deployed?

Describe booms, skimmers, dispersants, and effectiveness:

Has Shoreline or Sensitive Area Been Impacted?

Describe impacted areas, wildlife, and cleanup status:

Has Any Wildlife Been Affected?

Describe wildlife impact and rehabilitation efforts:

Are Pollution Response Teams On Scene?

List response organizations and resources deployed:

Distance to Nearest Shoreline (Nautical Miles)

Proximity to Sensitive Areas (Coral, Mangroves, Bird Sanctuaries)

Were Any Persons Injured?

Injury Log & Medical Status

Was Medical Evacuation (Medevac) Conducted?

Describe medevac method (helicopter/boat), time, and receiving facility:

Are Any Crew Members Missing?

Provide missing person details, last seen location, and search efforts:

Was Crew Evacuation Necessary?

Describe evacuation method, number evacuated, destination, and muster muster drill performance:

Did All Personnel Respond to Emergency Stations?

Describe muster discrepancies and reasons:

Was Emergency Drill Conducted Recently?

Last Drill Date:

Was General Emergency Alarm Sounded?

Time Alarm Sounded (UTC):

Was Engine Stopped Immediately?

Time Engine Stopped (UTC):

Were Tugs Requested?

Tug Assistance Details

Were Ballast/Cargo Transfer Operations Conducted?

Describe operations, quantities transferred, and purpose (trim, list correction, refloat):

Was Emergency Anchoring Deployed?

Describe anchoring deployment, scope, and holding ground:

Were Any Emergency Ship-to-Ship Operations Conducted?

Describe cargo transfer, bunkering, or personnel transfer operations:

Was Salvage Contract Signed?

Specify salvage company, contract type (LOF/others), and date/time signed:

Were Emergency Patch/Repair Materials Used?

Describe cement boxes, welding, clamps, or other temporary repairs:

Was Vessel Refloated?

Refloat Time (UTC):

Summary of All Response Actions & Chronology

Has Master Provided Written Statement?

Upload Master's Statement (Signed & Dated)

Provide Master's Oral Statement Summary:

Has OOW Provided Written Statement?

Upload OOW Statement (Signed & Dated)

Provide OOW Oral Statement Summary:

Has Chief Engineer Provided Written Statement?

Upload Chief Engineer's Statement (Signed & Dated)

Provide Chief Engineer's Oral Statement Summary:

Are Additional Witness Statements Available?

Number of Additional Witness Statements:

Master's Detailed Narrative of Events (If not uploaded above)

Chief Engineer's Detailed Narrative (If not uploaded above)

Are Official Log Books Available?

Log Books Secured & Sealed

Explain why log books are unavailable:

Is VDR (Voyage Data Recorder) Data Available?

VDR Data Secured & Download Initiated

Reason VDR data unavailable:

Is S-VDR (Simplified VDR) Fitted?

S-VDR Data Secured

Are ECDIS Recordings Available?

ECDIS Data & Screenshots Secured

Are Engine Room CCTV Recordings Available?

CCTV Footage Secured

Were Photographs/Videos Taken of Damage?

Upload Damage Photographs (Multiple files allowed)

Has Preliminary Damage Survey Been Conducted?

Upload Preliminary Survey Report

Have Class Society Surveyors Attended?

Provide surveyor details, attendance date, and preliminary findings:

Have P&I Club Surveyors Attended?

Provide P&I surveyor details and reference number:

Are Oil Samples Available for Analysis?

Specify samples taken (fuel, lube, hydraulic) and storage location:

Has Company Designated Person Ashore (DPA) Been Notified?

DPA Notification Time (UTC):

Has Flag State Administration Been Notified?

Provide flag state, notification method, reference number, and acknowledgment:

Has Coastal State Authority Been Notified?

Provide coastal state authority, notification time, and reference number:

Has Classification Society Been Notified?

Provide class society and notification details:

Has P&I Club/Insurance Been Notified?

Provide P&I club, claim number, and surveyor details:

Has SAR/MRCC Been Contacted?

Provide SAR center, case number, and resources deployed:

Have Port/Terminal Authorities Been Notified?

Provide port authority details and instructions received:

Have Charterers/Cargo Interests Been Notified?

Provide notification details and commercial impact:

Has Media/Press Inquired About Incident?

Provide media outlet, inquiry time, and official statement issued:

Notification Log

Current Vessel Status

Current Position if Vessel Moved

Is Vessel Currently Stable?

Describe stability concerns and monitoring measures:

Is Vessel Manned?

Explain unmanned status and security arrangements:

Are Cargo Operations Planned?

Describe cargo transfer plan, method, and safety measures:

Has Repair Plan Been Developed?

Provide repair scope, estimated duration, and repair facility:

Has Dry Docking Been Arranged?

Dry Dock Location & Scheduled Date:

Has Class Society Issued Interim Certificate?

Upload Interim Certificate

Forward Plan for Next 7 Days

Long-term Recovery Plan (Beyond 7 Days)