Provide complete vessel identification details as registered with flag state authorities. All fields marked mandatory must be completed for form submission.
Vessel Name
IMO Number
Call Sign
Flag State
Vessel Type
Container Ship
Bulk Carrier
Tanker (Oil/Chemical/Gas)
General Cargo
Ro-Ro Vessel
Passenger Ship
Offshore Vessel
Fishing Vessel
Tug & Tow
Other
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)
Define the precise nature and timing of the incident. This section establishes the fundamental classification for subsequent detailed reporting.
Date & Time of Incident (UTC)
Date & Time First Discovered (UTC)
Primary Incident Type
Machinery Failure Only
Grounding Only
Machinery Failure Leading to Grounding
Grounding Leading to Machinery Failure
Other Sequence of Events
Phase of Voyage at Time of Incident
At Sea (Open Ocean)
Coastal Navigation
Approach to Port
Harbor/Maneuvering
Anchored
Berthing Operations
Unberthing Operations
Drifting
Other:
Navigation Status
Under Own Power
Under Tow
At Anchor
Moored to Buoy
Alongside Berth
Aground
Not Under Command (NUC)
Restricted in Ability to Maneuver (RAM)
Other:
Brief Narrative Summary of Incident
Precise positional data and environmental context at time of incident. Use official chart datum and verified meteorological observations.
Geographic Position (Latitude)
Geographic Position (Longitude)
Charted Depth at Position (meters)
Actual Depth Sounding (meters)
Chart Number & Edition
Tidal Stage at Time of Incident
High Water
Low Water
Flood Tide (Rising)
Ebb Tide (Falling)
Slack Water
Unknown
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)
Wind Force (Beaufort Scale) | |
Sea State (Douglas Scale) | |
Visibility (Nautical Miles) | |
Current Strength (knots) | |
Daylight Conditions |
True Wind Direction & Speed
Sea/Swell Direction & Height
Visibility (Nautical Miles)
Ice Conditions Present
No Ice
Light Ice
Moderate Ice
Heavy Ice
Iceberg(s) Present
Traffic Density in Area
Light (0-5 vessels)
Moderate (6-15 vessels)
Heavy (16+ vessels)
Congested (Port Area)
Unknown
Did Machinery Failure Occur?
Machinery Failure Initiated (UTC)
Failure Development Pattern
Sudden/Catastrophic (No Warning)
Rapid (Minutes)
Gradual (Hours)
Intermittent (On/Off)
Progressive Degradation (Days/Weeks)
Were Any Warning Alarms/Indications Observed Prior to Failure?
Was Machinery Operating Within Normal Parameters Before Failure?
Pre-Failure Machinery Operating Parameters (Last 4 Hours)
Time (UTC) | Main Engine RPM | Fuel Pressure (bar) | Lube Oil Pressure (bar) | Cooling Water Temp (°C) | Scavenge Air Pressure (bar) | |
|---|---|---|---|---|---|---|
Was Vessel Due for Scheduled Maintenance on Failed System?
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?
Did Crew Attempt Emergency Repairs?
Did Vessel Make Contact with Seabed/Obstruction?
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
High Water Slack
High Water Ebb
Mid Ebb
Low Water Slack
Low Water Flood
Mid Flood
Unknown
Were Soundings Taken Immediately After Grounding?
Were Attempts Made to Refloat Immediately?
Was Anchoring Attempted After Grounding?
Type of Seabed Composition
Were Underwater Obstructions (Wrecks, Pinnacles) Charted?
Did Vessel Experience Multiple Grounding Contacts?
Detailed reconstruction of bridge operations, personnel, and navigational decision-making processes leading to the incident.
Master's Name & License Number
Officer of the Watch (OOW) Name & Rank
Lookout(s) Name(s) & Position
Watch Condition
Standard Navigational Watch
Enhanced Watch (Reduced Visibility)
Anchor Watch
Port Watch
Unmanned (Automation)
Other
Was Master Present on Bridge?
Was Pilot Embarked?
Primary Means of Navigation
ECDIS (Electronic Chart)
Paper Charts
Both ECDIS & Paper
Radar Navigation
Visual Pilotage
Other
Last Position Fix Time (UTC)
Last Position Fix Method
GPS
Radar Range/Bearing
Visual Bearing
Terrestrial RDF
Celestial
GLONASS
BeiDou
Galileo
Combined Methods
Was Vessel on Planned Track?
Were All Required Aids to Navigation Operational?
Was VTS (Vessel Traffic Service) Contacted?
Were Any Navigational Warnings in Force?
Engine room operations, machinery status, and technical parameters immediately preceding and during the incident.
Chief Engineer's Name & License Number
Engineer Officer of the Watch (EOW) Name & Rank
Engine Room Watch Condition
UMS (Unmanned Machinery Space)
Manned with Engineer Present
Manned with Rating Present
Dead Ship Condition
Other
Was Chief Engineer in Engine Room?
Main Engine Operational Status
Full Ahead
Slow Ahead
Dead Slow Ahead
Stop
Dead Slow Astern
Slow Astern
Full Astern
Not Available
Other
Was Engine on Bridge Control?
Was Fuel Changeover in Progress?
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)
Main Lube Oil Pressure | |
Main Cooling Water Temperature | |
Fuel Oil Pressure | |
Scavenge Air Pressure | |
Hydraulic Oil Pressure | |
Control Air Pressure |
Were Any Machinery Alarms Inhibited or Bypassed?
Last Machinery Space Inspection/Rounds (UTC)
Were Any Machinery Deficiencies Reported Before Incident?
Systematic evaluation of all damage sustained by vessel including hull, machinery, and structural components. Include underwater damage if known.
Was Hull Breached?
Was There Machinery Damage Beyond the Initial Failure?
Were Ballast/Cargo Tanks Breached?
Was Rudder/Propeller Damaged?
Were Deck Structures (Bulwarks, Railings) Damaged?
Did Any Cargo Get Damaged?
Watertight Integrity Status
Intact - All Boundaries Secure
Partially Compromised - Local Flooding
Significantly Compromised - Multiple Compartments
Critical - Progressive Flooding
Unknown
Current Draft Forward (meters)
Current Draft Aft (meters)
Vessel List After Incident
Upright (0°)
Slight List (<5°)
Moderate List (5-15°)
Severe List (15-30°)
Extreme List (>30°)
List Direction & Approximate Angle
Is Vessel in Danger of Capsizing?
Has Class Society Been Informed of Damage?
Has Any Pollution Occurred as Result of Incident?
Is Quantity of Pollutant Known?
Has Oil Spill Trajectory Been Modeled?
Are Pollution Containment Measures Deployed?
Has Shoreline or Sensitive Area Been Impacted?
Has Any Wildlife Been Affected?
Are Pollution Response Teams On Scene?
Distance to Nearest Shoreline (Nautical Miles)
Proximity to Sensitive Areas (Coral, Mangroves, Bird Sanctuaries)
Comprehensive account of all personnel on board, injuries sustained, and medical response actions.
Were Any Persons Injured?
Was Medical Evacuation (Medevac) Conducted?
Are Any Crew Members Missing?
Was Crew Evacuation Necessary?
Did All Personnel Respond to Emergency Stations?
Was Emergency Drill Conducted Recently?
Chronological account of all immediate and subsequent actions taken to secure vessel, ensure safety, and mitigate consequences.
Was General Emergency Alarm Sounded?
Was Engine Stopped Immediately?
Were Tugs Requested?
Were Ballast/Cargo Transfer Operations Conducted?
Was Emergency Anchoring Deployed?
Were Any Emergency Ship-to-Ship Operations Conducted?
Was Salvage Contract Signed?
Were Emergency Patch/Repair Materials Used?
Was Vessel Refloated?
Summary of All Response Actions & Chronology
Individual statements from key personnel involved in or witnessing the incident. These narratives provide critical human perspective for causal analysis.
Has Master Provided Written Statement?
Has OOW Provided Written Statement?
Has Chief Engineer Provided Written Statement?
Are Additional Witness Statements Available?
Master's Detailed Narrative of Events (If not uploaded above)
Chief Engineer's Detailed Narrative (If not uploaded above)
Critical evidence preservation status including official log books, electronic recordings, and photographic documentation required for investigation.
Are Official Log Books Available?
Is VDR (Voyage Data Recorder) Data Available?
Is S-VDR (Simplified VDR) Fitted?
Are ECDIS Recordings Available?
Are Engine Room CCTV Recordings Available?
Were Photographs/Videos Taken of Damage?
Has Preliminary Damage Survey Been Conducted?
Have Class Society Surveyors Attended?
Have P&I Club Surveyors Attended?
Are Oil Samples Available for Analysis?
Comprehensive record of all notifications made to authorities, organizations, and stakeholders. Include reference numbers and acknowledgment details.
Has Company Designated Person Ashore (DPA) Been Notified?
Has Flag State Administration Been Notified?
Has Coastal State Authority Been Notified?
Has Classification Society Been Notified?
Has P&I Club/Insurance Been Notified?
Has SAR/MRCC Been Contacted?
Have Port/Terminal Authorities Been Notified?
Have Charterers/Cargo Interests Been Notified?
Has Media/Press Inquired About Incident?
Notification Log
Organization Notified | Notification Time (UTC) | Method (Phone/Email/Fax) | Person Contacted | Reference / Acknowledgment | |
|---|---|---|---|---|---|
Current vessel status and planned actions for recovery, repair, and return to service.
Current Vessel Status
Still Aground
Refloated - Anchored
Refloated - Underway
Alongside Repair Facility
In Dry Dock
Under Tow
Other
Current Position if Vessel Moved
Is Vessel Currently Stable?
Is Vessel Manned?
Are Cargo Operations Planned?
Has Repair Plan Been Developed?
Has Dry Docking Been Arranged?
Has Class Society Issued Interim Certificate?
Forward Plan for Next 7 Days
Long-term Recovery Plan (Beyond 7 Days)
Initial assessment of potential causal factors across human, technical, and organizational dimensions. This is preliminary and subject to investigation findings.
Preliminary Root Cause Analysis Summary
Has Formal Safety Investigation Been Initiated?
Are Additional Technical Investigations Required?
Master's Signature
Chief Engineer's Signature
Form Completion Date & Time (UTC)