Bijlage IV Vaststelling modellen A- en B-certificaat, loodsnota en verklaring scheepsramp: verklaring scheepsramp

Vaststelling modellen A- en B-certificaat, loodsnota en verklaring scheepsramp

Incident report form collision – grounding, loss of anchor – close encounter – marine pollution (delete as appropriate) (Reports should also be submitted whenever an incident occurs which in the opinion of the pilot, may have led to a casualty) Section ‘A’ of this report consists of basic data statistical and reference purposes. Section A Statistical data Date Time of incident 1. 2. Position of occurrence and method of obtaining position 3. Piloted vessel name Port of registry/nationality Owners/agents Cargo: type IMO code (if known) Tonnage: GT NT length draf t: for AFT. Propulsion: main bow/stern thrusters: H.P. Propulsion: propellers number type fixed/C.P. rotation LH/RH Propulsion: controls: bridge/engine room directed by: Propulsion: speed max max/min manoeuvring Navigational aids operational status: Chart(s) Compass Steering mode: Radar(s) Radar(s) plotting mode Depth recorder V.H.F. Traffic information service Other navaids Aids/equipment reported inoperable by vessel: 4. Navigational data relating to incident Course(s)/ships head/helm Speed Conditions: visibility Wind Sea Tide: Direction/Rate HW/LW at Regulations: Lookout Lights/Shapes Sound/Signals 5. Crew disposition 6. Tug assistance/deployment 7. Vessel(s)/objects involved & extent of damage if any Section B Account of incident Section ‘B’ requires an explanation of the incident in concise terms following the sequence and if necessary expanding on section ‘A’ as appropriate, including authorities contacted at the time of the incident. A sketch should accompany this report whenever appropriate. Name (Block letters only) Signature of pilot Date of report Section C Cause of incident For analysis purposes only – at pilots option A significant contribution to Safety of Navigation will be made if the Cause of casualties can be readily established A brief, objective analysis will greatly assist in compiling information for this purpose. Recommendations as a result of incidents are also encouraged. Section D For