DAMAGE REPORT

 

Date: Time:

Damaged Vessel or Dock:

Name of Owner:

Captain or Person in Charge at Time of Accident:

Vessel Causing Damage:

Name of Vessel’s Owner:

Captain or Person in Charge at Time of Accident:

Place Damage Occurred:

If in Tow, Name of Tug:

Weather:

Tide: Wind:

Give Full Extent of Damage:

State Fully the Cause of the Accident:


Witness:
Witness Address:
Witness Phone #:

Note: Draw diagram of the accident on the reverse side of this sheet. Report by telephone immediately - (617) 908-1006 – and send this sheet in immediately with your daily log. Report all oil spills and environmental damage to the USCG at 1-800-424-8802 and the Acushnet Marine office.

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