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Maritime Casualty ChecklistYou must insist upon full disclosure from the shipping company of all of the following details in each case. |
General | |
Name: | Date of birth: |
Home address:   Rank or occupation: Kind and serial number of mariner's documents or license, if any: | |
Issued by: | Date of issue: |
Mariner's school and date of graduation: Total sea service: Date signed on this vessel: Duty station at time of casualty: |
Particulars of Vessel | |
Name: |
Official No.: |
Gross tonnage: | Net tonnaqe: |
Summer deadweight: | |
Flag: | Port of registry: |
Type (Freighter, passenger, tanker, etc.) Name and address of owner(s):     Name and address of operator(s) or manager(s):     Name and address of agent(s):     | |
Shipbuilders: |   |
Date of build: | Where built: |
Length overall: | Breadth extreme: |
Draught summer: | |
Propulsion (steam, diesel, etc.): | |
Number of engines: | |
Size (e.g., horse power): Type: Engine builders: Where built: | |
Particulars of boilers: | |
Type of propeller(s): | Direction of revolution: |
  | |
Engine(s) Operation/Performance Envelope | |
Knots       | RPM |
Engine(s) at Full speed Normal mode: Maneuvering mode: Engine(s) at Half Speed Normal mode: Maneuvering mode: Engine(s) at Slow speed Normal mode: Engine(s) at Astern speed Slow Astern mode: Half Astern mode: Full Astern mode: Engine(s) at Emergency Full Astern Emergency Astern mode:   Any troubles with the engine(s):     | |
Navigational/Maneuvering Controls | |
Type       | Location |
Steering apparatus: Any troubles with it: Standard compass: Steering compass: Any deviation of index of error with steering compass: Date when last checked: Course recorder: Whether operating at time of casualty: Direction finder: Whether operating at time of casualty: Type of echo sounding apparatus: Whether operating at time of casualty:   Number of gyro repeaters: | |
Whether operating at time of casualty: | Operating on what range: |
Distance from face or bridge to stem: Height of bridge above water at time of casualty:   | |
Navigation lights burning at time of casualty: | |
Watts of Bulb       | Condition of Light |
Mast head light(s): Range light: Side lights: Stern light: |
Particulars of Casualty | ||||||||
Original port of departure:
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Time and date: | |||||||
Port of call previous to casualty: Time and date of departure: Draft - Fore: Draft - Aft: Time and date of casualty: Draft - Fore: Draft - Aft: Location of casualty: Latitude and Longitude: Distance and true bearing from charted object, dock, anchorage, etc.: Body of water (geographical name): | ||||||||
Rules of the Road applicable:    __ Inland                __ International | __ Other (specify) | |||||||
Position of sunken ship:   | ||||||||
Physical status at time of casualty: |   | |||||||
Heading of vessel: Angle between vessels: (show by drawing sketch of  vessels with collision angle) Speed over the ground: | ||||||||
Engine(s) working:__ Ahead               __ Astern: | RPM: | |||||||
Name and number of chart(s) used:   | ||||||||
Weather conditions prevailing: |   | |||||||
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Visibility (miles, meters, yards, etc.): | ||||||||
Wind direction: | Force in knots: | |||||||
Gusty:    __ Yes               __ No | ||||||||
Tide or Current direction: | Force: | |||||||
Sea conditions when casualty occurred: | ||||||||
Height of sea: | Height of swell: | |||||||
Direction of sea: | Direction of swell: | |||||||
Did you observe the time of casualty by your watch or clock: Was it fast or slow by the engine room clock:   Name of pilot: Regulating Authority of pilot: Where was the captain at the time of casualty: When did he come to the bridge:   | ||||||||
Other personnel on duty at the time of casualty: | ||||||||
Name and Rank       | Location | |||||||
1. 2. 3.   | ||||||||
Who first sighted other vessel: What was the location of the observer: How did the observer inform you of the sighting (telephone, orally, etc.):   What time was the other ship first sighted: By radar: Visually (by eye or glasses): On what bearing: Estimated course and speed of the other ship: Your vessell's compass course and speed at that time: How would the vessels have passed if no action taken by either:   | ||||||||
What lights of the other vessel were first seen: |   | |||||||
Type: Distance: Bearing: Were they burning brightly: Sighted by eye or glasses:   | ||||||||
Response to sighting: | ||||||||
Event:       | Time: | |||||||
Helm action taken to avoid the casualty: Engine action was taken to avoid casualty: Signals heard from the other vessel:   | ||||||||
Personnel involved: | ||||||||
This vessel:       | Other vessel(s): | |||||||
Total number of crew: Deck department: Engine department: Steward department: Total number of passengers: Others (specify): Total number of persons dead, injured, or missing:   Location of damage sustained to the vessel: Any leakage of sea water: Estimate cost for repairs: Place where repairs were carried out: Nature and amount of cargo: Damage to cargo: © 2023 Seattle Trial Lawyer, Gary L. Wolfstone |