Please return without delay to:
Bundesstelle für Seeunfalluntersuchung (BSU)
Bernhard-Nocht-Str. 78
D-20359 Hamburg
Merchant Shipping
Sea/Marine Accident Report Form
Nature of accident
Location of accident
Time of accident (date and time)
Voyage 1st vessel involved 2nd vessel involved
from
to
Last port of departure
Purpose of voyage
1. Vessel particulars
Name of vessel
Kind/Nature/Type
Nationality / Flag
IMO Identification Number
MMSI Number
Call sign / Register No.
Port of Registry
Size in BRZ (gross space figure)/GRT
NRZ (net space figure)//NRT
Deadweight in m/t
Displacement at time of accident
Length overall
Breadth overall
Draft at time of accident F M A F M A
Year and place built
2. Propulsion
Main engine(s) (type, maker)
Engine power (HP/kW)
Propulsion (type and number)
(screw, Voith, jet, etc.)
Service speed
Speed at time of accident
3. Owner/Operator/
Agent/Charterer
Owner
(Name and postal address)
Ship's husband/
Supplier/Charterer/
Freighter
(Name and postal address)
4. Persons on board at
time of accident
Crew (number)
Other persons (status/number)
Captain/Master (name)
Other participants (status/names)
(use extra sheet if necessary)
5. Damage
Personal injury
brief description
Property damage
brief description
6. Whereabouts of vessels
7. Weather, sea and Wind (direction and force) Sea state/swell (direction and force)
current
at time of accident
Visibility Clouds/rainfall
Air temperature Water temperature
Current direction and intensity
HW (time) LW (time) Water level
Standard port Sunrise Sunset
Other data
Place: Date
___________________ ___________________ ______________________________
(Signature)
Annex Crew
1. Ship's Crew – Passengers – Persons Involved – Witnesses
Ship's crew certificate Copy
issued on attached not attached
issued by valid until
Number of crew acc. to crew certificate
Actually on board Crew list
attached not attached
Missing crew members (number, rank)
Other persons on board List of persons
(number and status)
attached not attached
2. Master and crew
(insofar as these were involved in the accident or made observations as witnesses)
Rank Name, first name Address/telephone no. License/qualification Location and function
date of birth at time of accident
Master
1st Officer
2nd Officer
3rd Officer
Chief Eng.
2nd Eng.
3rd Eng.
Other persons
Helmsman
Lookout
Pilot(s)
Annex Radar
Particulars of radar use
Please use a separate form for each radar unit!
Number of radar units on board
1. Unit particulars
Maker/manufacturer Type/model Unit No.
Year built Last service Range Nature of display
2. Operation particulars
Operating mode at time of accident/nature of In operation since Range selected
display
Anti-clutter for sea and rain Force
o no o yes
Image quality Interference
Plotting carried out Plotting method Whereabouts of plotting documents
o no o yes
3. Particulars of radar observer
Rank
Name First name Date of birth Place of birth
Address
License issued on issued by
Nature of radar observation Duration of observation from - to Breaks from - to
permanent with interruptions occasional
Activities before taking over radar observation
4. Particulars of observation
First location of targets
Range in miles Distance Direction Time
Manoeuvre started on basis of radar image Manoeuvre started on basis of optical sighting
Special observations regarding accident none see report
5. Shore radar advice
Station Advised as of
Name of adviser First name Date of birth Place of birth
Address
License issued on issued by
Report of radar adviser attached
yes no
Check list I
1. Supplementary vessel particulars
1.1 Vessel particulars
Construction yard Construction material
Class/special class features Classification society
Length between perpendiculars Moulded breadth
Draft
at port of departure before the accident after the accident
F M A F M A F M A
Trim
at port of departure before the accident after the accident
List (degrees port/stbd)
at port of departure before the accident after the accident
Stability (GM in cm, period of roll in sec.)
at port of departure before the accident after the accident
Special features/Remarks
1.2 Propulsion/bunker/stores
Type of propulsion
Nature and number Direction of rotation
- Fixed-pitch propeller
Number and arrangement
- Variable-pitch propeller
Number and arrangement
- Voith-Schneider
Number and arrangement
- Azipod drive/Schottel drive
Number and arrangement
- Jet drive
- Other
Nature and amount at time of accident Consumption/h
Fuel
Nature and amount
Lubricants
Nature and amount
Hydraulic fluids
Nature and amount
Other water-hazardous substances
Ballast
1. Supplementary vessel particulars
Check list I A
1.3 Manoeuvring units
Rudder/steering gear
Type Operating mode
Rudder design Maximum rudder angle
e.g. high-performance rudder/Becker's
rudder
Infinitely variable drive used yes no
Automatic pilot (maker/manufacturer) In operation Type/nature and number of rudder blades
yes / no
Special features/Remarks
Bow thruster
Nature and number Output
Stern thruster
Nature and number Output
1.4 Manoeuvring data
Maximum speed
Speed at time of accident through the water over ground
Speed table
Loaded In ballast
Sea River Sea River
Full ahead
Half ahead
Low ahead
Very slow
ahead
Output astern
%
Stopping distance and time (full ahead to full astern) m min
Reversing time
Turning circle to port to stbd
at full speed ahead in ballast loaded
Maximum path ahead in hard rudder position fully loaded m ballast m
Special features/Remarks
1. Supplementary vessel particulars
Check list I B
1.5 Navigational equipment
Number Kind Make Date of last inspection In operation
if appropriate yes / no
Standard magnetic
compass
Gyro compass
Echo sounder/
Echograph
Log
Radar
Automatic tracking aid
LORAN unit
Satellite navigator
Turn indicator
Radioequipment
Daylight signalling
lamp
Transmitting heading
device (THD)
Automatic identifi-
cation system (AIS)
Track control system
Voyage data recorder
(VDR)
Other
Nautical charts and
nautical publications
Check list II
When checking ship's papers always note:
2. Ship's papers issued on, issued by, valid until, if appropriate scope of validity etc.
2.1 Sea ships
2.1.1 General ship's papers
Certificate of registry
Other flag certificate
Tonnage certificate
Sailing permit (trade range)
Class certificate
2.1.2 Safety certificate (national/international)
Safety certificate (for passenger vessels)
Safety construction certificate (for cargo ships)
Safety construction and equipment certificate
Safety radiotelegraphy certificate (for cargo ships)
Radiotelephony certificate (for cargo ships)
Exemption certificate
Freeboard certificate
International certificate of fitness for the carriage of dangerous chemical in bulk
International certificate of fitness for the carriage of liquefied gas in bulk
International oil pollution prevention certificate
International pollution prevention certificate for the carriage of noxious liquid substances in bulk
International sewage pollution prevention certificate
Document authorisation for the carriage of grain (Grain Certificate)
Document of compliance with the regulations of SOLAS (IX/4.1 and 4.2) (International Ship Safety Management – ISM)
Safety Management Certificate (SMC) SOLAS Rule IX/4.3
High-speed Craft Safety Certificate (SOLAS Rule X/3)
Permit to operate high-speed craft in accordance with Section 1.9 of the HSC Code
2. Ship's papers
Check list II A
2.1.3 Log books
Oil log
Cargo log
2.1.4 Miscellaneous
Transfer certificate
issued on: by:
Certificate of fitness to be towed
issued on: by:
Check list III
3. Details of the marine accident (insofar as these are not contained in the attached documents)
3.1 Voyage prior to the marine accident
Guidelines for the voyage planning in accordance with Rule 34 Solas Chap. V
Decision A893 (21) maintained and documented: yes no
if appropriate documented by:
In the event of accidents with pilot on boards
Pilot Card handed out: yes no
If no, why not?
Voyage planning/manoeuvre planning
discussed and agreed with pilot yes no
3.2 Position/measures before the accident incident
Type of navigation
terrestrial celestial radio nav. radar
Last determined ship's position
Last courses/distances steered
Last rates of speed/speed through water
Advice from shore radar/coastal radio station or the like
First detection of other vessel/object
Bearing Distance
Navigational obstacles
environmental (e.g. weather or traffic situation) personal (e.g. fatigue, illness, alcohol)
Visual signals set/seen
lights shapes perceptibility
Sound signals given/heard
frequency
3. Details of the marine accident
Check list III A
3.3 Watch crews at the time of the accident
Bridge
Deck
Engine
Sea chart(s) used last amended:
worked with:
paper sea chart yes no
ECDIS licensed on: by:
only with Ecdis (no paper charts necessary any longer)
Manoeuvres – engine/rudder
Command Execution Manoeuvre signals (which?)
Execution
Signals given
no yes if yes, which?
3.4 Position/activities after the accident incident
Position
Contact established with the other party to the accident
Exchange of news/information
- with the other party to the accident
- with other bodies
- content of the information
- compulsory reports
Search, rescue, salvage actions
Assistance and support provisions to/by third parties an
Tug Ice breaker Other
Details if appropriate Requested
Protection and safeguarding provisions
Provisions to limitation of damage
3. Details of the marine accident
Check list III B
3.5 Consequences of the accident
Nature of the accident
Nature of the injury/damage
- Personal injury
l Injured persons, fatalities, missing persons (name and address, function)
l Personal particulars
- Damage to ship
- Damage to cargo
- Damage to third parties
- Damage/pollution to waters
Amount of loss/damage
Cause of accident – if appropriate reasons why cause was not investigated
Other particulars relating to the marine accident
Check list IV
1. Documents – records – plans etc.
Insofar as appropriate or necessary,
particulars on the following points:
1) – on board
2) - kept
3) – entries changed
4) - studied
5) – extracts made
6) - copied
7) - secured/confiscated
Ship's log
Bridge log/daybook
Engine log
Manoeuvre log/daybook
Radio log/daybook
Manoeuvre recorder/printer
Course recorder/printer
Data printer
Navigational publications and directories
Sea charts used – last on board amendments
General arrangement drawing
Individual drawings
Stability documents
Stowage plan
Miscellaneous
Check list V
5. Cargo particulars
Cargo
Nature
Deck cargo
Nature
Obstacles to visibility
no yes, if appropriate nature of obstacles to visibility
Dangerous goods
Nature
Quantity
Stowage
Special instructions
If appropriate specification
Ballast
Nature
Quantity
Other cargo particulars
Check list VI
6. Data sheet for preparing an activity profile
Name of vessel: Rank:
Name: Education:
Qualification:
Address:
Telephone: Telefax:
Operator:
Telephone: Telefax:
Date of embarkation: Port of embarkation:
Duration of voyage:
Overview of activities in the 96 hours before the accident
(Day X = date of accident)
Hour Day 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
X–4
X–3
X–2
X- 1
Day X
(X: time of accident; F: food/meals; W: watch duty; M: maintenance work; S: sleep; C: cargo watch;
R: recreation times including time on shore; A: alcohol consumption)
Health status:
Personal particulars:
Documents to be enclosed with the questionnaire (where available):
o Detailed report by the Master on the course and cause of the marine accident
o Report by the watch-keeping officer
o Sketches of the accident
o Photos
o Prints of the course recorder, data printer, relevant evidence
o Extracts from deck and engine logs
o Records by the vessel particulars recorder
o Statements by witnesses of the accident
o Crew list and crew certificate
o Reports by surveyors
o Expert opinions by experts (if appropriate post mortem findings too)
o Inspection reports by domestic or foreign authorities (e.g. water police)
o General arrangement plan of the vessel
o Detail drawings (e.g. engine room, ventilation systems, machinery and equipment,
hatches) cargo handling gear, anchorage
o Further data for investigating the cause of the accident:
o Bridge Poster
o Pilot Card
_______________________ __________________________ ______________
Place Date Company/Authority/Office Signature
