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    NIS Maritime Casualty Reporting

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    johnjovet
    The master or ship manager shall forward the "Maritime casualty report - Ship and personnel" within 72 hours of an accident. The report requests general information about the accident including vessel details, weather conditions, crew and passenger details, causes of the accident, injuries and damage sustained. Any preventative actions taken by management are also to be included. The completed report should be submitted to the Norwegian Maritime Authority.

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    NIS Maritime Casualty Reporting

    Uploaded by

    johnjovet
    37 views5 pages
    The master or ship manager shall forward the "Maritime casualty report - Ship and personnel" within 72 hours of an accident. The report requests general information about the accident including vessel details, weather conditions, crew and passenger details, causes of the accident, injuries and damage sustained. Any preventative actions taken by management are also to be included. The completed report should be submitted to the Norwegian Maritime Authority.

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    NIS Maritime Casualty Reporting

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    The master or ship manager shall forward the "Maritime casualty report - Ship and personnel" within 72 hours of an accident. The report requests general information about the accident including vessel details, weather conditions, crew and passenger details, causes of the accident, injuries and damage sustained. Any preventative actions taken by management are also to be included. The completed report should be submitted to the Norwegian Maritime Authority.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    37 views5 pages

    NIS Maritime Casualty Reporting

    Uploaded by

    johnjovet
    The master or ship manager shall forward the "Maritime casualty report - Ship and personnel" within 72 hours of an accident. The report requests general information about the accident including vessel details, weather conditions, crew and passenger details, causes of the accident, injuries and damage sustained. Any preventative actions taken by management are also to be included. The completed report should be submitted to the Norwegian Maritime Authority.

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    You are on page 1of 5

    Maritime casualty report – Ship and personnel

    The master or ship manager shall forward the “Maritime casualty report – Ship and
    personnel” within 72 hours after the accident. More information on notification and
    reporting requirements is available on: https://www.sdir.no/en/casualty

    Please forward report to: post@sdir.no


    Post: Norwegian Maritime Authority, Pb 2222, N-5509 HGSD, Norway

    Part A. General Information


    Name of vessel: Call sign:

    Vessel type: IMO no:

    Date of accident(d:m:y): time(local time):

    Vessels position at time of accident: (North/South) (East/West) Place:

    Geographical area: Type of waters:

    Contact person(s):

    Telephone: E-mail: @ .

    What has happened? Please give a brief summary on the course of events:

    If further space is required, continue on page 5 (Part K)

    Consequences (please tick of as relevant):

    loss of life injury no personal injuries

    vessel lost or vessel/equipment no damage to


    abandoned damaged vessel/equipment

    damage to
    pollution no pollution
    cargo/property

    near accident/marine incident with imminent danger of loss of life, property


    or severe pollution.

    KS-0197 E - engelsk Side 1 av 5


    Part B. Weather and sea state
    Wind direction: force: (m/s) Wave height: (m)
    Good (Over 5 Nm) Fog (under 0,5 Nm)
    Visibility: Moderate (2,1 – 4,9 Nm) Visibility below (0,25 Nm)
    Poor (0,5 – 2 Nm) Unknown
    Lighting: Daylight Night/dark Twilight/dusk Unknown

    Current (direction and force):

    Part C. Vessel particulars


    Gross tonnage: Built: Breadth: Length over all:
    Nationality: Hull material:
    Class: Trading area:
    Last class inspection (Place/date):
    VDR type: Accident data stored: Yes No

    At time of accident:
    Vessel’s activity:
    Loading condition: Type of cargo:
    Place of departure: Place of arrival:
    The vessels course: (°) Speed: (knots) and draught: (meter)

    Bridge team composition:


    Watch schedule in use: Nautical charts : Paper ECDIS ECS
    Pilot: Yes No Exemption Certificate: Yes No
    Persons on board:
    Safe manning: Additional crew: Passengers: Others: Total:

    Part D. Causes
    What where the immediate physical cause, and what other factors may have influenced
    the course of event (communication, organization, working conditions, weather, etc.)?

    KS-0197 E - engelsk Side 2 av 5


    Part E. Injuries and fatalities
    Number of injured persons: Number of fatalities or missing persons:
    If more than 2 injured/dead, use part K, or add attachments.
    DOB: Female Male Position:
    Nationality: Place on board:

    Accident occurred while injured was: Hours on duty:


    on duty off duty
    Personal protective equipment used:
    A
    Type of accident: Type of injury:
    Treatment: Hospitalized Medical treatment First aid
    Consequence: Death >72hrs absence from work
    <72hrs absence from work Alternative work
    DOB: Female Male Position:
    Nationality: Place on board:

    Accident occurred while injured was: Hours on duty:


    on duty off duty
    Personal protective equipment used:
    B
    Type of accident: Type of injury:
    Treatment: Hospitalized Medical treatment First aid
    Consequence: Death >72hrs absence from work
    <72hrs absence from work Alternative work

    Part F. Pollution
    Pollutant:
    Quantity: UN-number:

    Part G. Damage to vessel, equipment, cargo or property


    Please describe type and extent of damage to vessel, cargo, property or equipment:

    KS-0197 E - engelsk Side 3 av 5


    Part H. Risk assessment – risk analysis
    Has dangers with the work or ship-operation been assessed? How and by whom?

    Part I. Preventive action


    Has shipboard management or owners taken any preventive action?(short and long
    term):

    Part J. Comments from the vessel’s safety delegate(s)

    KS-0197 E - engelsk Side 4 av 5


    Part K. Additional comments, illustrations etc.
    Please specify which part the additional information refers to:

    KS-0197 E - engelsk Side 5 av 5

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