MARLOW-HUNTER MH31, Руководство оператора

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Documents and Forms
2.12
DEPARTMENT OF HOMELAND SECURITY
U.S. Coast Guard
OMB Control Number: 1625-0003
RECREATIONAL BOATING ACCIDENT REPORT
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INSTRUCTIONS : Use "Report required because" section below to determine if a report is required for your accident. If required, please have each vessel
owner or operator involved in the accident submit a report to their state reporting authority. Each boat operator/owner involved in an accident should submit
a separate report. For each question below, please provide answers if applicable and if known; otherwise leave blank. Privacy Act Notice: Authority- 46
U.S.C. 6102 and 33 CFR 173 & 174 authorize the collection of information on boating accidents. Purpose-The Coast Guard uses this information for statistical
purposes, chiefly to inform the public, to measure the Program's efforts, and to regulate issues relating to boating safety. Routine Uses-The Coast Guard
shares this information within the agency, and if state and federal law permit it, to the public.
REPORT SUBMISSION
Report required because
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At least one person in this accident
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: If so, how many? _______
At least one injured person in this accident
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: If so, how many? _______
At least one person in this accident
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and has not yet been
recovered: If so, how many? _______
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boat and other property
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caused
by this accident
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$2,000 or more:
Approximate value of damage to
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boat: $ __________
Approximate value of damage to
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other property: $ __________
Your or another
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in this accident was
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a
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Report submitted by
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:
Boat Operator
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Boat Owner
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Other
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: __________________________________________
__________________________________________
To be submitted within:
48 hours
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10 days
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To be submitted to:
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Phone:
You may submit any comments concerning the accuracy of the
burden estimate or any suggestions for reducing the burden to:
Commandant (CG-5422), U.S. Coast Guard, Washington, DC
20593-0001 or Office of Management and Budget, Paperwork
Reduction Project (1625-0003), Washington, DC 20503. Questions
relating to the collection of this data should be sent to the Coast
Guard.
For State Agency Use Only
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:
First Name Last Name Phone
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ACCIDENT SUMMARY
WHEN ACCIDENT DESCRIPTION :
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describe this accident
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Date:
Time: am pm
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WHERE
Body of Water Name
Location
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description DAMAGE TO YOUR BOAT :
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summarize any damage to
your boat
Nearest city/town
County: State:
YOUR BOAT
–
PEOPLE DAMAGE TO YOUR OTHER PROPERTY: (NOT BOAT)
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summarize any damage to your other property
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# people
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:
# people
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:
# people
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:
OTHER BOATS INVOLVED IN ACCIDENT
# of
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boats involved:
CG-3865 (1/11) Page 1 of 6
Figure 2.5