Encl. (2) to COMDTINST 16475.7
ENTANGLEMENT AND BOAT COLLISION REPORTING FORM
I.
REPORTING SOURCE
Time/Date:
_________________________________
Reporting Source: __________________________________
Vessel Name: _________________________________
Doc/Reg Number:
__________________________________
Radio Call:
_________________________________
Cell Phone:
__________________________________
1st or 2nd
How long can
hand Report: _________________________________
R/S remain O/S?:
__________________________________
II.
DETAILS OF INCIDENT
Position:
_________________________________
Geographic Desc:
__________________________________
O/S Wx:
Winds _______________T/_______________KTS,
Swell ____________________T/__________________FT
Seas _______________T/_______________FT,
Vis _______________NM,
Temp _______________F,
Baro______.______(R/F/S)
Species:
________________________________
Number of Animals: __________________________________
Dorsal Fin:
________________________________
Color:
__________________________________
Size:
________________________________
Dead/Alive:
__________________________________
Distinguishing
Marks:
________________________________
Photo/Video Taken: __________________________________
Type of
Entanglement:________________________________
Nature of Injury: ___________________________________
Traveling or
Anchored by Gear: ___________________________
Course/Speed:
___________________________________
III.
ENTANGLEMENT
Type of Gear & Identifying
Features (color, reg #, etc)
_______________________________________________________________________________________________
Type of Line
(Dia, color, material)
_______________________________________________________________________________________________
Mesh Visible?:
YES/NO
Float/Other
Gear Trailing?:
__________________________________
Part of Body
# Wraps around
Entangled?: ________________________________
Tail/Body:
__________________________________
Life Threating?/Describe:
_______________________________________________________________________________________________
IV.
ANIMAL'S APPEARANCE
First Impression of Condition:
_______________________________________________________________________________________________
Skin Condition (peeling, color,
whale lice, etc):
_______________________________________________________________________________________________
Obvious Bleeding/Wounds:
_______________________________________________________________________________________________
Marks Fresh or Healing?:
_______________________________________________________________________________________________
Weight (robust, emanciated,
ribs or vertebrae showing):
_______________________________________________________________________________________________
V.
ANIMAL'S BEHAVIOR
_______________________________________________________________________________________________
Breathing (pattern, sound,
smell?):
_______________________________________________________________________________________________
Struggling to Breathe?:
_______________________________________________________________________________________________
Lifting Head/Flukes
above water?:
_______________________________________________________________________________________________
Effects on movement (flexibility, bouyancy, surfacing angle, ability to dive, appendage movement, etc):
________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________
VI.
COLLISION
Type of Wound (prop wound,
part cut off, etc)?:
_______________________________________________________________________________________________
Location:
_________________________________
Severity:
__________________________________________
Vessel Involved: _________________________________
Doc/Reg #: __________________________________________
Operator:
_________________________________
Homeport:
__________________________________________
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