AUXILIARY SAR INCIDENT REPORT
Reverse CG-4612 AUX (REV. 10-96)
Always complete questions 1 - 13
1. Enter date and time you received request for assistance or when directed
by SCM to render assistance, report time as on a 24 hour clock (e.g., 1:00
PM on April 5, 1996, would be written as 04/05/96 1300.
2. How you were notified, if you were notified by another unit then how they
were notified. Check the appropriate box(s), if "Other" checked, specify.
3. Check the appropriate box(s), if "Other" checked, specify.
4. If question 3 answered as Non-Emergency SAR check appropriate box.
5. Give total time for all personnel on facility assisting in case.
(Example: 2 boat crew persons worked 35 minutes. Total Hr. 1 Min. 10.)
6. Check the appropriate box, if "other" checked, specify.
7. Check the appropriate box(s), if "other" checked, specify.
8. Check the appropriate box when ONLY communications assistance rendered.
If "Other" checked specify.
9. Enter appropriate number on Patrol status line: 1 = Reimbursable Patrol,
2 = Non-Reimbursable Patrol, 3 = Assistance by AUX member car.
4 = Watchstander or other shore based non-patrol duty. Enter the number
of crew on board (include Coxswain). Write in Coxswain's flotilla number.
Indicate name and member number for each crew member.
10. Check the appropriate box(s), if "other" checked, specify.
11. Enter date and time, report time as on a 24 hour clock (See #1 above.)
12. Give best estimate in nautical miles, (e.g. 2NM, 2.5NM, 12.3NM) to
SEARCH AREA from the nearest point of land. Distance TO ON SCENE OF
DISTRESS is from the harbor you left or diversion point in NMs.
13. Fill in ON SCENE weather conditions and check appropriate
box(s), if "Other" checked, specify. The weather should be On Scene
weather, if object not found then give the weather in the search area.
The wind direction is the direction from which the wind is blowing in
degrees True (e.g., 055 T).
Complete questions 14-23 (the area with the heavy shaded border) when on a
case with no C.G. unit Involvement or where SMC or other C.G. unit cannot
obtain information.
14. Write one of the following: WEATHER, MECHANICAL, FUEL SUPPLY, HUMAN
FACTOR, CARGO, UNKNOWN, then try to be more specific (e.g., mechanical/
battery dead, mechanical/broken water pump on engine, etc.)
15. Give Lat/Long, river name and mile, or body of water and closest city and
state. (circle direction as appropriate-N S E W)
16. Use statute miles, at least 1 and no decimals. For incidents occurring
ashore (not grounding), use "O." For inland waters use "1."
17. Check appropriate box. If "Foreign Owned" checked, indicate what
country vessel is registered.
18. Indicate one of the following: Fishing, Motorboating, Sailing,
Commercial Fishing, Passenger for Hire, Jet Ski, Water Skiing,
Sailboarding, or Other (Specify). For personnel only or marine vehicles,
use "O."
19. State length in feet and/or net tons for documented vessels.
Write in appropriate type of propulsion, (e.g. IB, OB, I/O, SAIL, ROWING,
etc.).
20. Enter vessel's name in the blank. Enter vessel's registration or
documentation number, or write Un-Registered/Un-Documented.
21. If possible fill out information on Owner or Operator.
22. Give estimate for each. Include cargo lost in value estimate and check
appropriate box.
23. Give on the appropriate line: The number of lives lost, if any, the
number of lives saved, if any, (this is the number of person/s helped, if
it was probable one or more would have died if assistance had not been
rendered). The total number of person/s assisted.
ATTACH ADDITIONAL SHEETS IF AMPLIFYING INFORMATION IS REQUIRED (ANY
COMMENTS FELT IMPORTANT TO THE CASE).
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