Have an account? Click here to log in...

Marine Casualty Reporting Form

Company Name

Phone

Vessel Name

Official Number

Has the vessel been issued a COI?

Yes
No

Cognizant OCMI

Incident Date

Incident Time

Waterway and Mile Marker

Incident Type

Unintended grounding or an unintended strike of /allision with a bridge
Intended grounding or intended strike of a bridge that creates a hazard to navigation, the environment or the safety of the vessel
Loss of propulsion, primary steering, or any associated component or control system that reduces the maneuverability of the vessel
Occurrence materially and adversely affecting the vessel’s seaworthiness or fitness for service or route, including but not limited to fire, flooding, or failure of or damage to fixed fire-extinguishi
Loss of life
An injury that requires professional medical treatment (treatment beyond first-aid) and, if the person is engaged or employed on board a vessel in commercial service, that renders the individual unfit
An occurrence causing property-damage in excess of $75,000, this damage including the cost of labor and material to restore the property to its condition before the occurrence, but not including the c
An occurrence involving significant harm to the environment as defined in §4.03-65

Please provide a brief description of the incident:

Were there barges in tow at the time of the incident?

Yes
No

If the above answer was yes, how many barges were in tow?

If there were barges in tow, were they loaded or empty?

Loaded
Empty

If there were loaded barges in tow, was any product released/spilled?

Yes
No
Unsure

If there was a release or spill of product, has someone notified the NRC?

Yes
No

Were appropriate Casualty Reporting forms submitted to the Coast Guard, as necessary?

CG-2692 Report of Marine Casualty
CG-2692A Barge Addendum
CG-2692B Report of Mandatory Chemical Testing Following a Serious Marine Incident
CG-2692C Personnel Casualty Addendum
CG-2692D Involved Persons and Witnesses Addendum

Was a CG-835 or CG-835V issued?

Yes
No

You will be prompted to upload a copy of the CG-835 or CG-835V as soon as you click submit.

If you are unable to upload it at this time, please email a copy as soon as possible to audits@thetvib.org.

Your name

Email *

Timeout Warning

Marine Casualty Reporting Form

Before you continue...