关于启用“水上交通事故调查处理文书英文格式”的通知

    Ship’S owner／operator

    Address

    Tel．

    Ship’S agent／charterer

    Address

    Tel．

  Port of   departure

  Port of   destination

 Kind of car90／quantity

    L．0．A

  Molded breadth

  Molded depth

    Hull material

    GT

    NT’

    DWT／allocation

  Age of ship

    Kind of ship

    Sulnlner draft

    F：    A：

  Draft while the accident   occurring

    F：    A：

  Draft when arriving at this port

    F：    A：

  Min．stroke

    Min．turning radius

    Max．spoed

    Type of main engine

    Power

 Number of cargo holds

 Radar type

    Max．range

    Blind ar℃a

    Beating error

    Distance error

 Type ofGPS

  Type／error of gyrocompass

  Type／error of magnetic conlpas8

Officer$on duh

    Nalne

    N0．of Certificate

  Range

    Grade

    Rank

  Dutv omoBr

 Duty algirIeer

    Nationality

    Kind of ship

 HuU   material

 The other ship

  Ship’S owner

 Port of d印arture

    Port of destination

    Time

    Distance

 Bearing of other ship

  First si曲ting

 Course   of other ship

 Speod of other ship

洲of   ownship

 Position   of own ship

 Course of own ship

 Position of captain

    Method of observation

    Communication method between two vessels

    Lights／shapes of own ship

    Lights／shapes of other ship

    Observer

    Time   of first sighting

 Radar observing

    Range

    Distance

 Bearing of   first sighting

    Situation of both ships when sighting

    Action to prevent collision

    Ownship

    Other ship

    Time／distance to make   avoidance

    /

  /

    First action to be taken

    Time／type of making sound   signal

 Action to prevent collision afterward

    Timr3

    Action

    Tirne

    Action

  Time／course／speed／of changing

    Other actions and time

  VHF equipped or not

  Auto bell recorder equipped or not

 Auto conrse recorder equipped 01"not

  VDR equipped or not

    Time of collision

    Place of collision

    Part of collision

    Own ship

    Other ship

    True COurse   of own ship when colliding

    Collision angle of both ships

 Actions   taken by both

    Ownship

 ships   after collision

    Other ship

 Salvage measure  and actions

    Current   direction

  Current speed

    Tide

    Visibility

    Weather

    Temperature

  Note：ship’s name，time，position   and track required to be marked

    Ship

    Cargo

    Other damage

    Loss

    and

    danmge

    0f

    ship

    Sketch of damaged part of own ship：

    Loss

    and

    damage

    of

    other

    ship

    Time of accident

    Place of aceident

    Vessel／facihty surveyed

    OwneF

  Place of survey

    Time of survey

    From to

    Sketch and description of damaged parts   of vessel．facility of whaIf

    Other damage

    Name

    PIace of work

    Signature

    of

    surveyor

  Witness of vessel／facility   surveyed