<p> Reporting form </p><p>The form is available on the Danish Maritime Accident Investigation Board homepage: www.dmaib.com:</p><p>Please send the form to:</p><p>E-mail: [email protected]</p><p>The Danish Maritime Accident Investigation Board Carl Jacobsens Vej 29 DK-2500 Valby Denmark</p><p>Furthermore, please enclose any relevant material, such as reports, photos, prints from instruments, copy of the log book, drawings, sketches and crew lists etc. </p><p>About The Danish Maritime Accident Investigation Board</p><p>The Danish Maritime Accident Investigation Board The Danish Maritime Accident Investigation Board is responsible for investigating marine accidents and serious occupational accidents on merchant- and fishing vessels. </p><p>The Board’s work is separated from other functions and activities of the Danish Maritime Authority.</p><p>Purpose The purpose of the investigations is to clarify the actual sequence of events that led to the accident. With this information in hand, others can take measures to prevent similar accidents in the future. </p><p>Information given to The Danish Maritime Investigation Board will solely be used for investigations, and will not be handed over to a third party.</p><p>The aim of the investigations is not to establish legal or economic liabilities.</p><p>Phone, 9 am to 4 pm Monday to Friday, +45 72 19 63 00 </p><p>Phone: +45 23 34 23 01 – 24 hours General information Please fill in all the information.</p><p>Name of ship:</p><p>Type of ship:</p><p>Call sign: IMO no.:</p><p>Pilot on board: Yes/No Draught :</p><p>Number of passengers: Number of crew members on board incl. the master: Date of accident: Time of accident:</p><p>Port of departure: Destination:</p><p>Departure date: Departure time:</p><p>Position: (In degrees and minutes) Wind direction: Velocity in m/s:</p><p>Wave height: Current direction and speed in knots:</p><p>Visibility in nm: Light: (light/dark/twilight)</p><p>Weather: (Rain/overcast/clear/snow/other)</p><p>Type of cargo:</p><p>Pollution from cargo: Type: Quantity: Other:</p><p>Pollution from bunkers: Oil type: Quantity: Other:</p><p>Death: Crew: Passengers: Other:</p><p>Injured persons: Crew: Passengers: Other:</p><p>External assistance? (towing, SAR, evacuation of injured persons, medical)</p><p>Description of damage to the ship and/or injury to person(s):</p><p>Damage to third party: (berth, buoys, other ship etc.)</p><p>VDR data secured: (Yes/No/NA) Description of accidental events Please enclose any reports, e.g. master’s report, photos and drawings.</p><p>Describe the events before, during and after the accident: Contact details Please attach crew list</p><p>Company contact: Name: (DPA or other) Phone: E-mail:</p><p>Master: Name: Certificate type: (Ship) phone no.: E-mail: Other persons Name: involved, witnesses Position: etc. E-mail:</p><p>Other persons Name: involved, witnesses Position: etc. E-mail:</p><p>Other persons Name: involved, witnesses Position: etc. E-mail:</p><p>Injured crewmember: Name: Position: E-mail:</p><p>Injured crewmember: Name: Position: E-mail:</p><p>Date:</p><p>Form filled in by: </p>