DEPARTMENT OF HOMELAND SECURITY U.S. Coast Guard REPORT OF BOARDING FORM CG-4100 (REV 2-15) INSTRUCTIONS FOR PROCESSING THE FORM Form CG-4100 is a two page form that consists of a white original and a yellow copy. Accurate and complete data must be legibly printed with a ballpoint pen on each set. Refer to the Maritime Law Enforcement Academy Boarding Officer Job Aid Kit (BOJAK) as a guide for current Code of Federal Regulations minimum equipment requirements. Place the inner front flap which is part of the bottom of the pad under the last copy of the set of forms to keep from marking the other sets. The U.S. Coast Guard Maritime Law Enforcement Manual, COMDTINST M16247.1 (series), describes in detail how to fill out the Report of Boarding. All items inspected in the Summary of Boarding shall be marked with a “X”. Any violation in the Summary of Boarding shall be circled and have the appropriate USC/CFR entered into the citation box adjacent to the violation. Use the written summary section to capture additional boarding details not addressed on form (i.e. description of violation, corrections actions taken, etc.) Completed form distribution: Compliance Boarding - No Violation Page 1 - Original: Scanned into MISLE. Page 2 - Yellow copy: Boat Operator. Violations, Termination, and Warnings: Page 1 - Original: Scanned into MISLE. Unit then transfers control and ownership of the MISLE Activity to the VCCC. Page 2 - Yellow copy: Boat Operator. CG-4100 (09/15) VESSEL TYPE CODE TABLE FISHING, COMMERCIAL PLEASURE (PRIVATELY OWNED) MERCHANT FCH CHARTER/PARTY/HEAD BOAT POWER MBG BARGE FCD CLAM DREDGE MFY FERRY FFS FACTORY SHIP PCC CABIN CRUISER MFC FREIGHTER, COASTAL FGN GILLNETTER PHP HIGH PERFORMANCE MFO FREIGHTER, OCEAN-GOING FHP HARPOONER PHB HOUSE BOAT MNG LNG CARRIER FLL LONGLINER PRA RUNABOUT MOC OIL CREW BOAT FMR MULTI-RIG PFS SPORT FISHER MOR OIL RIG BOAT FPB POT OR TRAP BOAT PYM YACHT, LUXURY MOTOR MPL PASSENGER LINER FRV RESEARCH VESSEL PYT YACHT, TRAWLER TYPE MRV RESEARCH VESSEL FSC SCALLOPER MTC TANKER, COASTAL FSS SEINER, SIDE CHUTE SAIL MTO TANKER, OCEAN-GOING FST SEINER, STERN CHUTE MTG TUG FSH SHRIMPER PSC CATAMARAN MTB TUG AND TOW FSP SUPPORT SHIP PSK KETCH FTP TRAWLER, PAIR PSM MOTORSAILER MOO OTHER (DESCRIBE IN SUMMARY) FTE TRAWLER, SIDE, EASTERN PSS SCHOONER FTW TRAWLER, SIDE, WESTERN PSL SLOOP FTS TRAWLER, STERN PST TRIMARAN FTO TROLLER (SNAPPER OR SALMON) PSO SAIL, OTHER FWL WHALER POO OTHER (DESCRIBE IN SUMMARY) FOO OTHER (DESCRIBE IN SUMMARY) NATIONALITY TABLE AL ALBANIA EG EGYPT LE LEBANON SE SEYCHELLES AG ALGERIA ES EL SALVADOR LI LIBERIA SL SIERRA LEONE AO ANGOLA EK EQUATORIAL GUINEA LY LIBYA SN SINGAPORE AC ANTIGUA AND BARBUDA ET ETHIOPIA MA MADAGASCAR SO SOMALIA AR ARGENTINA FJ FIJI MY MALAYSIA SF SOUTH AFRICA AS AUSTRALIA FI FINLAND MI MALAWI SL SIERRA LEONE AU AUSTRIA FR FRANCE MV MALDIVES SP SPAIN BF BAHAMAS, THE GB GABON MT MALTA CE SRI LANKA BA BAHRAIN GA GAMBIA MR MAURITANIA SU SUDAN BG BANGLADESH GE GERMANY MP MAURITIUS NS SURINAM BB BARBADOS GH GHANA MX MEXICO SW SWEDEN BE BELGIUM GR GREECE MN MONACO SZ SWITZERLAND BH BELIZE GP GUADELOUPE MO MOROCCO SY SYRIA BN BENIN GJ GRENADA MY MYANMAR TW TAIWAN BD BERMUDA GT GUATEMALA NR NAURU TZ TANZANIA BL BOLIVIA GV GUINEA NL NETHERLANDS TH THAILAND BR BRAZIL PU GUINEA-BISSAU NA NETHERLANDS ANTILLES TO TOGO VI BRITISH VIRGIN ISLANDS GY GUYANA NZ NEW ZEALAND TN TONGA BU BULGARIA HA HAITI NU NICARAGUA TD TRINIDAD AND TOBAGO CB CAMBODIA HO HONDURAS NI NIGERIA TS TUNISIA CM CAMEROON HK HONG KONG NO NORWAY TU TURKEY CA CANADA HU HUNGARY OO OTHER (DESCRIBE IN SUMMARY) TK TURKS AND CAICOS IS CV CAPE VERDE IC ICELAND PK PAKISTAN TV TUVALU CJ CAYMAN ISLANDS IN INDIA PN PANAMA TC UNITED ARAB EMIRATES CI CHILE ID INDONESIA PA PARAGUAY UK UNITED KINGDOM CH CHINA IR IRAN PE PERU US UNITED STATES CO COLOMBIA IZ IRAQ RP PHILLIPINES UY URAGUAY CF CONGO EI IRELAND PL POLAND NH VANUATU CS COSTA RICA IS ISRAEL PO PORTUGAL VE VENEZUELA CU CUBA IT ITALY QA QATAR VM VIETNAM CY CYPRUS IV IVORY COAST RO ROMANIA WS WESTERN SAMOA EZ CZECH REPUBLIC JM JAMAICA RU RUSSIA YE YEMEN DA DENMARK JA JAPAN ST ST LUCIA XX WITHOUT NATIONALITY DJ DJIBOUTI KE KENYA VC ST VINCENT AND THE GRENADINES DO DOMINICA KN KOREA, NORTH TP SAO TOME AND PRINCIPE DR DOMINICAN REPUBLIC KS KOREA, SOUTH SA SAUDI ARABIA EC ECUADOR KU KUWAIT SG SENEGAL ACTIVITY VIOLATION CODES U UNDERWAY DM MOTHERSHIP MJ D DRIFTING DR ROUNDTRIP MJ F ENGAGED IN FISHING DB CONTACT BOAT MJ E ENTERING PORT DC COCAINE P DEPARTING PORT DO DRUG OTHER (DESCRIBE IN SUMMARY) FF MAGNUSON-STEVENS FISHERY CONSERVATION AND MANAGEMENT ACT T TOWING FL LACEY ACT B BEING TOWED FE ENDANGERED SPECIES ACT L ON/OFF LOADING FM MARINE MAMMAL PROTECTION ACT A ANCHORED FS MARINE SANCTUARIES M MOORED FP NORTH PACIFIC FISHERIES ACT N NESTED FH NORTH PACIFIC HALIBUT ACT R REFUELING FK SOCKEYE SALMON ACT FA ATLANTIC SALMON CONVENTION ACT FT ATLANTIC TUNAS CONVENTION ACT FW WHALING CONVENTION FR FUR SEAL ACT FO FISHERIES OTHER MT MIGRANT TRANSPORTATION BS BOATING SAFETY NA NEUTRALITY ACT SO SMUGGLING OTHER OO OTHER LAWS (DESCRIBE IN SUMMARY) CG-4100 (09/15) MO DY YR BOARDING TIME HULL IDENTIFICATION NUMBER REPORT OF BOARDING VESSEL NUMBER/DOC NUMBER VESSEL NAME HAILING PORT MANUFACTURER TPYE OF BOAT Open M/B Sail Canoe/Kayak Inflatable POB PFDS Cabin M/B Rowboat Houseboat Other MODEL YEAR ADULT ADULT Outboard Inbrd Diesel Jet Drive Manual PROPULSION: Inbrd Gas Rowboat Sail Only Other Wood Steel Unknown VESSEL NET TONS (DOC) FEET INCHES HORSEPOWER CHILD CHILD Rubber MATERIAL: Aluminum Fiberglass Cement Other USE FLAG ENGINE COMPT FUEL COMPT CONSTRUCTION OWNER NAME OWNERSHIP NATIONALITY ADDRESS DOB MMDDYYYY OWNER CITY STATE ZIP TELEPHONE TYPE OF ID I.D. # OPERATOR/MASTER NAME OPERATOR COURSE: None CG CGAUX USPS NATIONALITY RED CROSS PUBLIC SCHOOL STATE/COUNTY OTHER ADDRESS DOB MMDDYYYY OPER. AGE CITY STATE ZIP TELEPHONE TYPE OF ID I.D. # OPERATOR/MASTER BODY OF WATER CITY STATE ACTIVITY LATITUDE LONGITUDE DETAILED LOCATION ??????? Inland Rules Col Regs OBSERVED IN USE SUMMARY OF BOARDING / VIOLATION VIOLATION CITATION VIOLATION CITATION 101 NUMBERING 119 UNSAFE CONDITION CREATING ESPECIALLY 102 CERTIFICATE HAZARDOUS CONDITION 103 DOCUMENT/OFFICIAL NUMBER 120 INTOXICATED PERSON 104 PERSONAL FLOTATION DEVICE 121 FAILURE TO TERMINATE 105 BELL 122 OVERLOADED 106 FIRE EXTINQUISHER (Y) (N); FIXED (Y) (N) 123 MANIFESTLY UNSAFE VOYAGE (DIST.COR) 107 BACKFIRE FLAME CONTROL 124 ACCUMULATION OF FUEL IN BILGES 108 VENTILATION 125 FUEL LEAK - ENGINE OR FUEL SYSTEM 109 MARINE SANITATION DEVICE REGULATED NAVIGATION AREAS/HAZARDOUS 110 INSTALLED TOILET AND NO MSO INSTALLED 126 BARS/LIMITED ACCESS AREAS/NAVAL VESSEL 111 POLLUTION PLACARD PROTECTION ZONES/SECURITY/ZONES 112 GARBAGE PLACARD 127 CORRECTED ON THE SPOT 113 WASTE MANAGEMENT PLAN 128 USCG AUX CHE DECAL EXP DATE 114 FCC SSL NOT POSTED/AVAILABLE 129 FED REG FIREARMS ONBOARD (RECORD 115 OPERATION WITHOUT FCC SSL MAKE/MODEL/SER # IN SUMMARY) 116 NAVIGATION & ANCHOR LIGHTS 130 OTHER (SPECIFY) 117 VISUAL DISTRESS SIGNALS(SUNRISE/SUNSET) 131 OTHER (SPECIFY) 118 NEGLIGENT/GROSS NEGLIGENT OPERATION 132 OTHER (SPECIFY) RESULTS OF BOARDING / LAW ENFORCEMENT ACTION TAKEN RESULTS OF BOARDING ACTION TAKEN SEIZED PROPERTY RECEIPTS SERIAL # Voyage Terminated Arrest Seizure Yes No WRITTEN SUMMARY DISTRICT UNIT TELEPHONE NUMBER BOARDING OFFICER BOARDING NUMBER MSLE ACTIVITY NUMBER BOARDING OFFICER SIGNATURE CG-4100 (09/15) PROMOTE BOATING SAFETY The Coast Guard requests your cooperation in promoting the safety of life and property on the nation's waterways. By observing the prescribed laws and regulations and by following safe boating practices, you can help reduce the number of lives lost or injuries sustained and prevent damage to property. PURPOSE OF BOARDING The Coast Guard is the primary maritime law enforcement and safety agency of the United States. Under statutory authority Coast Guard boarding officers may at any time go onboard vessels subject to the jurisdiction of the United States and make inquiries, examine ship's papers, and inspect, examine and search the vessel for the detection, prevention, and suppression of violation of U.S. Laws. The Coast Guard is also authorized to make seizures and arrests and use only that force which is reasonably necessary under the circumstances to compel compliance while conducting boardings. The Coast Guard enforces regulations related to recreational boating safety, boating while intoxicated, pollution prevention, vessel documentation and registration and many other areas including criminal laws such as possession and distribution of illegal drugs, illegal weapons, stolen boats, alien smuggling as well as Customs laws. Additionally, the Coast Guard checks for compliance with applicable U.S. Fisheries regulations and agreements. The Coast Guard accomplishes this through an active boarding policy in which boarding teams follow established procedures for going onboard U.S. and foreign vessels subject to U.S. jurisdiction to conduct inspections. ADDITIONAL INFORMAITON Boaters who have questions, comments or feedback concerning Coast Guard law enforcement boardings may go to the Boating Safety Resource Center website: http://www.uscgboating.org/ NOTICE OF VIOLATION IMPORTANT NOTICE TO OWNER OR OPERATOR CORRECT DISCREPANCY AS SOON AS POSSIBLE Continued operation without required safety equipment may be an invitation to a serious accident. It may also result in additional penalties for repeated violation of Federal Law. PROCEDURES The information from this Report of Boarding will be forwarded to the appropriate entity who will review all applicable information to determine if civil penalty action should be commenced. You may be offered an opportunity to prove correction of your discrepancy or discrepancies to avoid civil penalty action. Should civil penalty action be considered appropriate for the violation(s) noted, you will be notified in writing by a Coast Guard Hearing Officer of the charges against you, the maximum penalty which may be assessed, the procedures used in assessing the penalty, the amount of the penalty appearing appropriate, and of your rights in the proceeding.