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