- Name of person reporting and telephone number ________________________________________________
( _______ ) ____________________
- Description of boat
Type______________ Color__________ Trim___________
Registration No._________________ Length_____________
Name _______________ Make________ Other _________
- Engine type________________________ H. P.___________
No. of engines _____________________ Fuel capacity_____
- Survival equipment
 PFDs Paddles Smoke
signals Anchor
- Radio Yes No
Type _____________ Frequency ______
- Mobile phone Yes No
( _______ ) _________________
- Automobile license number ___________________________
Type_________________ Trailer license________________
Color________________ Make of auto_________________
Where parked_____________________________________
- Persons on board
| Name |
Age |
Address & Telephone |
_________________________________________________
_________________________________________________
_________________________________________________
_________________________________________________
- Do any of the persons on board have a medical problem?
Yes No
If yes, what?_____________________________
- Trip expectations. Leave at_________________ am pm
From ________________ going to______________________
Expect to return by (time) _______________ am pm
and
not later than __________________________ am pm
- Any other pertinent information?________________________
_________________________________________________
- If not returned by (time) call the Coast Guard
or (local authority) ___________________________ am pm
- Telephone numbers
( _____ ) ________________ ( _____ ) ________________
|
