MARINE FIRE NOTIFICATION GUIDE |
Part I – Initial Information
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Name of Reporting Person:
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Phone:
( ) --
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Address:
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Reporting Person’s Relationship to Incident (check box):
Agent Master/CEO Working Party (Title: ) Other (Specify: )
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Nature of Incident (check box):
Vessel Fire Facility Fire Explosion Collision Other (Specify: )
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Part II – Location of Incident
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Latitude:
. “ N
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Longitude:
. “ W
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Vessel Fire
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Vessel Name:
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Call Sign:
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Exact Location of Fire (i.e. compartment, deck):
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Agent Name:
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Agent Phone:
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Vessel Flag:
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Marina:
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Berth:
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Anchorage:
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Address (if applicable):
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Facility Fire
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Facility Name:
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Exact Location of Fire (i.e. where on facility):
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Facility Phone:
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Address (if applicable):
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Part III – Fire and Safety Information
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Fire Details
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Status of Fire (circle one):
Extinguished / Contained / Out of Control
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Class of Fire (check box):
Alpha (paper, wood, etc.) Bravo (fuels) Charlie (electrical) Delta (metals)
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Firefighting Efforts (check box):
None taken at time of report
In progress with vessel/facility crew
In progress with outside assistance:
Specifiy:_____________________________
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Source of Fire (check box):
Source known? NO
YES
Source Secured? NO
YES
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