Silverton 42 C Owner'S Manual Download

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GLOSSARY-15

THE OPERATOR/OWNER OF A VESSEL USED FOR RECREATIONAL PURPOSES IS REQUIRED TO FILE A REPORT IN WRITING
WHENEVER AN ACCIDENT RESULTS IN: LOSS OF LIFE OR DISAPPEARANCE FROM A VESSEL; AN INJURY WHICH REQUIRES MEDICAL
TREATMENT BEYOND FIRST AID; OR PROPERTY DAMAGE IN EXCESS OF $2000 OR COMPLETE LOSS OF THE VESSEL. REPORTS IN
DEATH AND INJURY CASES MUST BE SUBMITTED WITHIN 48 HOURS. REPORTS IN OTHER CASES MUST BE SUBMITTED WITHIN 10
DAYS. REPORTS MUST BE SUBMITTED TO THE REPORTING AUTHORITY IN THE STATE WHERE THE ACCIDENT OCCURRED. THIS
FORM IS PROVIDED TO ASSIST THE OPERATOR IN FILING THE REQUIRED WRITTEN REPORT.

DEPARTMENT OF TRANSPORTATION
U.S. COAST GUARD

CG-3865 (Rev. 9/95)

BOATING ACCIDENT REPORT

STATE ASSIGNED CASE NO._______________

COMPLETE ALL BLOCKS

(INDICATE THOSE NOT APPLICABLE BY "NA")

ACCIDENT DATA

TIME

AM
PM

DATE OF ACCIDENT

NAME OF BODY OF WATER

LOCATION (GIVE LOCATION PRECISELY)

NUMBER OF VESSELS
INVOLVED

COUNTY

STATE

ZIP CODE

NEAREST CITY OR TOWN

WEATHER
(CHECK ALL APPLICABLE)
[ ] CLEAR

[ ] RAIN

[ ] CLOUDY

[ ] SNOW

[ ] FOG

[ ] HAZY

WATER CONDITIONS
[ ] CALM (WAVES LESS THAN 6")
[ ] CHOPPY (WAVES 6" TO 2')
[ ] ROUGH (WAVES 2' TO 6')
[ ] VERY ROUGH (GREATER THAN 6')

[ ] STRONG CURRENT

TEMPERATURE
(ESTIMATE)
AIR_______

WATER_____

WIND
[ ] NONE
[ ] LIGHT (0-6 MPH)
[ ] MODERATE (7-14 MPH)
[ ] STRONG (15-25 MPH)
[ ] STORM (OVER 25 MPH)

VISIBILITY

DAY

NIGHT

[ ] GOOD [ ]
[ ] FAIR

[ ]

[ ] POOR [ ]

NAME OF OPERATOR

OPERATOR TELEPHONE NUMBER
(

)

DATE OF BIRTH
MO

DAY

OPERATOR'S EXPERIENCE
[ ] NONE
[ ] UNDER 100 HOURS
[ ] > 100 HOURS

INSTRUCTION IN BOATING SAFETY
[ ] STATE COURSE

[ ] U.S. POWER SQUADRON

[ ] USCG AUXILIARY [ ] AMERICAN RED CROSS
[ ] NONE

[ ] MALE

[ ] FEMALE

OPERATOR ADDRESS

NAME OF OWNER

OWNER ADDRESS

OWNER TELEPHONE NUMBER
(

)

NUMBER OF PEOPLE
ON BOARD

NUMBER OF PEOPLE
BEING TOWED

RENTED BOAT?
[ ] YES

[ ] NO

BOAT NO. 1 (THIS VESSEL)

BOAT REGISTRATION OR DOCUMENTATION NUMBER

STATE

HULL IDENTIFICATION NUMBER

BOAT NAME

BOAT MANUFACTURER

LENGTH

MODEL

YEAR BUILT

TYPE OF BOAT
[ ] OPEN MOTORBOAT
[ ] CABIN MOTORBOAT
[ ] AUXILIARY SAIL
[ ] SAIL (ONLY)
[ ] ROWBOAT
[ ] CANOE/KAYAK
[ ] PERSONAL WATERCRAFT
[ ] PONTOON BOAT
[ ] HOUSEBOAT
[ ] OTHER (SPECIFY)

HULL MATERIAL
[ ] WOOD
[ ] ALUMINUM
[ ] STEEL
[ ] FIBERGLASS
[ ] RUBBER/VINYL/CANVAS
[ ] RIGID HULL INFLATABLE
[ ] OTHER (SPECIFY)

ENGINE
[ ] OUTBOARD
[ ] INBOARD
[ ] INBOARD-

STERNDRIVE (I/O)

[ ] AIRBOAT

PROPULSION
[ ] PROPELLER
[ ] WATER JET
[ ] AIR THRUST
[ ] MANUAL
[ ] SAIL

PERSONAL FLOTATION DEVICES
(PFDS): WAS BOAT ADEQUATELY
EQUIPPED WITH COAST GUARD
APPROVED PFDS?
[ ] YES

[ ] NO

WERE PFDS ACCESSIBLE?
[ ] YES

[ ] NO

NUMBER OF
ENGINES

TOTAL
HORSEPOWER

FIRE EXTINGUISHERS
ON BOARD?

[ ] YES

[ ] NO

USED?

[ ] YES

[ ] NO

FUEL
[ ] GASOLINE
[ ] DIESEL
[ ] ELECTRIC

OPERATION AT TIME OF ACCIDENT
(CHECK ALL APPLICABLE)
[ ] CRUISING
[ ] CHANGING DIRECTION
[ ] CHANGING SPEED
[ ] DRIFTING
[ ] TOWING
[ ] BEING TOWED
[ ] ROWING/PADDLING
[ ] SAILING
[ ] LAUNCHING
[ ] DOCKING/UNDOCKING
[ ] AT ANCHOR
[ ] TIED TO DOCK/MOORED
[ ] OTHER (SPECIFY)

ACTIVITY AT TIME OF ACCIDENT
(CHECK ANY IF APPLICABLE)
[ ] FISHING
[ ] TOURNAMENT
[ ] HUNTING
[ ] SWIMMING/DIVING
[ ] MAKING REPAIRS
[ ] WATERSKIING/TUBING/ETC.
[ ] RACING
[ ] WHITEWATER SPORTS
[ ] FUELING
[ ] STARTING ENGINE
[ ] NON-RECREATIONAL
[ ] OTHER (SPECIFY)

TYPE OF ACCIDENT
[ ] GROUNDING
[ ] CAPSIZING
[ ] FLOODING/SWAMPING
[ ] SINKING
[ ] FIRE OR EXPLOSION (FUEL)
[ ] FIRE OR EXPLOSION (OTHER)
[ ] SKIER MISHAP
[ ] COLLISION WITH VESSEL
[ ] COLLISION WITH FIXED OBJECT
[ ] COLLISION WITH FLOATING OBJ.
[ ] FALLS OVERBOARD
[ ] FALLS IN BOAT
[ ] STRUCK BY BOAT
[ ] STRUCK BY MOTOR/PROPELLER
[ ] STRUCK SUBMERGED OBJECT
[ ] OTHER (SPECIFY)

[ ] HIT AND RUN

ESTIMATED SPEED

[ ] NONE

[

]

UNDER 10 MPH

[ ] 10 - 20 MPH

[ ] 21 - 40 MPH

[

]

OVER 40 MPH

FORM APPROVED OMB NO. 2115-0010

WHAT CONTRIBUTED TO ACCIDENT?
(CHECK ALL APPLICABLE)
[ ] WEATHER
[ ] EXCESSIVE SPEED
[ ] IMPROPER LOOKOUT
[ ] RESTRICTED VISION
[ ] OVERLOADING
[ ] IMPROPER LOADING
[ ] HAZARDOUS WATERS
[ ] ALCOHOL USE
[ ] DRUG USE
[ ] HULL FAILURE
[ ] MACHINERY FAILURE
[ ] EQUIPMENT FAILURE
[ ] OPERATOR INEXPERIENCE
[ ] OPERATOR INATTENTION
[ ] CONGESTED WATERS
[ ] PASSENGER/SKIER BEHAVIOR
[ ] DAM/LOCK
[ ] OTHER (SPECIFY)