Damage report | Captain Owners

1 Date /Time
2 Vessel’s name
3 Tel. Number
4 E-mail
5 Master
6 Crew on board
7 Damage

8 Hull leakage
9 Tanks sounded
10 Oil spill No Yes:
11 Position
12 Nearest port
13 Voyage from / to
14 Cargo
15 Draft Fore: Aft:
16 Weather / Current
17 Tug assistance No Yes:
18 VDR / SVDR No Yes:
19 Contact details agent
load / discharge port
20 Informed:
21 - Assurance No Yes:
22 - Surveyor No Yes:
23 - Local authorities No Yes:
24 - Class No Yes:
25 - P&I club No Yes:
26 - ILT No Yes:
27 - Dirkzwager No Yes:
28 Additional remarks

Version: 16-10-2019 Page: 1 of 1