Captain's Information:
Name of Vessel Operator: _________________________________
Captain's experience level: _________________________________
Medical condition at launch: _________________________________
Captain's medical problems:_________________________________
Telephone Number:________________________________________
Address:________________________________________________
Name of Vessel:
Registration Number:________________________________
Type:____________________________________________
Make:___________________________________________
Length (LOA): _______ ft. Width of Beam: _______ ft ______in
Draft of vessel:_______ Color of Hull(s): _________
Number of Hull(s):_____ Condition: ____________
Identifiable markings: ________________________________
Deck color: ___________ Condition: ____________________
Rafts/Dinghies:
Number: _________ Size: ____ ft. ____ in. Color: ___________
Radio:
Type (VHF, UHF, handheld) ____ Frequencies Monitored ______
Cellular Phone Number ________________________________
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Age |
Phone |
Address |
Physical Condition |
Experience
Years. |
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Write additional crew names or information on back of float plan.
Engine Type: Inboard Outboard Engine Horsepower: ________ hp
Fuel Supply (in days) _______
Survival equipment onboard (check and number of each)
| Life Jackets: # ________ |
Flares: day Color __________ |
EPIRB: # ______ |
| Medical Kit: # _______ |
Flares: night Color _________ |
Loran: GPS |
| Anchor: #_______ |
Smoke signals: ________ |
Paddles: # _____ |
| Add additional safety equipment here: |
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Food for _____ days Water for _____ days
Trip Information: (with GPS coordinates, if known)
Date of Departure: ____/____/____ Time of departure: _____
Departure from: ___________________________________
Destination: ______________________________________
Expected Arrival Time: _______ or no later than: __________
Reason for trip:____________________________________
Trailer and Vehicle information:
Trailer Description: _________________________________
Vehicle Make: _____________ Vehicle color: ____________
Model: ___________ Model Year: _________
Vehicle and trailer location: ___________________________
Reporting Party's Information:
Name: __________________________________________
Address: ________________________________________
Telephone:_______________________________________
If vessel is overdue, how long have they been overdue? (approximate hours): ________
