ANNEX II

MARINE CASUALTY OR INCIDENT NOTIFICATION DATA (Part of the European Marine Casualty Information Platform)

Note: Underlined numbers mean that data should be provided for each ship if more than one ship is involved in the marine casualty or incident.

01.

Member Sate responsible/contact person

02.

Member Sate investigator

03.

Member State role

04.

Coastal state affected

05.

Number of substantially interested States

06.

Substantially interested States

07.

Notification entity

08.

Time of the notification

09.

Date of the notification

10.

Name of the ship

11.

IMO number/distinctive letters

12.

Ship flag

13.

Type of marine casualty or incident

14.

Type of ship

15.

Date of the marine casualty or incident

16.

Time of the marine casualty or incident

17.

Position – Latitude

18.

Position – Longitude

19.

Location of the marine casualty or incident

20.

Port of departure

21.

Port of destination

22.

Traffic separation scheme

23.

Voyage segment

24.

Ship operation

25.

Place on board

26.

Lives lost:

• Crew

• Passengers

• Other

27.

Serious injuries:

• Crew

• Passengers

• Other

28.

Pollution

29.

Ship damage

30.

Cargo damage

31.

Other damage

32.

Brief description of the marine casualty or incident

33.

Brief description of the reasons not to undertake a safety investigation.