Owner`s manual
Boating Accident Report
C-1
Appendix C
DC 325
Boating Accident Report
DEPARTMENT OF
TRANSPORTATION
U.S. COAST GUARD
C.G. 1865 (REV.1/88)
BOATING ACCIDENT REPORT
FORM APPROVED
OMB No.211-0010
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, or an injury which requires medical treatment beyond first aid: or property damage in excess of $200 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 reporting authority in the state where the accident occurred. This form is provided to assist the
operator to filing the required written report.
COMPLETE ALL BLOCKS (indicate those not applicable by “NA”)
NAME AND ADDRESS OF OPERATOR
AGE OF OPERATOR
DATE OF BIRTH
OPERATOR’S EXPERIENCE
This type of boat Other boat operating Exp.
Under 20 Hours Under 20 Hours
20 to 100 Hours 20 to 100 Hours
100 to 500 Hours 100 to 500 Hours
Over 500 Hours Over 500 Hours
OPERATOR TELEPHONE NUMBER OWNER TELEPHONE No.
NAME AND ADDRESS OF OWNER RENTED BOAT
YES
NO
NUMBERS OF
PERSONS ON
BOARD
FORMAL INSTRUCTION IN BOATING SAFETY
None State U.S. Power Squadrons
USCG Auxiliary American Red Cross
Other (Specify) ___________________________
VESSEL No. (this vessel)
BOAT REGISTER No. BOAT NAME BOAT MAKE BOAT MODEL MFR HULL IDENTIFICATION No.
TYPE OF BOAT
Open Motorboat
Cabin Motorboat
Auxiliary Sail
Sail (only)
Rowboat
Canoe
Other (Specify)
HULL MATERIAL
Wood
Aluminum
Steel
Fiberglass
Rubber/vinyl
Other Specify)
ENGINE
Outboard
Inboard gasoline
Inboard diesel
Inboard-outdrive
Jet
Other (Specify)
PROPULSION
No. of engines _________
Horse Power (total) _____
Type of fuel ___________
CONSTRUCTION
Length ____________________
Year built (boat) _____________
Has boat had a Safety Examination?
Outboard
NO
For current year? YES NO Year ________
Indicate whether USCG Auxiliary Courtesy Marine Exam
State/local examination Other
ACCIDENT DATA
DATE OF ACCIDENT
TIME am
pm
NAME OF BODY OF WATER
LOCATION (Give location precisely) Lat
Long
STATE
NEAREST CITY OR TOWN COUNTY
WEATHER
Clear Rain
Cloudy Snow
Fog Hazy
WATER CONDITIONS
Calm (waves less than 6")
Choppy (waves 6" to 2')
Rough (greater than 6')
Strong Current
TEMEPERATURE
(Estimate)
Air _______________ F°
Water ____________ F°
WIND
None
Light (0- 6mph)
Moderate(7-14 mph)
Strong (15-25 mph)
Storm (Over 25 mph)
VISIBILITY
DAY NIGHT
Good
Fair
Poor
OPERATION AT TIME OF ACCIDENT
(Check all applicable)
Commercial Activity Drifting
Cruising At Anchor
Maneuvering Tied to Dock
Approaching Dock Fueling
Leaving Dock Fishing
Water Skiing Hunting
Racing Skin Diving/
Towing Swimming
Other (Specify) Being Towed
TYPE OF ACCIDENT
(Check all applicable)
Grounding Collision with
Capsizing Fixed Object
Flooding Collision with
Sinking Floating Object
Fire or explosion (fuel) Falls Overboard
Fire or explosion Falls in boat
(Other than fuel) Hit by Boat or
Fallen Skier Propeller
Collision with Vessel Other (Specify)
WHAT IN YOUR OPINION CONTRIBUTED TO THE
ACCIDENT (Check all applicable)
Weather Alcohol use
Excessive speed Drug use
No proper Lookout Fault of Hull
Restricted Vision Fault of Machinery
Overloading Fault of Equipment
Improper Loading Hunting
Racing Operator
Inexperience
Hazardous Waters Operator Inattention
Other (Specify)
PERSONAL FLOTATION DEVICES (PFD’S) PROPERTY DAMAGE FIRE EXTINGUISHERS
Was the boat adequately equipped with Was the vessel carrying NON approved
COAST GUARD APPROVED FLOTATION flotation devices? Yes
No
DEVICES? Yes No Were they accessible? Yes No
Were they accessible? Yes No Were they used? Yes No
Were they serviceable? Yes No If Yes, indicate kind.
Were they used by survivors? Yes No
What type? I, II, III, IV, V (specify) ________________________
Were PFD’s properly used? Yes No
Adjusted Yes No
Sized Yes No
Include any comments of PFD’s under ACCIDENT DESCRIPTION on other side of form
Estimated amount
This boat $
Other boat $
Other Property $
Were they used? (If
yes, list Type(s) and
number used.)
Yes No NA
Types:
DESCRIBE PROPERTY DAMAGE
NAME AND ADDRESS OF OWNER OF DAMAGED
PROPERTY