NAME D.O.B. ADDRESS TELEPHONE VESSEL
None
Weather:
Water Conditions:
Wind:
Visibility:
Calm (waves less than 6'')
Clear
Dawn
Good
Cloudy
Light (0-6 mph)
Choppy (waves 6" to 2')
Hazy
Rain
Fair
Day
Moderate (7-14 mph)
Rough (waves 2' to 6')
Thunderstorm
Fog
Poor
Dusk
Strong (1 5-25 mph)
Very Rough (larger than 6')
Night
(Check all that apply)
Storm (over 25 mph)
(You may enter a primary, secondary and tertiary accident type for each vessel by placing a 1, 2, or 3 in the appropriate box)
Accident Type:
V-1 V-2
Struck by boat
Falls overboard
Capsizing
Grounding
Struck by propeller
Collision with fixed object
Sinking
Struck underwater object
Collision with floating object
Fire/Explosion (fuel)
Skier hit object
Collision with vessel
Fire/Explosion (non-fuel)
Vessel wake damage
Fallen Skier
Falls in boat
Other:
Flooding (swamping)
(You may enter up to three contributing causes for each Vessel)
Possible Contributing Factors:
V-1 V-2
V-2
V-1 V-2
V-1
Machine failure (state below)
Alcohol use
Sharp turn
No proper look-out
Careless/Reckless Operation
Hazardous waters
Hull failure
Congested waters
Operator inattention
Viol. Of Nav. Rule (state below)
Vision obstructed
Operator inexperience
Improper anchoring
Overloading
Drug use
Weather
Equip. failure (state below)
Improper loading
Standing/sitting on gun-
Other:
Lack of proper lights
Excessive speed
wale, bow or transom
(You may enter up to three for each vessel)
(You may enter up to three for each vessel)
Activity at Time of Accident:
Operation at Time of Accident
Commercial Activity
Starting Engine
At Anchor
Towing a boat
Water Skiing/Tubing
Being Towed
Fishing Recreational
Drifting
Changing Direction
Fishing Tournament
Swimming, Snorkeling,
Scuba Diving
Tied to Dock (moored)
Hunting
Recreational Cruising
Approaching Dock
Launching/Loading
Rowing/Paddling
ALABAMA LAW ENFORCEMENT AGENCY
DPS- Alabama Marine Patrol
Boating Accident Reporting Form
Case Number: For
Internal Use Only
MAI-9
11/18
Total Estimated Damage Amount
General Information:
Number Vessels Involved
Person Filing Report:
Date of Accident
Time of Accident
Body of Water
Precise Location
Nearest City or Town
County
Latitude deg min sec
Telephone:
Longitude deg min sec
Snow
Strong Current
Temperature:
Air
deg F
Water
deg F
Water Depth:
Feet
Restricted Vision
V-1 V-2
Leaving Dock
V-1 V-2
Cruising
Sailing
Maneuvering
Other:
V-1 V-2
Racing
Fueling
Other:
V-1 V-2
WITNESSES Also see witness statements. Use additional sheets if necessary.
V-1 V-2
V-1 V-2
V-1 V-2
V-1 V-2
Vessel Speed At Time of
Accident
Not Moving
Under 10 MPH
10 -20 MPH
21 -40 MPH
Over 40 MPH
melynda.moore@alea.gov
Email:
(334) 517-2954
Montgomery, AL 36130-4115
PO Box 304115
ALEA - DPS-MARINE PATROL
Mail, Fax or Email Form To:
Fax:
(334) 517-2950
Questions:
that total less than $2000.00.
This report is to be used for property damage only accidents
Alabama Marine Police Officer.
damage greater than $2000.00 must be reported by an
Any accidents resulting in fatalities, injuries, and/or property
Address:
