Cruise Ship Passenger Overboard Incident Report Form

Incident documentation form for passenger overboard events, including last known location, reported time, GMDSS communication log, coast guard notification, search pattern, and crew response actions.

Incident Overview

• Date of Incident
• Date and Time Reported
• Reporting Vessel / Location
• Incident Type
• How Was the Incident Reported?

Passenger and Last Known Location

• Passenger Name
  Enter only if known and needed for identification.
• Cabin Number
• Last Known Location
  Describe the last verified location on board or near the vessel, including deck, side, and nearby landmarks.
• Last Seen Date and Time
• Last Seen By
  Crew member, passenger, or CCTV reference if available.
• Location Certainty

Immediate Crew Response

• Immediate Response Actions Taken
• Crew Members on Scene
  Approximate number of crew members directly involved in the immediate response.
• Was the Passenger Accounted For?
• Was There Any Injury or Medical Need?
• Medical Response Details

Communications and Notifications

• Was GMDSS Activated?
• GMDSS Communication Log
  Log each communication event in chronological order.
• Was the Coast Guard Notified?
• Coast Guard Notification Record
  Document each notification attempt and response.

Search Pattern and Recovery Actions

• Search Pattern Used
• Search Area Description
• Search Start Time
• Search End Time
• Recovery or Follow-Up Actions

Witnesses, Evidence, and Follow-Up

• Number of Witnesses
• Witness Statements Summary
• Evidence Preserved
• Follow-Up Required
• Follow-Up Notes