DAMAGE REPORT NO.
Date of Accident at Voyage
Description of events as noted in log and / or note of protest :
Has it been entered in Official log ?
(Please send log extract)
Are third parties responsible in your opinion ?
If yes, who ?
Was he held responsible in writing ?
(Please attach copy)
Have you lodged a note of protest relating to this damage ?
If yes, send a copy to HO ?
If not, do you intend to lodge a note of protest ?
Complete description of damages (attach a sketch, if necessary) :
Was Classification Surveyor called in ?
If yes, what are the recommendations in certificate ? (Please forward copy of certificate)
Were damages surveyed by underwriter’s surveyor ?
If so, by whom and when ?
Send copies of all surveyor’s certificates to H.O.
Were all visible damages inspected by Master when taking over command ?
For Engine Damages For Hull Damages
Date : Data :
Chief Engineer : Master :
Remarks : Number Reports as Damages Occur