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CAQA Bluewater Maritime · Simulated workplace

Marine Incident Report Form

FormControlled document
BLU-FRM-001
v2.1
Document ownerSafety and Compliance Manager
Version2.1
Approved12 January 2026
Next review12 January 2027
StatusCurrent

Purpose. Crew and shore staff use this form to report any incident, injury, near miss, spill, grounding, collision, equipment failure or security event so it can be entered in the incident register and reported to the regulator where required.

1.When to use this form

Complete this form for any event that caused or could have caused injury, damage, pollution or a breach of the certificate of operation. The master or supervisor must complete it within 24 hours and give it to the Safety and Compliance Manager. Serious incidents must also be reported by telephone immediately.

2.Reportable marine incidents

Death, serious injury, loss of a vessel, grounding, collision, fire, flooding, pollution and a close-quarters situation that endangered the vessel are reportable to the Australian Maritime Safety Authority. The Safety and Compliance Manager will lodge the report within the required time using the information on this form.

3.Describing the event

Describe what happened in order, with the vessel's position, speed and heading, the weather and sea state, the people involved and the equipment in use. Attach the relevant pages of the deck and engine logs and any photographs.

4.Immediate actions

Record what was done to make the vessel and people safe, any first aid or medical evacuation, and who was notified.

5.Follow-up

The Safety and Compliance Manager will decide whether an investigation is required and will record corrective actions in the incident register.

6.Complete the form

BLU-FRM-001 v2.1 · CAQA Bluewater MaritimeUncontrolled when printed. Simulated document created by CAQA for training and assessment.