• PILOT'S REPORT OF MARINE SAFETY OCCURRENCE

    State of Washington Board of Pilotage Commissioners

  • WAC 363-116-200 1 (b)

    A state licensed pilot and state licensed pilot trainee involved in a near-miss occurrence shall complete the board-required Report of Maritime Safety Occurrence form and file it with the board as soon as possible after the near-miss occurrence, but in no event more than ten days afterwards. If a pilot trainee is involved, both the pilot trainee and the supervising pilot shall file a Report of Marine Safety Occurrence. A near-miss occurrence is where a pilot and pilot trainee successfully takes action of a non-routine nature to avoid a collision with another vessel, structure or aid to navigation, to avoid a grounding of the vessel or to avoid causing damage to the environment. Information relating to near-miss occurrences provided by a pilot and pilot trainee on this form shall not be used for imposing any sanctions or penalties against the pilot or pilot trainee involved in the occurrence. A state pilot or pilot trainee may also use this form on a voluntary basis for reporting out of the ordinary occurrences or concerns for navigational safety encountered or observed during the course of piloting a vessel as well as safety issues encountered or observed on the vessel, the dock, or in the area around the vessel.
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  • TYPE OF OCCURRENCE (INDICATE ALL THAT APPLY)

  • LOCATION INFORMATION

    (PLACE NAME/DESCRIPTION, TSS LOCATION, TERMINAL)

  • PILOTED VESSEL INFORMATION

  • OTHER VESSEL(S) INVOLVED?

  • ENVIRONMENTAL CONDITIONS

  • NARRATIVE DESCRIPTION OF OCCURRENCE (OR UPLOAD SEPARATE DOCUMENT)

  • Topics to Consider: How problem arose, How problem was discovered, Contributing factors, Actions or inactions, Experience, Procedures, Judgments, Decisions, Personal alertness, Perceptions, Communications, Language difficulty, Ship design

    Please include: Intended route (for example, Pilot Station to Terminal 18) and any calls made to VTS and the time of the calls.

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