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INCIDENT ALERT
NOTE: This report must be forwarded by the Owner or Master within 4 hours of the incident to:
+61 2 6230 6868 (fax) or 1800 622 153 (free fax within Australia) or Reports@amsa.gov.au (Email).
A detailed report (form AMSA 19) is to be forwarded to AMSA via the above means within 72 hours of the incident.
Do not use this form to report pollution incidents under the MARPOL convention. For pollution incidents use the reporting
format from IMO Resolution 851(20) as amended, for harmful substances or marine pollutant reports (POLREPS, AMSA Forms
197 or 196).
DESCRIPTION OF INCIDENT/DAMAGE
Ships name
IMO number
Call sign
Satcom number
Flag
Master
Gross tonnage
Class society
Propulsion
Ship type
Container
Tanker
Bulk Carrier
Tug
OSV
Other
Recreational
DCV
Operators name and address
Contact number
INCIDENT DETAILS
Voyage
From
To
Ships Location (eg port, at sea, lat, long)
Location on ship where incident occurred
am/pm
Nature of Incident
Collision
Grounding
Fire
Death
Structural failure
Disappearance
Flooding
Loss
Machinery failure
Presumed lost
Cargo gear
Pilotage
Births
Dangerous goods
Other (specify)
AMSA 18 (09/13)
(e)
(c)
(d)
a tropical storm;
sub-freezing air temperature associated with gale force
winds causing severe ice accretion on superstructures;
winds of force 10 on the Beaufort scale for which no storm
warning has been received.
dangerous ice;
a dangerous derelict;
Australian legislation provides significant penalties for failing to comply with any of the above.
AMSA 18 (09/13)