DISTRESS CALL INFORMATION FORM



IMMEDIATE DANGER (Y/N)		

CALL SIGN			

NATURE OF PROBLEM		

LOCATION OF VESSEL		

	LAT/LON			

	COURSE (T/M)		

	SPEED			

	DESTINATION		

	ETA			

DATE AND TIME (ZULU)		

DESCRIPTION OF VESSEL		

	LENGTH			

	TYPE 			

	COLOR			

NAME OF VESSEL			

REG/DOC #			

CONDITION AND POB		

NAME OF SKIPPER			

TYPE OF HELP NEEDED		

SEAS AND WX CONDITIONS		

VISIBILITY			

EMERGENCY EQUIPMENT ON BOARD	

	EPIRB (121.5, 243.0, 406, NONE)

	FOOD			

	WATER			

	ANCHOR			

	FLARES			

	LIFE RAFT		

RADIO EQUIPMENT ON BOARD	

RADIO SCHEDULE			

POINT OF CONTACT (NAME/PH#)	

PORT OF DEPARTURE		

REMARKS