2024 ABCs of California Boating

ACTIVITY DBW FORM BAR-1 11/17 THIS CONFIDENTIAL REPORT IS USED IN RESEARCH FOR THE PREVENTION OF ACCIDENTS AND A COPY IS FORWARDED TO THE UNITED STATES COAST GUARD ACTIVITY RECREATIONAL COMMERCIAL OTHER FIRE EXTINGUISHER ON BOARD TYPE OF BOAT OPEN MOTORBOAT CABIN MOTORBOAT PERSONAL WATERCRAFT HOUSEBOAT PONTOON INFLATABLE SAILBOAT (aux. engine) SAILBOAT (sail only) CANOE/KAYAK RAFT ROWBOAT AIRBOAT OTHER (specify) PERSON COMPLETING THE REPORT DBW FORM BAR-1 11/17 RECREATIONAL COMMERCIAL OTHER OPEN MOTORBOAT CABIN MOTORBOAT PERSONAL WATERCRAFT FIRE EXTINGUISHER ON BOARD TYPE OF BOAT HOUSEBOAT PONTOON INFLATABLE SAILBOAT (aux. engine) SAILBOAT (sail only) CANOE/KAYAK RAFT ROWBOAT AIRBOAT OTHER (specify) PERSON COMPLETING THE REPORT

SIGNATURE DATE SIGNATURE DATE

NAME ADDRESS PHONE ( ) NAME ADDRESS PHONE ( )

OVER 100 HOURS AGE MARINA/RAMP LAUNCHED FROM: INFORMATION: VESSEL #2 (OTHER VESSEL INVOLVED) THIS VESSEL ONLY # INJURED # DEAD ESTIMATED DAMAGE RENTED BOAT YES NO # OF PERSONS ON BOARD # OF PERSONS TOWED BOAT NUMBER (CF OR DOC #) MFR. HULL ID # BOAT NAME DEPTH (TRANS. TO KEEL) BEAM WIDTH LENGTH YES NO STATE COURSE INFORMAL NONE OTHER: 10 TO 100 HOURS OVER 100 HOURS AGE MARINA/RAMP LAUNCHED FROM: INFORMATION: VESSEL #2 (OTHER VESSEL INVOLVED) THIS VESSEL ONLY # INJURED # DEAD ESTIMATED DAMAGE RENTED BOAT YES NO # OF PERSONS ON BOARD # OF PERSONS TOWED BOAT NUMBER (CF OR DOC #) MFR. HULL ID # BOAT NAME DEPTH (TRANS. TO KEEL) BEAM WIDTH LENGTH YES NO CALIFORNIA BOATER CARD STATE COURSE INFORMAL NONE OTHER: # OF ENGINES HORSE POWER # OF ENGINES HORSE POWER BOAT MANUFACTURER BOAT MODEL YEAR BUILT SPEED AT TIME OF ACCIDENT BOAT MANUFACTURER BOAT MODEL YEAR BUILT SPEED AT TIME OF ACCIDENT MPH

INFORMATION: OPERATOR #2 IS OWNER DIFFERENT THAN OPERATOR? YES NO OPERATOR NAME, ADDRESS, PHONE # OWNER NAME AND ADDRESS INFORMATION: OPERATOR #2 IS OWNER DIFFERENT THAN OPERATOR? YES NO OPERATOR NAME, ADDRESS, PHONE # OWNER NAME AND ADDRESS

YES NO

YES NO

HULL MATERIAL

HULL MATERIAL

STEEL OTHER (specify) STEEL OTHER (specify)

WOOD ALUMINUM FIBERGLASS PLASTIC RUBBER/VINYL/CANVAS PLASTIC RUBBER/VINYL/CANVAS WOOD ALUMINUM FIBERGLASS

# ONBOARD

TYPE OF FIRE EXTINGUISHER

# ONBOARD

TYPE OF FIRE EXTINGUISHER

FIRE EXTINGUISHER USED FIRE EXTINGUISHER USED

YES NO

YES NO

INBOARD POD DRIVE OTHER: TOTAL HORSEPOWER: HP HP NONE

ENGINE TYPE (select one) ENGINE TYPE (select one)

PROPULSION (select all that apply) PROPULSION (select all that apply)

OUTBOARD STERNDRIVE (I/O) OUTBOARD STERNDRIVE (I/O)

SAIL MANUAL WATER JET AIR THRUST OTHER (describe) SAIL MANUAL WATER JET AIR THRUST OTHER (describe)

PROPELLER

PROPELLER

LIFE JACKETS ON BOARD LIFE JACKETS ON BOARD

YES NO

YES NO

MPH

OPERATOR EXPERIENCE

CALIFORNIA BOATER CARD

OPERATOR EXPERIENCE

OPERATION AT TIME OF ACCIDENT OPERATION AT TIME OF ACCIDENT

10 TO 100 HOURS UNDER 10 HOURS

UNDER 10 HOURS

CRUISING CHANGING DIRECTION CHANGING SPEED TOWING SKIER/TUBER TOWING SKIER – SKIER DOWN TOWING ANOTHER VESSEL BEING TOWED BY ANOTHER VESSEL DRIFTING AT ANCHOR TIED TO DOCK LAUNCHING DOCKING/LEAVING DOCK SAILING OTHER (specify) CHANGING SPEED TOWING SKIER/TUBER TOWING SKIER – SKIER DOWN TOWING ANOTHER VESSEL BEING TOWED BY ANOTHER VESSEL DRIFTING AT ANCHOR TIED TO DOCK LAUNCHING DOCKING/LEAVING DOCK SAILING OTHER (specify) CRUISING CHANGING DIRECTION

LIFE JACKETS ACCESSIBLE LIFE JACKETS ACCESSIBLE

YES NO

YES NO

QUALIFICATION OF PERSON COMPLETING REPORT QUALIFICATION OF PERSON COMPLETING REPORT

OPERATOR OWNER OTHER (specify) OPERATOR OWNER OTHER (specify)

OPERATOR EDUCATION

OPERATOR EDUCATION

USCG AUXILARY US POWER SQUADRON

USCG AUXILARY US POWER SQUADRON

TYPE OF FUEL

LIFE JACKETS WORN

TYPE OF FUEL

LIFE JACKETS WORN

OTHER:

GAS DIESEL ELECTRIC

YES NO

OTHER:

GAS DIESEL ELECTRIC

YES NO

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