Pre-trip safety checklist

NMFS Observer Programs' Information That Can Be Gathered Only Through Questions

Safety Checkoff form

OMB: 0648-0593

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Download: pdf | pdf
August 2020

OMB Control No. 0648‐0593, expires 04/30/2023

SAFETY CHECKOFF FORM

Observer Name
Vessel Name

Trip Number
Vessel Doc Number

Safety Check list ‐ ("NO GO" Deficiencies Highlighted)
USCG Safety Exam Decal #
Life Saving Equipment
Life Raft Type: SOLAS A, 

Expiration Date:

/

Distance Rating:

(Month/Year)

SOLAS B, 

Lifefloat,  IBA,  NONE,  or Other:
(Circle One or if other reference in space provided)
Expiration Date:

/

Capacity?

(Month/Year)

Life Raft Hydrostatic Release Expiration Date:

/

Total # of People Onboard:
(This number is including the Observer, Can not exceed capacity)

(Month/Year)

Life Raft Hydro Setup Correct:

Y   or   N

EPIRB Location:

EPIRB Battery Expiration Date:

EPIRB Hydrostatic Release Expiration Date:

/

(Month/Year)

/
(Month/Year)

EPIRB Registration:

/

/

 Is this EPIRB registered to this vessel? 

(Month/Day/Year)

Personal Flotation Device for each person on board (POB)?
Immersion Suit for each POB?

Y   or   N

Orange Ring Buoy(s) with Line attached?
Distress Flares? 

Y   or   N

Y   or   N
Location(s):

(only required above 32'00 N latitude)
Y   or   N

Location(s):

Location(s):

Expiration Date for each distress flare.
Parachute

Hand
(Month/Year)

Parachute

Hand
(Month/Year)

Hand
(Month/Year)

Parachute

Smoke
(Month/Year)

Smoke
(Month/Year)

Fire Extinguishers Charged?

Location 1:

Location 3:

Location 2:

Location 4:

Communication Equipment

Other

(Month/Year)

Hand
(Month/Year)

Fire Fighting Equipment

Single Side Band
VHF

(Month/Year)

Hand
(Month/Year)

Hand
(Month/Year)

Smoke
(Month/Year)

(Month/Year)

Y   or   N

Vessel Call Letters:
Satellite Phone # (if applicable)
Vessel Cell Phone # (if applicable)

First Aid Kit?
Ditch Bag?

Y   or   N
Y   or   N

Location(s):
Location(s):

Vessel Safety Orientation? Y   or   N
General Alarm Tested?
Y   or   N
High Water Alarm Tested? Y   or   N
Engine on/off, steering, gear selection, etc.?
Y   or   N
Entrapment: exit routes?
Y   or   N
Hazardous: hatched, winches, machinery, lines, slippery areas, stability concerns etc.?
Y   or   N
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August 2020

OMB Control No. 0648‐0593, expires 04/30/2023

SAFETY CHECK OFF FORM
STATION BILL
Position

Trip #

Person Overboard
Signal:  

Fire
Signal:  

Flooding
Signal:  

Abandon Ship
Signal:  

Station/Bring/Duty

Station/Bring/Duty

Station/Bring/Duty

Station/Bring/Duty

Captain
Crew
Crew
Crew
Observer
Date Drill 
Performed

Detailed Description of Vessel and Comments:

Fishing Vessel USCG Safety Requirements 
for the WARM WATERS of the Gulf of Mexico and South Atlantic
These safety requirements are determined by the fishing location
Fishing Location

Inside the Boundary  Within 12 NM of 
Line Within 3 
Coastline (Boundary 
Nautical Miles
Line)

12 to 20 miles of 
Coastline

Between 20 & 50 
miles

Over 50 Nautical 
Miles

Inflatable Life Raft with  Inflatable Life Raft with 
Float free Life Float with 
SOLAS B pack or Coastal  SOLAS A pack or Ocean 
light and line
Service Pack
Service Pack

Survival Craft Equipment

No Survival Craft 
Required

No Survival Craft 
Required

EPIRBs

Not Required

Required

Required

Required

Required

Distress Signals

3 Red Flares OR 3 other 
flares with a night signal

3 ‐ 6 ‐ 3 (Parachute ‐ 
Hand ‐ Smoke)

3 ‐ 6 ‐ 3 (Parachute ‐ 
Hand ‐ Smoke)

3 ‐ 6 ‐ 3 (Parachute ‐ 
Hand ‐ Smoke)

3 ‐ 6 ‐ 3 (Parachute ‐ 
Hand ‐ Smoke)

*RED flares include parachute and hand flares which can be seen both day and night.

These safety requirements are determined by the vessel size
Vessel Size
Life Rings

Vessels < 26 feet 
long

Vessels 26 to 40 feet 
long

Vessels < 65 feet 
long

Vessels ≥ 65 feet long

1 Buoyant Cushion OR 1  1 Orange Life Ring with  1 Orange Life Ring  with  3 Orange Life Rings 1 with 90 feet of 
Orange Life Ring
60 feet of line
60 feet of line
line

Fire Extinguishers

at least 1

1 to 2

2 to 3

2 in the Bridge, 1 in the Galley AND 2 
in the Engine Room

* make sure fire extinguishers are charged and strategically placed around vessel (galley & engine room & near exits)

To be completed by captain:  
Sampling protocol has been explained by observer and is understood.  Yes ____  No ____
Wheel watch while underway requirement has been explained by observer and is understood.

Yes ____  No ____

Observer Signature and Date:

 /        /

Captain Signature and Date:

 /        /

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File Typeapplication/pdf
File TitleSafety Checkoff form.xlsx
Authorjudy.gocke
File Modified2020-10-22
File Created2020-10-22

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