Incident Report

Incident Date*

Incident Time*

Location of Incident*

Boat Harbor* — Select Harbor — Channel Islands Marina Del Rey

Boat Name* — Select Harbor First —

Boat Model

Boat Color

Document #

Sail Number

Engine / Diesel Information

MMSI Number

Skipper Full Name*

Skipper Phone*

Skipper Email*

Skipper Member Level* — Select — Small Medium Large

True Wind Speed* — Select — 0-5 knots 5-10 knots 10-15 knots 15-20 knots 20-25 knots 25-30 knots 30-35 knots 35-40 knots 40+ knots

Swell Height* — Select — 0-2 feet 2-4 feet 4-6 feet 8-10 feet 10+ feet

Light Conditions* — Select — Low light (sunrise/sunset) Daytime Night

Visibility* — Select — Less than 10 boat lengths Less than 1 nautical mile 1-3 nautical miles 3-5 nautical miles 5+ nautical miles

Ocean Tide* — Select — Low Rising low Rising medium Rising high High Ebbing High Ebbing Medium Ebbing Low