Crew Injury/Illness Report on Board
Vessel & Crew Details
Vessel Name
IMO Number
Date of Report
Name of Crew
Rank/Position
Nationality
Date of Birth
Date of Sign On
Incident Details
Date of Incident
Time
Location
Description of Incident
Type of Injury/Illness
First Aid Given
Further Treatment/Action Taken
Witness(es)
Remarks
Report Prepared By
Name
Rank/Position
Date