Claims Causation Reporting Form - Wreck Removal

PRIVILEGED AND CONFIDENTIAL: IN CONTEMPLATION OF LITIGATION

Vessel Name Country Vessel Position

Club File Reference Port Weather Condition

Salvage Additional Notes

Attempted

LOF/Scopic

Wreck removal cause*

* 1. Adverse weather 3. Contact with a fixed floating object

2. Collision with 3rd Party party vessel 4. Contact with flotsam/debris

Sunk, stranded
or abandoned

Obstruction to
navigation

Risk of pollution

Wreck removal
order issued

Physical Damage

To 3rd party

Vessel Position

Depth/angle

Drug or alcohol related Surveyor’s opinion

of primary cause**
Statement of facts
included in report

Crew’s certificates **Primary Cause: 1. 3rd Party Negligence 5. Inadequate procedures/guidance

valid and appropriate 2. Act of God 6. Insufficient training
for ship trade 3. Human factor 7. Personal illness
4. Inadequate ship maintenance 8. Shore-based management

www.shipownersclub.com This summary report is not a substitution for a full indepth report. However, it does form part of the survey report and therefore has the same status. Claims Causation Reporting Form - Wreck Removal