Float Plan – Maritime Surveyors

Contact Information

Name of person filing:
Phone number:
VHF radio call sign (if applicable):
Primary VHF channel monitored:

Description of Vessel

Type:
Color:
Trim:
Registration No:
Document No:
Length:
Vessel Name:
Make:
Other info:
Engine Type:
Horsepower:
No. of Engines:
Fuel Capacity:

Survival Equipment (Check as appropriate)

PFDs
Flares / Type:
Mirror
Smoke Signals
Flashlight
Food
Paddles
Water
Anchor
Raft / Type:
Dinghy
EPIRB / Type:
Other:

Communication / Navigation Equipment

Radio VHF-FM
MF
HF
Other:
DSC VHF-FM
MF
HF
MMSI:
Cellular phone / Number:
LORAN C
GPS
RADAR

Automobile / Trailer

Auto license No. / State:
Auto make / model:
Auto color:
Auto year:
Trailer type:
Trailer license No:
Where parked:

Persons On Board

Number of Persons:

Person 1

Name:
Age:
Address:
Telephone No:

Person 2

Name:
Age:
Address:
Telephone No:

Medical Information

Do you or any persons on board have a medical problem?
Yes
No

If yes, what?

Trip Expectations

Leave at:
From:
Going to:
Via:
Via:
Via:
Expected to arrive / return by:
Not later than:
If not returned by:
Call the COAST GUARD, or (local authority):
Telephone numbers: