DRAFT_CG-0692A Barge Addendum

OMB No.1625-0001
Exp. Date: 01/31/2016

DEPARTMENT OF HOMELAND SECURITY
U.S.COASTGUARD

Barge Addendum
Note: This form shall be used to report data on barges causing or sustaining damage in the marine casualty/accident described on form CG-2692.
This form may only be used in addition to form CG-2692, never alone.

Section I - Reporting Vessel/Facility Information – Incident Date/Time:
1. Towing Vessel Name

2. Date/Time (local) of Occurrence

Section II – Barge(s) Causing or Sustaining Damage:
3a. Barge Name
3d. Barge Length

3b. Barge Official Number

3c. Barge Flag

3e. Barge Gross Tons

3f. Load Condition

__feet __ meters
3g. Barge Class/Type

__ Loaded

__ Empty

3h. Barge Service or Occupation

3i. Name of Barge Owner

3j. Name of Barge Agent

3k. Property Damage
Estimated Damage Cost(s) to:

Describe the Extent of Property Damage:

Barge:

$ ____________________

Cargo:

$ ____________________

4a. Barge Name
4d. Barge Length

4b. Barge Official Number

4c. Barge Flag

4e. Barge Gross Tons

4f. Load Condition

__feet __ meters
4g. Barge Class/Type

__ Loaded

__ Empty

4h. Barge Service or Occupation

4i. Name of Barge Owner

4j. Name of Barge Agent

4k. Property Damage
Estimated Damage Cost(s) to:

Describe the Extent of Property Damage:

Barge:

$ ____________________

Cargo:

$ ____________________

5a. Barge Name
5d. Barge Length

5b. Barge Official Number

5c. Barge Flag

5e. Barge Gross Tons

5f. Load Condition

__feet __ meters
5g. Barge Class/Type

__ Loaded

__ Empty

5h. Barge Service or Occupation

5i. Name of Barge Owner

5j. Name of Barge Agent

5k. Property Damage
Estimated Damage Cost(s) to:

Describe the Extent of Property Damage:

Barge:

$ ____________________

Cargo:

$ ____________________

6a. Barge Name
6d. Barge Length

6b. Barge Official Number

6c. Barge Flag

6e. Barge Gross Tons

6f. Load Condition

__feet __ meters
6g. Barge Class/Type
6i. Name of Barge Owner
6k. Property Damage
Estimated Damage Cost(s) to:
Barge:
$ ____________________
Cargo:

__ Loaded

__ Empty

6h. Barge Service or Occupation
6j. Name of Barge Agent

Describe the Extent of Property Damage:

$ ____________________

CG-2692A (Rev. XX-15)

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INSTRUCTIONS FOR COMPLETION OF FORM CG-2692A
BARGE ADDENDUM
An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number. The Coast Guard estimates that the average
burden for this report is .5 hours. You may submit any comments concerning the accuracy of this burden estimate or any suggestions for reducing the burden to: Commandant (CG-INV), U.S. Coast
Guard Stop 7501, 2703 Martin Luther King Jr Ave SE, Washington, DC 20593-7501 or Office of Management and Budget, Paperwork Reduction Project (1625-0001), Washington, DC 20503.
WHEN TO USE THIS FORM
1. This form, when submitted in conjunction with a CG-2692, satisfies the requirement for written reports of casualties and accidents found in the Code of Federal Regulations for vessels. Specifically, it
provides information on one or more barges that cause or sustain damage as a result of their involvement in a reportable marine casualty. This form may only be used in addition to form CG-2692, never
alone.
2. One or More Barges as Part of a Tow. This form shall be used to enter information on all barges that were part of the tow and that caused or sustained damage as a result of the marine casualty
reported on the CG-2692.
3. Multiple Anchored or Moored Barges. This form shall be used to enter information on multiple barges that were moored or anchored (such as in a fleeting area) and either cause or sustained damage
or broke away and caused or sustained damage during an incident that meets the criteria of a marine casualty required to be reported on a CG-2692.
4. This form should not be use if the incident involves only a single barge while moored or anchored. This type of incident shall be documented as any other vessel using the CG-2692.
COMPLETION OF THIS FORM
5. In accordance with 46 CFR §4.05-10 this form shall be filled out as completely and accurately as possible. Please type or print clearly. Fill in all blanks that apply to the kind of accident that has
occurred. If a block is not applicable, the abbreviation “NA” should be entered in that space. If the answer is unknown and cannot be obtained before the report has to be submitted (i.e. within 5 days of
the accident), the abbreviation “UNK” should be entered in that block. If “NONE” is the correct response, enter it in the block.
6. If more than 4 barges caused or sustained damage in the marine casualty additional CG-2692As should be completed necessary to enter the required information for all barges.
7. Once completed, deliver, email, or fax this form with a corresponding CG-2692 within 5 days of the casualty to the Coast Guard Sector, Marine Safety Unit, or Activity nearest the location of the
casualty or, if at sea, nearest the arrival port.
NOTICE: The information collected on this form is routinely available for public inspection. It is needed by the Coast Guard to carry out its responsibility to investigate marine casualties, to identify
hazardous conditions or situations and to conduct statistical analysis. The information is used to determine whether new or revised safety initiatives are necessary for the protection of life or property in
the marine environment.

CG-2692A (Rev. XX-15)

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