Marine Mammal Authorization Program Injury/Mortality Rep

MARINE MAMMAL AUTHORIZATION PROGRAM
MORTALITY/INJURY REPORTING FORM
National Marine Fisheries Service, 1315 East-West Highway, Silver Spring, MD 20910

PLEASE PRINT NEATLY AND IN CAPITAL LETTERS
1. LAST NAME OF VESSEL OWNER/OPERATOR

2. FIRST NAME OF VESSEL OWNER/OPERATOR

4.MAILING ADDRESS

5. EMAIL ADDRESS

6. CITY

8. STATE

3. MI

7. PHONE NUMBER

9. ZIP

10. VESSEL NAME

11. COAST GUARD DOC. NO. OR VESSEL STATE REG. NO.

12. STATE COMMERCIAL VESSEL NO.

13. FISHERY GEAR TYPE AND TARGET SPECIES

_____________________________________________________________________________________
14. DATE OF MORTALITY/INJURY (MM DD YYYY)

17. LOCATION OF MORTALITY/INJURY

16. OBSERVER PRESENT
___ YES ___ NO

15. APPROXIMATE TIME OF MORTALITY/INJURY
AM/PM
.
.

LATITUDE

o

‘

LONGITUDE

o

‘

18. ENTER SPECIES CODE, TYPE OF MORTALITY/INJURY (SEE LIST OF CODES ON PREVIOUS PAGE), AND THE NUMBER OF EACH
SPECIES INVOLVED. MAKE ONE ENTRY FOR EACH SPECIES INVOLVED IN THIS INCIDENT. YOU MAY MAKE UP TO THREE
MORTALITY/INJURY CODES PER SPECIES.
SPECIES

MORTALITY/INJURY CODE

NUMBER

DESCRIPTION OF UNKNOWN SPECIES OR CIRCUMSTANCES OF MORTALITY/INJURY INCIDENT
Please provide a detailed description of the animal involved, including color patterns, length, and body shape and size (drawings are helpful).
State whether the animal involved was a whale, dolphin, porpoise, seal, sea lion, walrus, manatee, or sea otter. You may also use this space
for other comments regarding this incident, including length of interaction and behavior of animal after release.

OMB CONTROL NO. 0648-0292 (expires 03/31/2019)

NOAA/NMFS
OFFICE OF PROTECTED RESOURCES F/PR2
1315 EAST WEST HIGHWAY
SILVER SPRING MD 20910-9721

POSTAGE WILL BE PAID BY ADDRESSEE

NATIONAL OCEANIC & ATMOSPHERIC ADMINISTRATION
NATIONAL MARINE FISHERIES SERVICE
OFFICE OF PROTECTED RESOURCES F/ PR2
1315 EAST WEST HIGHWAY
SILVER SPRING MD 20910-9721

1 • • 1 .111 • • • 1 .1• • • • • 11 11 • • • 1 .1• • 1 • • • 1 • • 1 .1• • • 11 1 .1• • 1

IMPORTANT!
MARINE MAMMAL
REPORTING FORM

MARINE MAMMAL AUTHORIZATION PROGRAM
MORTALITY/INJURY REPORTING FORM
National Marine Fisheries Service, 1315 East-West Highway, Silver Spring, MD 20910

INSTRUCTIONS FOR COMPLETING THE MORTALITY/INJURY REPORTING FORM
This reporting form is required ONLY WHEN there is an incidental mortality or injury (M/I) to a marine mammal during commercial
fishing activities. You are required to report the incidental mortality or injury within 48 hours after the end of the fishing trip (even if
an observer is on board), or, for non-vessel fisheries, within 48 hours of an occurrence of an incidental mortality or injury. A separate
report form is required for each fishery, for each date, and for each location.
PLEASE PRINT NEATLY AND IN CAPITAL LETTERS.
The reporting form should be detached from this instruction sheet, folded, and sealed prior to mailing. No postage is necessary
for mailing. Forms may also be filled out online, emailed to [email protected], or faxed to NMFS at 301-713-0376.
Questions regarding completion of this form, and requests for additional forms, may be directed to the NMFS Office of Protected
Resources, 1315 East-West Hwy., Silver Spring, MD 20910-3226, 301-427-8402.

MORTALITY/INJURY REPORT FIELD DEFINITIONS
VESSEL NAME: Enter the name of the vessel as it is identified for commercial fishing operations. For non-vessel
fisheries, leave this blank.
COAST GUARD DOCUMENT NO.: Enter the vessel’s Coast Guard Documentation number; OR Enter the
VESSEL’S STATE REGISTRATION NO.: One of these numbers must be provided. For non-vessel fisheries,
enter the state fishery permit number.
STATE COMMERCIAL VESSEL LICENSE NO.: Enter the vessel’s state commercial vessel license number, if
applicable.
GEAR TYPE AND TARGET SPECIES: Enter the type of fishing gear used and the target species being fished
when this incident occurred.
DATE OF MORTALITY/INJURY: Enter the date the mortality/injury occurred. For example: November 1, 2018 is entered as
11/01/2018.
TIME OF MORTALITY/INJURY: Enter the approximate time of day the mortality/injury occurred. Indicate AM if the
mortality/injury occurred between midnight & noon, or PM if the mortality/injury occurred between noon and midnight.
OBSERVER PRESENT: Check yes if the trip was observed, check no if the trip was not observed.
LOCATION OF MORTALITY/INJURY LATITUDE & LONGITUDE: Use standard entries in degrees and minutes.
SPECIES INCIDENTALLY KILLED OR INJURED: Enter the species code and the mortality/injury code of the animal(s)
involved. Refer to the species and mortality/injury code lists included on page 2 of these instructions. Enter the number of
animals involved in each mortality/injury. You may enter up to three (3) injury codes per species. Make as many entries as apply
to the date, time, and location entered in items 14-17.
DESCRIPTION OF UNKNOWN SPECIES OR CIRCUMSTANCES OF M/I INCIDENT: If you have entered a species code
for an unidentified species, please provide a detailed description of the animal involved, including color patterns, length, and body
shape (drawings are helpful). State whether the animal involved was a cetacean (whale, dolphin, or porpoise), pinniped (seal or sea
lion), walrus, manatee or sea otter. You may also use this space for other comments regarding this incident.

OMB Control No. 0648-0292 (expires 03/31/2019)

MARINE MAMMAL AUTHORIZATION PROGRAM
MORTALITY/INJURY REPORTING FORM
National Marine Fisheries Service, 1315 East-West Highway, Silver Spring, MD 20910

SPECIES AND STOCK CODES FOR MARINE MAMMALS
Seals and sea lions

Dolphins and porpoises

Toothed and baleen whales

100101105115116117121124127129130131132203204-

047049053054055058060061063068072073235-

002005007010011012016038039221230231232210220-

Steller (northern) sea lion
California sea lion
Northern (Pribilof) fur seal
Harbor seal
Spotted seal
Ringed seal
Ribbon seal
Gray seal
Hawaiian monk seal
Northern elephant seal
Bearded seal
Harp seal
Hooded seal
Unidentified sea lion
Unidentified seal

Atlantic white-sided dolphin
Pacific white-sided dolphin
Common dolphin
Bottlenose dolphin
Grampus (Risso’s) dolphin
Spotted dolphin
Spinner dolphin
Striped dolphin
Northern right whale dolphin
Harbor porpoise
Dall’s porpoise
Rough-toothed dolphin
Unidentified small cetacean
(porpoise or dolphin)

North Atlantic right whale
Gray whale
Fin whale
Minke whale
Humpback whale
Sperm whale
Beluga whale
False killer whale
Killer whale
Pilot whale
Beaked whale
Bryde’s whale
Dwarf sperm whale
Unidentified baleen whale
Unidentified toothed whale

Other Marine Mammals

114- Walrus

135- Sea otter

139- Manatee

MORTALITY/INJURY CODES FOR MARINE MAMMALS
01020304050607-

Visible blood flow
Loss of/damage to appendage/jaw
Inability to use appendage(s)
Asymmetry in shape of body or body position
Any noticeable swelling or hemorrhage (bruising)
Laceration (deep cut)
Rupture or puncture of eyeball

08091011121314-

Listlessness or inability to defend
Inability to swim or dive
Equilibrium imbalance
Ingestion of gear
Released trailing gear/gear perforating body
Other wound or injury
Killed

COLLECTION MANDATE
This collection of information is mandated by the Marine Mammal Protection Act of 1972, as amended (16 U.S.C. 1361 et. seq.), and by implementing
regulations contained at 50 CFR 229.4. The information supplied on this form will be used by the National Marine Fisheries Service to estimate levels of
incidental mortalities and injuries in U.S. commercial fisheries. Certain information supplied on this form may be considered proprietary and therefore
subject to data confidentiality restrictions of 50 CFR Part 229.11.
Public reporting burden for this collection of information is estimated to average 0.25 hours per response, including the time for reviewing instructions,
searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments
regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Director, Office of
Protected Resources, National Marine Fisheries Service, 1315 East-West Hwy., Silver Spring, MD 20910-3226.
The National Marine Fisheries Service may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a
current and valid OMB control number. The OMB control number for this form is 0648-0292, which expires on 03/31/2019.
OMB Control No. 0648-0292 (expires 03/31/2019)