CG-2692A (03/16) Bargge Addendum

DEPARTMENT OF HOMELAND SECURITY

OMB No: 1625-0001

U.S. Coast Guard
BARGE ADDENDUM

Exp. Date: 03/31/2019

Note: This form shall be used to report data on barges causing or sustaining damage in the marine casualty 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 - Casualty Date/Time
1. Towing Vessel Name

2. Date/Time (local) of Occurrence

Section II - Barge(s) Causing or Sustaining Damage
3a. Barge Name

3b. Barge Official Number

3c. Barge Flag

3d. Barge Length

3e. Barge Gross Tons

3f. Load Condition

feet

Loaded

meters

3g. Barge Class/Type

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
feet

4b. Barge Official Number

4c. Barge Flag

4e. Barge Gross Tons

4f. Load Condition
Loaded

meters

4g. Barge Class/Type

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
feet

5b. Barge Official Number

5c. Barge Flag

5e. Barge Gross Tons

5f. Load Condition

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
feet

6b. Barge Official Number

6c. Barge Flag

6e. Barge Gross Tons

6f. Load Condition
Loaded

meters

6g. Barge Class/Type
6i. Name of Barge Owner
6k. Property Damage Estimated Damage Cost(s) to:

Empty

6h. Barge Service or Occupation
6j. Name of Barge Agent
Describe the Extent of Property Damage

Barge: $
Cargo: $

CG-2692A (03/16)

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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. http://www.uscg.mil/top/units/
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 (03/16)

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