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pdfOMB Control Number: 0648-0593 Expiration Date: XX/XX/20XX
VESSEL SAFETY CHECKLIST
Vessel Name: ___________________ Vessel #: __________________ Obs. Trip #: ______________
USCG DOCUMENTED / STATE REGISTERED
NO GO ITEMS IN RED
pg. 1
USCG SAFETY DECAL:
Mark the sticker as it appears on the vessel.
Does the Beacon ID on NOAA Registration match the UIN on
EPRIB? Y
N
Vessel Length: ____________ ft
Is the decal valid? Y
N
pg. 6 - 9
SURVIVAL CRAFT:
Inflatable Raft (circle type):
Solas A Solas B Coastal PA PB Ocean Service
Ovatek w/ valid Solas kit
IBA
Buoyant Apparatus
Not Required
Total Capacity:_______
Total number of POB: ________
Float Free/ Readily Accessible? Y
N N/A
Service Due Decal Exp Date: ____/________
Hydrostatic Release Exp Date: ____/________
FIRE EXTINGUISHERS:
Number: ________
Charged extinguishers found in every main area? Y
pg. 13
EPIRB :
Type (circle): CAT I CAT II
NOT REQUIRED
Location: ___________________
Float Free/ Readily Accessible? Y
N N/A
Battery Exp: ____/________
Hydrostatic Release Exp: ____/________
NOAA Registration Valid? Y N
Mark the sticker as it appears on the vessel.
pg. 14 - 16
N
Location: _________________ Location: ___________________
Location: __________________Location: ___________________
Is the hydrostatic
release setup
properly?
Y
N
N/A
pg. 11
DISTRESS SIGNALS:
Location: __________________________
(number)
(Exp. month/year – earliest date)
Parachute
______
_____/__________
Smoke
______
_____/__________
Handheld
______
_____/__________
pg. 5
THROWABLE FLOTATION DEVICES:
Ring (with attached line)
Lifesling
Cushion
Number: ________ Location (s): _______________________
Easily accessible/unobstructed? Y N
COMMUNICATION EQUIPMENT:
pg. 3 - 4
PFDS:
Number: ________ Location (s): _____________________
Available for everyone on board? Y N
IMMERSION SUITS:
pg. 22 - 23
Number of Working Communication Devices
VHF : _______ SSB : _______ SAT Phones : _______
Vessel Satellite phone #: ________________________________
pg. 3 - 4
*Immersion Suits required above 32’00 N Latitude for documented vessels.
Number: ________ Location (s)_____________________
Available for everyone on board? Y N
VESSEL SAFETY CHECKLIST
PLACEHOLDER FOR OMB# / EXPIRATION DATE
Obs. Trip #: ______________
ADDITIONAL SAFETY CHECKS:
Did the vessel conduct a safety orientation? Y N
Was the General Alarm tested? Y N
Was the High Water Alarm tested? Y N
Watertight doors (when required) - do they close properly? Y
Hatches/passageways—are they unobstructed? Y N
Exit Routes identified? Y N
Discussed your role during an emergency with the captain? Y N
First Aid Kit? Y N
Name of individual trained in CPR/First Aid onboard:
___________________________________________
Where will you go during emergencies?
__________________________________
Discussed safe places to work on deck with captain/ crew? Y
Are emergency call instructions posted? Y N
Were instructions for an emergency call discussed? Y
N
N
N
Did the captain demonstrate vessel controls/taking out of gear? Y N
Will the vessel maintain a wheel watch? Y N
If no, inform the captain, your contractor, and coordinator. Do not
remain on the vessel.
Observer’s Signature: ________________________________________ Date: ________________
Captain’s Name:
____________________________________________
Captain’s Signature: __________________________________________ Date: _______________
Names of POB:
Crew: __________________________________________________________
Crew: __________________________________________________________
Crew: __________________________________________________________
Crew: __________________________________________________________
Crew: __________________________________________________________
Crew: __________________________________________________________
Additional comments/ Issues:
Refer to Federal Regulations for deficiencies
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Expiration Date: XX/XX/20XX
Observer Trip ID ____________ (Office Only)
OMB Control No. 0648-0593
NOAA Fisheries Panama City Observer Programs
Fisherman Feedback Form
The information on this form will be used by the NOAA Fisheries Panama City Observer
Programs to evaluate how well the observers are performing their duties and to serve as a
line of communication between the fishermen and the Observer Program.
Observers are asked to leave a copy of this comment card with the vessel after the
completion of a trip. Please fill out this form after each trip that you have been covered
by an observer from the Panama City Observer Program. This form can be filled out by
the captain or owner of the vessel.
Please provide us with some feedback or request more information about the observer
program by calling, emailing, or sending this form back to:
Alyssa Mathers, Observer Coordinator
NOAA Fisheries
3500 Delwood Beach Rd
Panama City, FL 32408-7403
Phone: (850) 234-6541 ext. 226; Fax: (850) 235-3559
[email protected]
Help develop a program that will work better for you. We appreciate your feedback.
Thank you,
Alyssa Mathers, Observer Coordinator, Panama City Observer Programs
Vessel Name __________________ Captain or Owner Name ____________________
Landing Date (mm/dd/yy) ________________ Port (City, State) ________________________
Please check the Yes or No box for each question:
1) Where the logistics in setting up the trip acceptable?
2) Was the observer on time and prepared for the trip?
3) Did the observer review the safety checklist with you?
4) Was the observer courteous and polite and get along with the crew?
5) Did the observer record the positions (lat/lon) for all the hauls?
6) Did the observer explain their sampling requirements and protocols?
7) Did the observer take length measurements of fish caught?
8) Did the observer take catch information from the work deck?
9) Did the observer identify fish species correctly?
1
Yes
No
06-19
Expiration Date: XX/XX/20XX
Observer Trip ID ____________ (Office Only
OMB Control No. 0648-0593
NOAA Fisheries Panama City Observer Programs
10) Did you have any other concerns regarding the observer or observing procedures, or
safety issues during the trip?
If yes, please explain in comments below:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Would you like more information from the observer program?
Copy of this trips logs
Vessel Reimbursement Form with Instructions
More information about observers and observer programs
Copy of current fishing regulations
List of Coast Guard vessel inspectors by area
Copy of current selection letter
If you requested information above, please indicate your preferred method of delivery
and leave the appropriate contact information:
Phone _______________________________________________________________
Fax _________________________________________________________________
Email _______________________________________________________________
Mail ________________________________________________________________
To verify that this form was filled out by the appropriate captain/owner, please sign the
line below.
Captain or Owner Signature: ________________________________________________
2
06-19
04/30/2020
OMB Control #0648-0593. Expires XX/XX/20XX
Highly Migratory Species Observer Notification Form
This form is provided for your response. Please provide the information requested below and return by mail or e-mail
([email protected]) at least 5 days prior to your estimated departure. If the vessel is not fishing or is involved in another fishery
during the selection period, please indicate this under Vessel Fishing Status.
Captain's Name: _____________________ Vessel Name: _____________________________
Documentation/Vessel Number: __________________________ Overall Length: ________(ft)
Crew Size: ______ (include skipper) Bunk Capacity: ______Life Raft Capacity: _______
Contact Person/Telephone Number(s): _________________________________
Communication Equipment (please check)
Commercial Fishing Vessel Safety
Examination Decal
Cellular phone:
Serial Number:
VHF:
Date of expiration: _____/______ Month/ Year
Single Side Band:
Call sign:
Vessel Fishing Status:
Port of Departure:
Dock Facility: _______________________________________________________________
Street: ______________________________________________________________________
City: ______________________________ State: ___________________________
Telephone Number: (
) _________________________
Departure Date: ____________ Departure Time: ________ (AM or PM)
Dock Facility: _______________________________________________________________
Expected Landing Port:
Street: ______________________________________________________________________
City: ______________________________ State: ____________________
Telephone Number: (
) _______________________
Anticipated Landing Date: _____________
I certify under penalty of perjury under the laws of the United States of America that the information given on
this form is true and correct, and that I have full authority to execute this form.
Signature
Date _______________________
For the Pelagic Observer Program, please return by mail to SEFSC Pelagic Observer Program, 75
Virginia Beach Dr. Miami, FL 33149 or e-mail (popobserver@ noaa.gov). For questions call 800-8580624.
For the Shark Observer Program, please return by mail to SEFSC Shark Bottom Longline Observer
Program, 3500 Delwood Beach Rd, Panama City, FL 32408-7403 or fax to (850) 235-3559. For questions
call (850) 234-6541.
Public Burden Statement - Effective 4/30/2020
A Federal agency may not conduct or sponsor, and a person is not required to respond to, nor
shall a person be subject to a penalty for failure to comply with an information collection
subject to the requirements of the Paperwork Reduction Act of 1995 unless the information
collection has a currently valid OMB Control Number. The approved OMB Control Number for this
information collection is 0648-0593. Without this approval, we could not conduct this
information collection. Public reporting for this information collection is estimated to be
approximately 30 minutes per response, including the time for reviewing instructions,
searching existing data sources, gathering and maintaining the data needed, and completing
and reviewing the information collection. All responses to this information collection are
mandatory. Send comments regarding this burden estimate or any other aspect of this
information collection, including suggestions for reducing this burden to the NOAA/NMFS/SEFSC
at: 75 Virginia Beach Drive, Miami, FL 33149, Attn: Fisheries Biologist Andy Davis,
[email protected]
OMB Control #0648-0593. Expires XX/XX/20XX
NMFS/SEFSC/POP
REIMBURSEMENT INVOICE FOR CONTRACT OBSERVERS
VESSEL NAME
TRIP NUMBER
ORGANIZATION CODE
TASK NUMBER
DATES OF TRIP
TO
RATE
DAYS AT SEA
MEAL EXPENSES
$25 / DAY
RATE
SUBTOTAL
X
DAYS AT SEA
LIABILITY INSURANCE
*ATTACH ENDORSEMENT AND BILLING STATEMENT
COMPANY NAME
AGENT NAME
PHONE
CORPORATION / OWNER NAME
TIN (Taxpayer Identification Number)
MAILING ADDRESS
PHONE
DATE
SIGNATURE
TOTAL
Public Burden Statement - Effective 4/30/2020
A Federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with an information collection subject to the requirements of the Paperwork
Reduction Act of 1995 unless the information collection has a currently valid OMB Control Number. The approved OMB Control Number for this information collection is 0648-0593. Without this approval, we could not conduct this
information collection. Public reporting for this information collection is estimated to be approximately 30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and
maintaining the data needed, and completing and reviewing the information collection. All responses to this information collection are mandatory. Send comments regarding this burden estimate or any other aspect of this information
collection, including suggestions for reducing this burden to the NOAA/NMFS/SEFSC at: 75 Virginia Beach Drive, Miami, FL 33149, Attn: Fisheries Biologist Andy Davis, [email protected]
May 2020
OMB Control #0648-0593. Expires XX/XX/20XX
Invoice Instructions
This invoice will be used to obtain reimbursement for observer expenses incurred during a deployment
aboard a U.S. commercial long-line vessel. (Complete all areas in bold/highlighted) [INVOICE MUST BE
SUBMITTED WITHIN 90 DAYS OF RECEIVING NOTICE]
TRIP NUMBER - office use only
VESSEL NAME - name of vessel that carried observer
ORGANIZATION CODE - office use only
DATES OF TRIP - dates observer was aboard vessel
MEAL EXPENSES - calculate food costs: (rate) x (days at sea) = subtotal. Observer's
personal food may be deducted from subtotal. If so, a copyo of the receipt will be
provided.
COMPANY NAME - Name of insurance company
AGENT NAME - Insurance contact
PHONE - Insurance contact number
TOTAL - total cost incurred (food and/or insurance)
CORPORATION/OWNER NAME - person or entity whose name will appear on check
TIN - (Taxpayer Identification Number) - Social security number, if check is going to an
individual or EIN (corporate number), if paying a corporation
MAILING ADDRESS - address where you would like the check sent
PHONE - contact number for additional information
DATE - date of signature
SIGNATURE - signature of authorized person
Please return to:
IMPORTANT
Pelagic Observer Program
Southeast Fisheries Science Center
75 Virginia Beach Dr.
Miami FL, 33149
or
Use included, brown
envelope - no postage
necessary
1 - We need a SSN or EIN or the check will not be processed
2 - We need original signatures on the invoice, please do not fax!
3 - Remember the information at the bottom of the invoice tells us who to
make check out to and where to send it, please write legibly.
4 - Insurance agencies - if you will be receiving the check, remember that
the "Corporation/Owner name" field is NOT the vessel, but the company
name.
Allow 3-4 weeks to receive payment. Please contact our office if you have not received payment within 3 months of
sending invoice. If you have any questions concerning this invoice or payment schedule, please call us at 1-800-858-0624.
THIS PAGE LEFT BLANK INTENTIONALLY
NMFS/SEFSC/POP
MEALS
OMB Control #0648-0593. Expires XX/XX/20XX
REIMBURSEMENT INVOICE FOR CONTRACT OBSERVERS
VESSEL NAME
ORGANIZATION CODE
TASK NUMBER
FN7100
MEAL EXPENSES
LIABILITY INSURANCE
*ATTACH ENDORSEMENT AND BILLING STATEMENT
DAYS AT SEA
$25 / DAY
Vessel ID:
1
X
33GENF200035
DATES OF TRIP
U8LCBACP00
RATE
AGR #:
TRIP NUMBER
TO
SUBTOTAL
DAYS AT SEA
#N/A
COMPANY NAME
AGENT NAME
PHONE
COMPANY / OWNER NAME
TIN (Taxpayer Identification Number)
TOTAL
MAILING ADDRESS
PHONE
DATE
SIGNATURE
Public Burden Statement - Effective 4/30/2020
A Federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be
subject to a penalty for failure to comply with an information collection subject to the requirements of the
Paperwork Reduction Act of 1995 unless the information collection has a currently valid OMB Control Number. The
approved OMB Control Number for this information collection is 0648-0593. Without this approval, we could not
conduct this information collection. Public reporting for this information collection is estimated to be approximately
30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering
and maintaining the data needed, and completing and reviewing the information collection. All responses to this
information collection are mandatory. Send comments regarding this burden estimate or any other aspect of this
information collection, including suggestions for reducing this burden to the NOAA/NMFS/SEFSC at: 75 Virginia
Beach Drive, Miami, FL 33149, Attn: Fisheries Biologist Andy Davis, [email protected]
August 2020
OMB Control No. 0648‐0593, expires XX/XX/20XX
SAFETY CHECKOFF FORM
Observer Name
Vessel Name
Trip Number
Vessel Doc Number
Safety Check list ‐ ("NO GO" Deficiencies Highlighted)
USCG Safety Exam Decal #
Life Saving Equipment
Life Raft Type: SOLAS A,
Expiration Date:
/
Distance Rating:
(Month/Year)
SOLAS B,
Lifefloat, IBA, NONE, or Other:
(Circle One or if other reference in space provided)
Expiration Date:
/
Capacity?
(Month/Year)
Life Raft Hydrostatic Release Expiration Date:
/
Total # of People Onboard:
(This number is including the Observer, Can not exceed capacity)
(Month/Year)
Life Raft Hydro Setup Correct:
Y or N
EPIRB Location:
EPIRB Battery Expiration Date:
/
(Month/Year)
EPIRB Hydrostatic Release Expiration Date:
/
(Month/Year)
EPIRB Registration:
/
Is this EPIRB registered to this vessel?
/
(Month/Day/Year)
Personal Flotation Device for each person on board (POB)?
Immersion Suit for each POB?
Y or N
Orange Ring Buoy(s) with Line attached?
Distress Flares?
Y or N
Y or N
Location(s):
(only required above 32'00 N latitude)
Y or N
Location(s):
Location(s):
Expiration Date for each distress flare.
Parachute
Hand
(Month/Year)
Parachute
Hand
(Month/Year)
Hand
(Month/Year)
Parachute
Smoke
(Month/Year)
Smoke
(Month/Year)
Fire Extinguishers Charged?
Location 1:
Location 3:
Location 2:
Location 4:
Communication Equipment
Other
(Month/Year)
Hand
(Month/Year)
Fire Fighting Equipment
Single Side Band
VHF
(Month/Year)
Hand
(Month/Year)
Hand
(Month/Year)
Smoke
(Month/Year)
(Month/Year)
Y or N
Vessel Call Letters:
Satellite Phone # (if applicable)
Vessel Cell Phone # (if applicable)
First Aid Kit?
Ditch Bag?
Y or N
Y or N
Location(s):
Location(s):
Vessel Safety Orientation? Y or N
General Alarm Tested?
Y or N
High Water Alarm Tested? Y or N
Engine on/off, steering, gear selection, etc.?
Y or N
Entrapment: exit routes?
Y or N
Hazardous: hatched, winches, machinery, lines, slippery areas, stability concerns etc.?
Y or N
Page 1 of 2
OMB Control No. 0648‐0593, expires XX/XX/20XX
August 2020
SAFETY CHECK OFF FORM
STATION BILL
Position
Trip #
Person Overboard
Signal:
Fire
Signal:
Flooding
Signal:
Abandon Ship
Signal:
Station/Bring/Duty
Station/Bring/Duty
Station/Bring/Duty
Station/Bring/Duty
Captain
Crew
Crew
Crew
Observer
Date Drill
Performed
Detailed Description of Vessel and Comments:
Fishing Vessel USCG Safety Requirements
for the WARM WATERS of the Gulf of Mexico and South Atlantic
These safety requirements are determined by the fishing location
Fishing Location
Inside the Boundary Within 12 NM of
Coastline (Boundary
Line Within 3
Line)
Nautical Miles
12 to 20 miles of
Coastline
Between 20 & 50
miles
Over 50 Nautical
Miles
Inflatable Life Raft with Inflatable Life Raft with
Float free Life Float with
SOLAS B pack or Coastal SOLAS A pack or Ocean
light and line
Service Pack
Service Pack
Survival Craft Equipment
No Survival Craft
Required
No Survival Craft
Required
EPIRBs
Not Required
Required
Required
Required
Required
Distress Signals
3 Red Flares OR 3 other
flares with a night signal
3 ‐ 6 ‐ 3 (Parachute ‐
Hand ‐ Smoke)
3 ‐ 6 ‐ 3 (Parachute ‐
Hand ‐ Smoke)
3 ‐ 6 ‐ 3 (Parachute ‐
Hand ‐ Smoke)
3 ‐ 6 ‐ 3 (Parachute ‐
Hand ‐ Smoke)
*RED flares include parachute and hand flares which can be seen both day and night.
These safety requirements are determined by the vessel size
Vessel Size
Life Rings
Vessels < 26 feet
long
Vessels 26 to 40 feet
long
Vessels < 65 feet
long
Vessels ≥ 65 feet long
1 Buoyant Cushion OR 1 1 Orange Life Ring with 1 Orange Life Ring with 3 Orange Life Rings 1 with 90 feet of
Orange Life Ring
60 feet of line
60 feet of line
line
Fire Extinguishers
at least 1
1 to 2
2 to 3
2 in the Bridge, 1 in the Galley AND 2
in the Engine Room
* make sure fire extinguishers are charged and strategically placed around vessel (galley & engine room & near exits)
To be completed by captain:
Sampling protocol has been explained by observer and is understood. Yes ____ No ____
Wheel watch while underway requirement has been explained by observer and is understood.
Yes ____ No ____
Observer Signature and Date:
/ /
Captain Signature and Date:
/ /
Page 2 of 2
TRIP NUMBER________________
OMB Control #0648-0593. Expires XX/XX/20XX
Sea Turtle Release Equipment Checklist
PLACE AN “X” IN THE BOX FOR EVERY ITEM PRESENT ON THE VESSEL
AND CROSS THROUGH A BOX WITH A SINGLE LINE FOR ITEMS THAT ARE
NOT PRESENT. DO NOT LEAVE ANY BLANKS. WRITE ANY ADDITIONAL
COMMENTS BESIDE ITEM DESCRIPTIONS.
REQUIRED FOR TURTLES NOT BOATED:
A- (1) Long-handled line cutter.
B- (1) Long-handled dehooker for internal hooks.
C- (1) Long-handled dehooker for external hooks (The long-handled dehooker for
internal hooks used for Item B will also satisfy this requirement).
D- (1) Long-handled device to pull an “Inverted V” (If 6’ J-Style Dehooker is used
for Item C, it will also satisfy this requirement).
E-(1) Turtle control device (2 devices are recommended).
REQUIRED FOR TURTLES BOATED:
F- (1) Dip net.
G- (1) Standard automobile tire.
H- (1) Short-handled dehooker for internal hooks.
I- (1) Short-handled dehooker for removing external hooks (The short- handled
dehooker for internal hooks used for Item H will also satisfy this requirement).
J- (1) Long-nose or needle-nose pliers.
K- (1) Bolt cutter.
L- (1) Monofilament line cutter.
M- (2) Types of mouth openers/mouth gags from the following list:
A block of hard wood;
A set of (3) canine mouth gags;
A set of (2) sturdy dog chew bones;
(2) rope loops covered with hose;
A hank of rope;
A set of (4) PVC splice couplings;
A large avian oral speculum.
RECOMMENDED EQUIPMENT:
(N)- (1) Turtle hoist.
Public Burden Statement - Effective 4/30/2020
A Federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a
person be subject to a penalty for failure to comply with an information collection subject to the
requirements of the Paperwork Reduction Act of 1995 unless the information collection has a currently
valid OMB Control Number. The approved OMB Control Number for this information collection is
0648-0593. Without this approval, we could not conduct this information collection. Public reporting for
this information collection is estimated to be approximately 30 minutes per response, including the time
for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and
completing and reviewing the information collection. All responses to this information collection are
mandatory. Send comments regarding this burden estimate or any other aspect of this information
collection, including suggestions for reducing this burden to the NOAA/NMFS/SEFSC at: 75 Virginia
Beach Drive, Miami, FL 33149, Attn: Fisheries Biologist Andy Davis, [email protected]
OMB Control #0648-0593. Expires XX/XX/20XX
August 2020
Shrimp - Observer FAX Notification Form
This form is provided for your response. Please complete and return this form at least 48 hours prior to
your estimated departure. The information can be mailed to: NOAA/NMFS, Galveston Laboratory,
4700 Avenue U, Galveston, TX 77551 or Faxed to (409-766-3489); ATTN: MIKE HARRELSON,
PAT CRYER, ELLEN SIKES, KAYLA CHAPMAN and/or JASON WILLIAMS. If the vessel is
not fishing or is involved in another fishery during the selection period, please state in the comment
section of this form which fishery and gear used (include contact number).
Captain's Name: _______________________________ Vessel Name: ____________________________
Documentation/Vessel Number: _______________________________ Overall Length: __________ (ft)
Crew Size: _______ (include skipper)
Bunk Capacity: _________
Life Raft Capacity: __________
Contact Person/Telephone Number(s): _____________________________________________________
Communication Equipment (please list)
Cellular / SAT phone:
VHF:
Commercial Fishing Vessel Safety
Examination Decal
Serial Number:
Date of issuance
________/________
Month
Year
Single Side Band:
Call sign:
Vessel Fishing Status:
Port of Departure:
Dock Facility: _________________________________________________________________________
Street: _______________________________________________________________________________
City: ___________________________ State: _____
Departure Date: ___/___/___
Phone Number: (
Time: ___:___ (AM or PM)
) _______-____________
Anticipated Landing Date: ___/___/___
Expected Landing Port: (if different from port of departure)
Dock Facility: _________________________________________________________________________
Street: _______________________________________________________________________________
City: ____________________________ State: ______
Phone Number: (
) ______-_____________
Primary Language: (if other than English) ________________________
Comments: __________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
PAPERWORK REDUCTION ACT STATEMENT: A Federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be
subject to a penalty for failure to comply with an information collection subject to the requirements of the Paperwork Reduction Act of 1995 unless the information
collection has a currently valid OMB Control Number. The approved OMB Control Number for this information collection is 0648-0593. Without this approval, we
could not conduct this information collection. Public reporting for this information collection is estimated to be approximately 65 minutes per response, including the
time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the information
collection. All responses to this information collection are mandatory to obtain benefits. Send comments regarding this burden estimate or any other aspect of this
information collection, including suggestions for reducing this burden to the National Marine Fisheries Service, Shrimp and Reef Fish Observer Programs at: 4700
Avenue U, Galveston, Texas 77551, Attn: Fisheries Administrator, Elizabeth Scott-Denton.
OMB Control Number: 0648-0593 Expiration Date: XX/XX/20XX
The SEFSC has recently placed an observer aboard your vessel for
observer coverage. In an attempt to monitor the quality of observers we send on commercial
vessels, we would appreciate it if you would take the time to fill out this questionnaire. We wish
to ensure that the observers conduct themselves professionally, are safe, and get along with the
crew during a voyage.
Please complete the information below and return it to < Mailing Address of Laboratory>.
Your information is important to us in order to run a better observer program. Please consult
with your captain if you are the owner and were not present during the trip.
Vessel Name __________________
Vessel ID _________________
Captain or Owner Name ____________________
Landing Date (mm/dd/yy) ________________
Port (City, State) ________________________
Your status (check one): Owner
Captain __ Other
1) Were the logistics in setting up the trip acceptable? Yes
No
2) Was the observer on time and prepared for the trip? Yes
No
3. Was the observer's conduct while aboard your vessel professional? Yes
No
4. Did you and the observer discuss vessel safety procedures prior to departure? Yes
5. Was the observer seen doing anything that seemed unsafe? Yes - explain/list No
No
6. Did the observer seem to experience seasickness? Yes
No
7. Did the observer help maintain cleanliness standards in accordance with the vessel's normal
policy in the following areas?
Work: Yes __ No _ N/A
Bunk: Yes __ No
N/A
Galley: Yes __ No
N/A
8) Did the observer take catch information from the work deck? Yes
No
9. Did the observer explain their sampling requirements and duties prior to departure?
Yes
No
10. Was sampling conducted in a timely manner so as not to substantially impact your normal
operations? Yes
No
Additional comments:
OMB Control No. 0648-0593
Expiration Date: XX/XX/20XX
VESSEL REIMBURSEMENT FORM
OBSERVER TRIP ID
OBSERVER NAME
VESSEL NAME
DATES OF TRIP
MEAL EXPENSES
TOTAL COST
$25/DAY X
CORPORATION / OWNER NAME
EIN or SSN
DATE
OFFICE USE ONLY
MAILING ADDRESS AND PHONE #
SIGNATURE
INVOICE CODE
TASK NUMBER
PLEASE FILL OUT ALL BLANKS (EXCLUDING INVOICE CODE AND TASK NUMBER) AND MAIL TO:
Alyssa Mathers
NOAA Fisheries
3500 Delwood Beach Road
Panama City, FL 32408
PAPERWORK REDUCTION ACT STATEMENT: The information provided on this form will be used to reimburse you for specific expenses during the observed trip identified on the form. That trip
was observed in order to collect information that is used in analyses that support the conservation and management of living marine resources and that are required under the Magnuson-Stevens Fishery
Conservation and Management Act (MSA), the Endangered Species Act (ESA), the Marine Mammal Protection Act (MMPA), the National Environmental Policy Act (NEPA), the Regulatory
Flexibility Act (RFA), Executive Order 12866 (EO 12866), and other applicable law. The public reporting burden for this form is estimated to average 10 minutes per response, including the time for
completing, reviewing, and transmitting the information on the form. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for
reducing the burden to: National Marine Fisheries Service, F/SF1, National Observer Program, 1315 East West Highway, Silver Spring, MD 20910. Providing the requested information is required to
have the Central Administrative Support Center (CASC) and United States Treasury process and pay the reimbursement. The information on this form will be kept confidential as required under Section
402(b) of the MSA (18 U.S.C. 1881a(b)) and regulations at 50 C.F.R. Part 600, Subpart E. Notwithstanding any other provision of the law, no person is required to respond to, nor shall any person be
subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act, unless that collection of information displays a currently valid OMB
Control Number.
06-2019
Expiration Date: XX/XX/20XX
OMB Control No. 0648-0593
Southeast Fisheries Observer Programs - Panama City
Pre-Trip Safety Check
OBS TRIP ID
DATE
VESSEL NAME
VESSEL #
Life Saving Equipment (circle Y for yes or N for no)
CGVSE
Safety Examination Decal? Y / N
Decal #
Date of Expiration:
/
Vessel Distance Rating:
NM
EPIRB
EPIRB present? Y / N
Stowed in a float-free location? Y / N
EPIRB Registration Expiration Date:
Hydrostatic Release Exp. Date:
/
EPIRB Category: I / II
/
/ NA
Registered To:
Battery Expiration Date:
/
FLARES
3 of any flare required for operations <3nm offshore
3 Parachute, 6 Hand & 3 Smoke required for operations >3nm offshore
Record flare expiration dates:
Hand:
/
Hand:
Hand:
/
Hand:
Hand:
/
Hand:
/
/
/
Smoke:
Smoke:
Smoke:
/
/
/
Parachute:
Parachute:
Parachute:
/
/
/
PFDs AND IMMERSION SUITS (not including observer equipment)
Personal Floatation Device for each POB? Y / N
# of PFDs
Immersion suit for each POB*? Y / N
*required in federal waters above 32 N latitude
# of Immersion Suits
06-2019
FIRE FIGHTING EQUIPMENT
Vessels <26 ft require 1 B-I unless equipped with an outboard in certain conditions
Vessels >26 ft but <40 ft require 2 B-I or 1 B-II
Vessels >40 ft but <65 ft require 3 B-I or 1 B-II & 1 B-I
Location
Type
Manufacture
Date
Brand
First
Model #
Green
Y/N
Photo
Y/N
1
2
3
*If cannot determine both brand AND model, a photo MUST be taken*
STATION BILLS posted? Y / N
ONBOARD DRILLS logged? Y / N
LIFE RAFTS AND RINGS
Orange ring buoy with line attached? Y / N
Rigid life float? Y / N (>12nm but <20nm until 2015)
Inflatable life raft? Y / N
Capacity for all POB? Y / N
Life raft Capacity
_
Raft Repack Date
/_
Hydrostatic Release Exp. Date:
/
Life raft configured correctly*? Y / N
*Please take picture of configuration
5
Hydrostatic release
expiration date
5 Fabrication Marks Present? Y / N
Upper Fabrication mark towards rope? Y / N
Please provide signatures to verify that a safety check was
conducted and that the information above is accurate.
Observer:
Date:
/
/
Owner/Operator:
Date:
/
/
06-2019
| File Type | application/pdf |
| Author | Kate Walter |
| File Modified | 2023-12-13 |
| File Created | 2022-10-14 |