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Float Plan |
| Personal Information | |||
| Name of Person Reporting | Telephone Number | ||
| Description of the Boat | |||
| Type | Color | ||
| Trim | Registration No. | ||
| Length | Name | ||
| Manufacturer | Engine Type | ||
| Horsepower | No. of Engines | ||
| Fuel Capacity | Range | ||
| Other Information
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| Persons Aboard (attach additional sheets as necessary) | |||||
| Name | |||||
| Age | |||||
| Address | |||||
| Phone | |||||
| Medical Information |
| Do any of the persons aboard have a medical problem? YES
NO (circle one) If yes, describe the problem(s) in this space.
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| Survival
Equipment (Circle as appropriate. For a more complete listing use our Safety Inventory form) |
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| PFD's | FLARES | MIRROR | SMOKE SIGNALS |
| FLASHLIGHT | FOOD | PADDLES | WATER |
| ANCHOR | RAFT or DINGHY | EPRIB | RADIO |
| If you have a radio on board, specify what type: | |||
| Trip Expectations | |||
| Leaving From | Going To | ||
| Date Leaving | Time Leaving | ||
| Expected Return (date/time) | In no event later than (date/time) | ||
| Automobile Information | |||
| Make & Model | Color | ||
| Auto License No. | License State/Type | ||
| Trailer? | YES / NO | Trailer License No. | |
| Any Other Pertinent Information |
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| IF NOT RETURNED BY | (Time & Date) | CALL THE U.S. COAST GUARD OR CONTACT THE LOCAL AUTHORITIES |
| Emergency Numbers | |||
| U.S. Coast Guard: | Local Police Dept.: | ||
| Marine Patrol: | Other | ||
| Other | Other | ||
Return to Marine Medical Systems Home Page | Go to the Safety Inventory