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Coast Guard Sector Anchorage 96 Hour Work/Rest History Form for Serious Marine Incidents Mail Coast Guard Sector Anchorage Attn Marine Investigations 510 L Street Suite 100 Anchorage Alaska 99501 / 907-271-6733 Email Sector. Anchorage uscg. mil Name Address Phone Email Date of birth Position on this vessel How long working on this vessel this contract/season/trip Time working in this industry Directions Place an X in the Day of Casualty column beside the time the incident occurred. Then using the key provided work backwards for 96 hours placing a letter representing your activity for each hour in the space provided beside the time. Coast Guard Sector Anchorage 96 Hour Work/Rest History Form for Serious Marine Incidents Mail Coast Guard Sector Anchorage Attn Marine Investigations 510 L Street Suite 100 Anchorage Alaska 99501 / 907-271-6733 Email Sector. Anchorage uscg. mil Name Address Phone Email Date of birth Position on this vessel How long working on this vessel this contract/season/trip Time working in this industry Directions Place an X in the Day of Casualty column beside the time the incident occurred* Then using the key provided work backwards for 96 hours placing a letter representing your activity for each hour in the space provided beside the time. You may place more than one letter in a space if you participated in more than one of these activities in that hour. 2300-2400 2200-2300 2100-2200 2000-2100 A Free Time Ashore 1900-2000 1800-1900 1700-1800 1600-1700 1500-1600 1400-1500 1300-1400 1200-1300 S Sleep R Recreation on Board 1100-1200 1000-1100 0900-1000 0800-0900 0700-0800 0600-0700 F Meal D Alcoholic Drink 0500-0600 0400-0500 0300-0400 0200-0300 0100-0200 O Other vessel work Ashore or onboard 2400-0100 X Time of Incident W On watch 4 Days Prior Day of Incident Additional Comments Form updated 12 December 2013. Anchorage uscg. mil Name Address Phone Email Date of birth Position on this vessel How long working on this vessel this contract/season/trip Time working in this industry Directions Place an X in the Day of Casualty column beside the time the incident occurred* Then using the key provided work backwards for 96 hours placing a letter representing your activity for each hour in the space provided beside the time. You may place more than one letter in a space if you participated in more than one of these activities in that hour. You may place more than one letter in a space if you participated in more than one of these activities in that hour. 2300-2400 2200-2300 2100-2200 2000-2100 A Free Time Ashore 1900-2000 1800-1900 1700-1800 1600-1700 1500-1600 1400-1500 1300-1400 1200-1300 S Sleep R Recreation on Board 1100-1200 1000-1100 0900-1000 0800-0900 0700-0800 0600-0700 F Meal D Alcoholic Drink 0500-0600 0400-0500 0300-0400 0200-0300 0100-0200 O Other vessel work Ashore or onboard 2400-0100 X Time of Incident W On watch 4 Days Prior Day of Incident Additional Comments Form updated 12 December 2013. Anchorage uscg. mil Name Address Phone Email Date of birth Position on this vessel How long working on this vessel this contract/season/trip Time working in this industry Directions Place an X in the Day of Casualty column beside the time the incident occurred* Then using the key provided work backwards for 96 hours placing a letter representing your activity for each hour in the space provided beside the time. You may place more than one letter in a space if you participated in more than one of these activities in that hour. 2300-2400 2200-2300 2100-2200 2000-2100 A Free Time Ashore 1900-2000 1800-1900 1700-1800 1600-1700 1500-1600 1400-1500 1300-1400 1200-1300 S Sleep R Recreation on Board 1100-1200 1000-1100 0900-1000 0800-0900 0700-0800 0600-0700 F Meal D Alcoholic Drink 0500-0600 0400-0500 0300-0400 0200-0300 0100-0200 O Other vessel work Ashore or onboard 2400-0100 X Time of Incident W On watch 4 Days Prior Day of Incident Additional Comments Form updated 12 December 2013.

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