Marine Mammal Authorization Program Mortality/Injury Reporting Form
This reporting form is required ONLY WHEN there is an incidental or intentional mortality or injury to a marine mammal during commercial fishing activities. You are required to report the 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 a mortality or injury. A separate report form is required for each fishery, for each date, and for each location.

Questions regarding completion of this form may be directed to the National Marine Fisheries Service, Office of Protected Resources, (301) 427-8402, nmfs.mireport@noaa.gov.

1-Last name of vessel owner/operator or permit holder
Your answer
2-First name of vessel owner/operator or permit holder
Your answer
3-Middle initial of vessel owner/operator or permit holder
Your answer
4-Mailing address - Street
Your answer
5-Email address
Your answer
6-City
Your answer
7-Phone number
Your answer
8-State
Your answer
9-ZIP code
Your answer
10-Vessel name
Your answer
11-Coast Guard DOC. No. or Vessel State Reg. No.
Your answer
12-State Commerical Vessel No.
Your answer
13-Fishery gear type and target species
Your answer
14-Date of mortality/injury
MM
/
DD
/
YYYY
15-Approximate time of mortality/injury
Time
:
16-Observer present
17-Location of mortality/injury
Latitude (Degrees, Minutes)
Your answer
Longitude (Degrees, Minutes)
Your answer
General location (if Lat/Long unknown)
Your answer
18-Enter species code
18-Enter type of mortality/injury code (up to 3)
You may make up to three mortality/injury codes per species.
Required
18-Enter the number of animals involved
Your answer
Next
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