Incident Report Form

1. Date of Incident *Please click the calendar icon to select your date *(Required)

YYYY dash MM dash DD

2. In what Country did the incident occur?(Required)

2B. At what state did the incident occur?(Required)

3. At what port (or place) did the incident occur?(Required)

3B. Name of port or place(Required)

4. How often do you call this port?(Required)

Weekly basis

Monthly basis

Quarterly basis

Annual basis

Other

5. What was the type of vessel?(Required)

Bulk

Car carriers

Container

Off shore

Tanker

Other

6. Who made the demand? Please select the relevant title/department. If the title/department is not mentioned, please select "Other" and specify in the comment. Please do not include a name, just the title or department who made the demand.(Required)

Animal health inspectors

Bunker barge/surveyors

Canal Inspector

Cargo or hull surveyor

Customs

Dock/terminal workers/stevedores/foreman

Draft surveyor

Electrician

Environmental authority e.g. Oil Pollution officer

Fire inspector

Flag state control

Harbor master/port captain

Immigration authority

Loading master

Mooring and tug boat operation

Narcotic and drug authorities

Pilot

Port agent

Port health/quarantine authority/sanitary officers

Port gangway

Port Police and Coast Guard

Port state control (PSC)

P&I surveyor

Safety/Security/National Guard/Military

Other

7. What was demanded?(Required)

Alcohol

Cigarettes

Large cash payment - more than USD 150 (specify amount in comments)

Miscellaneous items/presents

Small cash payment - less than USD 150 (specify amount in comments)

Soda drinks

Sundries

Other

8. What were the (implied or stated) consequences of not adhering to the demand?(Required)

Delay of vessel

Physical violence

Safety of the crew's possession

Safety of the vessel

Threat of fines for alleged non-compliance

Threat of imprisonment

Threat of vessel detention

No consequence

Other

9. Is your company a member of MACN? (Voluntary question)

Yes

Do not want to disclose

Do not know

10. Size of your company? (Voluntary question)

... - 50 employees

50 - 100 employees

100 - 500 employees

500 - 1000 employees

1000 - ... employees

Do not want to disclose

Do not know

11. What is your role/position? (Voluntary question)

Captain/Master

Chief Engineer

Chief Officer

Compliance Officer/Team

Crew Member

DPA/HSEQ

Junior Officer (Second/Third Officer/Trainer)

Port Agent/P&I Surveyor

Second Engineer

Vessel Operations/Technical Team

Do not want to disclose

Other

12. What action would you recommend to combat/resist corrupt demands at the port in question? (Voluntary question)

Better preparation of seafarers and company (e.g. clarity on the port regulations and the ships cargo and conditions)

Contact Internal Operations and/or Compliance Team to receive support

Contact MACN/MACN Local Partner to receive support

Coordinated approach of vessels and shipping companies

Resistance - Continue to say "No"

Do not know

Other

13. Do you have any other comments?

MACN

Maritime Anti-Corruption Network
Wildersgade 14,
1408 Copenhagen
Denmark

VAT number: DK41887958

macn@macn.dk
Secretariat
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About MACN

MACN is comprised of like-minded companies dedicated to promoting compliance with anti-corruption laws and committed to the elimination of corrupt practices.

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