Maritime Bridge Collision Risk Assessment Form
Maritime Bridge Collision Risk Assessment Form
Type of Vessel
*
Please Select
Cargo Ship
Tanker
Passenger Vessel
Tug/Barge
Fishing Vessel
Other
Bridge Name or Identifier
*
Current Environmental Conditions
*
Clear weather
Fog/Mist
Strong winds
Heavy rain
High current/tide
Other
Bridge Protection Measures in Place
*
Fender system
Navigation lights/signals
Warning signs
Escort tug
None
Other
Operational Procedures Being Followed
*
Bridge transit plan in place
Pilot onboard
Speed restrictions observed
Communication with bridge authority
Other
Risk Factors Assessment
*
Rows
Low
Medium
High
Visibility
1
2
3
Traffic density
4
5
6
Bridge clearance
7
8
9
Vessel maneuverability
10
11
12
Communication effectiveness
13
14
15
Overall Risk Rating for Bridge Collision
*
1
2
3
4
5
Recommended Mitigation Actions
Assessor Name/Team
Date of Assessment
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit Assessment
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