DEPARTMENT OF HOMELAND SECURITY U.S. Coast Guard

REPORT OF BOARDING

FORM CG-4100 (REV 2-15)

INSTRUCTIONS FOR PROCESSING THE FORM

Form CG-4100 is a two page form that consists of a white original and a yellow copy. Accurate and complete data must be legibly printed with a ballpoint pen on each set. Refer to the Maritime Law Enforcement Academy Boarding Officer Job Aid Kit (BOJAK) as a guide for current Code of Federal Regulations minimum equipment requirements. Place the inner front flap which is part of the bottom of the pad under the last copy of the set of forms to keep from marking the other sets.

The U.S. Coast Guard Maritime Law Enforcement Manual, COMDTINST M16247.1 (series), describes in detail how to fill out the Report of Boarding.

All items inspected in the Summary of Boarding shall be marked with a “X”. Any violation in the Summary of Boarding shall be circled and have the appropriate USC/CFR entered into the citation box adjacent to the violation.

Use the written summary section to capture additional boarding details not addressed on form (i.e. description of violation, corrections actions taken, etc.)

Completed form distribution:

Compliance Boarding - No Violation

Page 1 - Original: Scanned into MISLE. Page 2 - Yellow copy: Boat Operator.

Violations, Termination, and Warnings:

Page 1 - Original: Scanned into MISLE. Unit then transfers control and ownership of the MISLE Activity to the VCCC.

Page 2 - Yellow copy: Boat Operator.

CG-4100 (09/15)

VESSEL TYPE CODE TABLE FISHING, COMMERCIAL PLEASURE (PRIVATELY OWNED) MERCHANT

FCH CHARTER/PARTY/HEAD BOAT POWER MBG BARGE FCD CLAM DREDGE MFY FERRY FFS FACTORY SHIP PCC CABIN CRUISER MFC FREIGHTER, COASTAL FGN GILLNETTER PHP HIGH PERFORMANCE MFO FREIGHTER, OCEAN-GOING FHP HARPOONER PHB HOUSE BOAT MNG LNG CARRIER FLL LONGLINER PRA RUNABOUT MOC OIL CREW BOAT FMR MULTI-RIG PFS SPORT FISHER MOR OIL RIG BOAT FPB POT OR TRAP BOAT PYM YACHT, LUXURY MOTOR MPL PASSENGER LINER FRV RESEARCH VESSEL PYT YACHT, TRAWLER TYPE MRV RESEARCH VESSEL FSC SCALLOPER MTC TANKER, COASTAL FSS SEINER, SIDE CHUTE SAIL MTO TANKER, OCEAN-GOING FST SEINER, STERN CHUTE MTG TUG FSH SHRIMPER PSC CATAMARAN MTB TUG AND TOW FSP SUPPORT SHIP PSK KETCH FTP TRAWLER, PAIR PSM MOTORSAILER MOO OTHER (DESCRIBE IN SUMMARY) FTE TRAWLER, SIDE, EASTERN PSS SCHOONER FTW TRAWLER, SIDE, WESTERN PSL SLOOP FTS TRAWLER, STERN PST TRIMARAN FTO TROLLER (SNAPPER OR SALMON) PSO SAIL, OTHER FWL WHALER

POO OTHER (DESCRIBE IN SUMMARY) FOO OTHER (DESCRIBE IN SUMMARY)

NATIONALITY TABLE AL ALBANIA EG AG ALGERIA ES AO ANGOLA EK AC ANTIGUA AND BARBUDA ET AR ARGENTINA FJ AS AUSTRALIA FI AU AUSTRIA FR BF BAHAMAS, THE GB BA BAHRAIN GA BG BANGLADESH GE BB BARBADOS GH BE BELGIUM GR BH BELIZE GP BN BENIN GJ BD BERMUDA GT BL BOLIVIA GV BR BRAZIL PU VI BRITISH VIRGIN ISLANDS GY BU BULGARIA HA CB CAMBODIA HO CM CAMEROON HK CA CANADA HU CV CAPE VERDE IC CJ CAYMAN ISLANDS IN CI CHILE ID CH CHINA IR CO COLOMBIA IZ CF CONGO EI CS COSTA RICA IS CU CUBA IT CY CYPRUS IV EZ CZECH REPUBLIC JM DA DENMARK JA DJ DJIBOUTI KE DO DOMINICA KN DR DOMINICAN REPUBLIC KS EC ECUADOR KU

ACTIVITY U UNDERWAY D DRIFTING F ENGAGED IN FISHING E ENTERING PORT P DEPARTING PORT T TOWING B BEING TOWED L ON/OFF LOADING A ANCHORED M MOORED N NESTED R REFUELING

EGYPT LE LEBANON SE SEYCHELLES EL SALVADOR LI LIBERIA SL SIERRA LEONE EQUATORIAL GUINEA LY LIBYA SN SINGAPORE ETHIOPIA MA MADAGASCAR SO SOMALIA FIJI MY MALAYSIA SF SOUTH AFRICA FINLAND MI MALAWI SL SIERRA LEONE FRANCE MV MALDIVES SP SPAIN GABON MT MALTA CE SRI LANKA GAMBIA MR MAURITANIA SU SUDAN GERMANY MP MAURITIUS NS SURINAM GHANA MX MEXICO SW SWEDEN GREECE MN MONACO SZ SWITZERLAND GUADELOUPE MO MOROCCO SY SYRIA GRENADA MY MYANMAR TW TAIWAN GUATEMALA NR NAURU TZ TANZANIA GUINEA NL NETHERLANDS TH THAILAND GUINEA-BISSAU NA NETHERLANDS ANTILLES TO TOGO GUYANA NZ NEW ZEALAND TN TONGA HAITI NU NICARAGUA TD TRINIDAD AND TOBAGO HONDURAS NI NIGERIA TS TUNISIA HONG KONG NO NORWAY TU TURKEY HUNGARY OO OTHER (DESCRIBE IN SUMMARY) TK TURKS AND CAICOS IS ICELAND PK PAKISTAN TV TUVALU INDIA PN PANAMA TC UNITED ARAB EMIRATES INDONESIA PA PARAGUAY UK UNITED KINGDOM IRAN PE PERU US UNITED STATES IRAQ RP PHILLIPINES UY URAGUAY IRELAND PL POLAND NH VANUATU ISRAEL PO PORTUGAL VE VENEZUELA ITALY QA QATAR VM VIETNAM IVORY COAST RO ROMANIA WS WESTERN SAMOA JAMAICA RU RUSSIA YE YEMEN JAPAN ST ST LUCIA XX WITHOUT NATIONALITY KENYA VC ST VINCENT AND THE GRENADINES KOREA, NORTH TP SAO TOME AND PRINCIPE KOREA, SOUTH SA SAUDI ARABIA KUWAIT SG SENEGAL

VIOLATION CODES DM MOTHERSHIP MJ DR ROUNDTRIP MJ DB CONTACT BOAT MJ DC COCAINE DO DRUG OTHER (DESCRIBE IN SUMMARY) FF MAGNUSON-STEVENS FISHERY CONSERVATION AND MANAGEMENT ACT FL LACEY ACT FE ENDANGERED SPECIES ACT FM MARINE MAMMAL PROTECTION ACT FS MARINE SANCTUARIES FP NORTH PACIFIC FISHERIES ACT FH NORTH PACIFIC HALIBUT ACT FK SOCKEYE SALMON ACT FA ATLANTIC SALMON CONVENTION ACT FT ATLANTIC TUNAS CONVENTION ACT FW WHALING CONVENTION FR FUR SEAL ACT FO FISHERIES OTHER MT MIGRANT TRANSPORTATION BS BOATING SAFETY NA NEUTRALITY ACT SO SMUGGLING OTHER OO OTHER LAWS (DESCRIBE IN SUMMARY)

CG-4100 (09/15)

REPORT OF BOARDING MO DY YR BOARDING TIME HULL IDENTIFICATION NUMBER VE

SSEL

VESSEL NUMBER/DOC NUMBER VESSEL NAME HAILING PORT

MANUFACTURER POB PFDS TPYE OF BOAT

Rowboat

Sail

Cabin M/B

Open M/B Canoe/Kayak

Houseboat

Inflatable

Other

MODEL YEAR ADULT ADULT PROPULSION: Rowboat

Inbrd Diesel

Inbrd Gas

Outboard Jet Drive

Sail Only

Manual

Other

NET TONS (DOC) FEET INCHES HORSEPOWER CHILD CHILD MATERIAL:

Wood Steel Rubber Unknown

OtherCementFiberglassAluminum

USE FLAG ENGINE COMPT FUEL COMPT CONSTRUCTION

OWNE

R

OWNER NAME OWNERSHIP NATIONALITY

ADDRESS DOB MMDDYYYY

CITY STATE ZIP TELEPHONE TYPE OF ID I.D. #

OPE

RATO

R/M

ASTE

R

OPERATOR/MASTER NAME OPERATOR COURSE: None CG CGAUX USPS

RED CROSS PUBLIC SCHOOL STATE/COUNTY OTHER NATIONALITY

ADDRESS DOB MMDDYYYY OPER. AGE

CITY STATE ZIP TELEPHONE TYPE OF ID I.D. #

OBS

ERVE

D IN

USE BODY OF WATER CITY STATE ACTIVITY

LATITUDE LONGITUDE DETAILED LOCATION ???????

Inland Rules Col Regs

SUMMARY OF BOARDING / VIOLATION VIOLATION CITATION VIOLATION CITATION

101 NUMBERING 119 UNSAFE CONDITION CREATING ESPECIALLY HAZARDOUS CONDITION102 CERTIFICATE

103 DOCUMENT/OFFICIAL NUMBER 120 INTOXICATED PERSON

104 PERSONAL FLOTATION DEVICE 121 FAILURE TO TERMINATE

105 BELL 122 OVERLOADED

106 FIRE EXTINQUISHER (Y) (N); FIXED (Y) (N) 123 MANIFESTLY UNSAFE VOYAGE (DIST.COR)

107 BACKFIRE FLAME CONTROL 124 ACCUMULATION OF FUEL IN BILGES

108 VENTILATION 125 FUEL LEAK - ENGINE OR FUEL SYSTEM

109 MARINE SANITATION DEVICE

126

REGULATED NAVIGATION AREAS/HAZARDOUS

BARS/LIMITED ACCESS AREAS/NAVAL VESSEL

PROTECTION ZONES/SECURITY/ZONES

110 INSTALLED TOILET AND NO MSO INSTALLED

111 POLLUTION PLACARD

112 GARBAGE PLACARD 127 CORRECTED ON THE SPOT

113 WASTE MANAGEMENT PLAN 128 USCG AUX CHE DECAL EXP DATE

114 FCC SSL NOT POSTED/AVAILABLE 129 FED REG FIREARMS ONBOARD (RECORD MAKE/MODEL/SER # IN SUMMARY)115 OPERATION WITHOUT FCC SSL

116 NAVIGATION & ANCHOR LIGHTS 130 OTHER (SPECIFY)

117 VISUAL DISTRESS SIGNALS(SUNRISE/SUNSET) 131 OTHER (SPECIFY)

118 NEGLIGENT/GROSS NEGLIGENT OPERATION 132 OTHER (SPECIFY)

RESULTS OF BOARDING / LAW ENFORCEMENT ACTION TAKEN

RESULTS OF BOARDING ACTION TAKEN ArrestVoyage Terminated Seizure

SEIZED PROPERTY RECEIPTS

Yes No SERIAL #

WRITTEN SUMMARY

DISTRICT UNIT TELEPHONE NUMBER BOARDING OFFICER

BOARDING NUMBER MSLE ACTIVITY NUMBER BOARDING OFFICER SIGNATURE

CG-4100 (09/15)

PROMOTE BOATING SAFETY

The Coast Guard requests your cooperation in promoting the safety of life and property on the nation's waterways. By observing the prescribed laws and regulations and by following safe boating practices, you can help reduce the number of lives lost or injuries sustained and prevent damage to property.

PURPOSE OF BOARDING

The Coast Guard is the primary maritime law enforcement and safety agency of the United States. Under statutory authority Coast Guard boarding officers may at any time go onboard vessels subject to the jurisdiction of the United States and make inquiries, examine ship's papers, and inspect, examine and search the vessel for the detection, prevention, and suppression of violation of U.S. Laws. The Coast Guard is also authorized to make seizures and arrests and use only that force which is reasonably necessary under the circumstances to compel compliance while conducting boardings.

The Coast Guard enforces regulations related to recreational boating safety, boating while intoxicated, pollution prevention, vessel documentation and registration and many other areas including criminal laws such as possession and distribution of illegal drugs, illegal weapons, stolen boats, alien smuggling as well as Customs laws. Additionally, the Coast Guard checks for compliance with applicable U.S. Fisheries regulations and agreements. The Coast Guard accomplishes this through an active boarding policy in which boarding teams follow established procedures for going onboard U.S. and foreign vessels subject to U.S. jurisdiction to conduct inspections. ADDITIONAL INFORMAITON

Boaters who have questions, comments or feedback concerning Coast Guard law enforcement boardings may go to the Boating Safety Resource Center website: http://www.uscgboating.org/

NOTICE OF VIOLATION IMPORTANT NOTICE TO OWNER OR OPERATOR

CORRECT DISCREPANCY AS SOON AS POSSIBLE

Continued operation without required safety equipment may be an invitation to a serious accident. It may also result in additional penalties for repeated violation of Federal Law.

PROCEDURES

The information from this Report of Boarding will be forwarded to the appropriate entity who will review all applicable information to determine if civil penalty action should be commenced. You may be offered an opportunity to prove correction of your discrepancy or discrepancies to avoid civil penalty action.

Should civil penalty action be considered appropriate for the violation(s) noted, you will be notified in writing by a Coast Guard Hearing Officer of the charges against you, the maximum penalty which may be assessed, the procedures used in assessing the penalty, the amount of the penalty appearing appropriate, and of your rights in the proceeding. Within 30 days of receipt of this notification you may request a hearing; provide, in writing, any information or material in lieu of a hearing that denies, explains, or mitigates the violation; or you may pay the preliminarily assessed penalty.

PRIVACY ACT STATEMENT

Authority: 46 U.S.C. 89; 46 U.S.C. 2302; 46 U.S.C. 4106; 46 U.S.C. 4311; 46 U.S.C. 12122; and 46 U.S.C. 12309.

Purpose: To document USCG commercial fishing boarding event, assess civil penalty action & facilitate collection of civil penalties (if appropriate), and to provide vessel owner/operator written notice of boarding.

Routine Uses: Authorized USCG personnel will use this information to locate a violator and to determine if civil penalty action(s) will be assessed. Any external disclosures of data within this record will be made in accordance with DHS/USCG-013, Marine Information for Safety and Law Enforcement, 74 Federal Register 30305, June 25, 2009.

Disclosure: Furnishing vessel registration/certificate of number is mandatory. Failure to furnish the requested information upon boarding may subject the owner to a fine or penalty.

CG-4100 (09/15)