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.
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1-Last name of vessel owner/operator or permit holder *
2-First name of vessel owner/operator or permit holder
3-Middle initial of vessel owner/operator or permit holder
4-Mailing address - Street
5-Email address
6-City
7-Phone number (Numbers only, no hyphens or dashes)
8-State
9-ZIP code
10-Vessel name
11-Coast Guard DOC. No. or Vessel State Reg. No.
12-State Commerical Vessel No.
13-Fishery gear type and target species *
14-Date of mortality/injury *
DD
/
MM
/
YYYY
15-Approximate time of mortality/injury *
Time
:
16-Observer present *
17-Location of mortality/injury *
Latitude (Degrees, Minutes)
Longitude (Degrees, Minutes)
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 *
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