Boat Safety Form

Please Read and then complete as much information as you can in the following form.

Name*

First

Last

Address*

Street Address Street Address Line 2 City State / Province / Region Postal / Zip Code Country

Email*

Phone no.*

Mobile no.

Boat Name*

Boat Length*

CRT reg. no.*

Hull ID no. (if present)

Year Built

Builder: Steel Work

Builder: Fit Out

Previous Cert Number

Expiry Date

Engine: Make

Engine: Type

Engine: Fuel Used

Location of gas test point

Fire Extinguisher: Qty, Type & Rating

Gas Fridge: Make & Model

Gas Fridge: Flued

Yes

Catalytic Heater: Make & Model

Catalytic Heater: Flued

Yes

Cooker/oven grill: Make & Model

Hob: Make & Model

Stove: Make & Model

Stove: Fuel Type

Water Heater, Instant Type

Central Heating: Make & Model

Number of Berths

High Level Vents: Number

High Level Vents: Type

Low Level Vents: Number

Low Level Vents: Type

If you are not able to attend on the day of examination, a Calcutt Boats representative may be asked to assist the examiner; this will be charged at £55 per hour.*

I understand

I have read and understood the terms above, issued by the BSS Examination board of Canal and River Trust.*

I have

I understand that the fee for the examination and certification is £200 for leisure craft and £230 for liveaboard or shared ownership craft*

I Understand