Last updated: 19-January-2017

Ballast Water Management Reporting PDF Form

NOTE: Adobe Acrobat or Adobe Reader, version 9 or later, is required to use the PDF BWMR form.   Adobe Reader can be downloaded from adobe.com.

Instructions     Standard PDF Form     36 Tank PDF Form     Sample form

Extended form: The standard form can report the ballast water history of up to 20 tanks.  The Extended Form can report up to 36 tanks.

Completion Instructions

VESSEL INFORMATION

Vessel name:  Enter the name of the vessel. For tug and barge combinations, please list multiple vessel names separated by a hyphen.

ID number:  Select "IMO Number" or "Official Number" from the pull-down menu, and enter the vessel identification number into the adjacent field. For tug and barge combinations, please list multiple vessel numbers separated by a hyphen.

Country of Registry:  Choose from the country pull-down menu.

Owner/operator:  Enter the name of the registered owner(s) of the vessel.  If under charter, enter operator name.

Type:  Select a vessel type from the pull-down menu.  If the exact vessel type is not available, select "Other".

Gross Tonnage:  Enter the Gross Tonnage of the vessel.  If reporting a tug-barge combo, report total combined gross tonnage.

Ballast water volume units:  Select cubic meters, metric tons, or gallons from the pull-down menu.  NOTE: this volume unit will be applied to all volume entries on the BWMR.

Total ballast water capacity:  Enter the maximum total volume of ballast water that can be carried in the vessel according to its Ballast Water Management Plan.  If reporting a tug-barge combo, report total combined ballast water capacity.

Number of tanks on ship:   Enter the total number of ballast water tanks, cargo holds, and other spaces that are used for carrying ballast water.

Onboard BW Management System:   If the vessel is equipped with an approved ballast water management system, enter the US Coast Guard designated system identification number:

VOYAGE INFORMATION

Arrival port (port and state):   Enter the name of the port or place that is the destination for this voyage. No abbreviations please. Select the matching state or territory from the pull-down menu.

Arrival date:   Enter the date of arrival to the arrival port. Use European date format (DD/MM/YYYY).

Last port (port and country):   Enter the name of the last location at which the vessel called, either outside the US EEZ or the previous US location. No abbreviations please. Select the Country or US territory of the last port from the pull-down menu.

Next port (port and country):   Enter the name of the next location at which the vessel plans to arrive. Select the Country or US territory of the next port from the pull-down menu.

Total ballast water on board:   Enter the total volume of ballast water on board upon arrival into the arrival port.  Do not count potable water.  If reporting a tug-barge combo, report total combined ballast water on board.

Number of tanks in ballast:   Enter the total number of ballast water tanks, cargo holds, and other spaces that are carrying ballast water upon arrival to the Arrival port.

Number of tanks discharged:   Enter the total number of ballast water tanks, cargo holds, and other spaces carrying ballast water discharged at, or en route to, the Arrival port.

Alternate BW management conducted, per instructions from COTP:   Check this box only if you have received specific instructions from a COTP on how to conduct an alternative BW management on one or more of the tanks discharged.

BALLAST WATER HISTORY

Record all tanks discharged inside coastal waters (12nm) of the US, either en route to or at the arrival port.

Ballast Water History is reported on an "event" basis.  Rather than reporting discharge, management and source events on a single line, as in earlier BWMR forms, each ballast water event is now reported on a separate line.  For each tank, fill in ballast water events in descending date order, with the most recent discharge at the top.

Illustrated examples are available at the end of this document

NOTE: US Coast Guard NOBOB policy also requires vessels entering the Great Lakes and Hudson River (north of the George Washington Bridge) after operating beyond the U.S. EEZ to report the Ballast Water History of empty BW tanks that underwent an alternative management (e.g., Salt Water Flush, conducted a mid-ocean exchange the last time the tanks contained ballast water).

TANK INFORMATION

Tank name/number:   Enter the specific name and number of the tank, including its location and side (center, port or starboard), e.g. WT 1P.

Tank capacity:   Enter the maximum volume that the tank or hold can carry.

BALLAST WATER EVENTS

1. Discharge Events

Event:   Select either "Discharge to US waters" or "Discharge to facility" from the pull-down menu in the top line of the tank block.

Date:   Enter the date that ballast water was discharged, using DD/MM/YYYY format.

Location:   Enter the port or place name (including state, territory, or country), or latitude and longitude of the location where ballast water was discharged.

Volume:   Enter the volume of ballast water that was discharged.

2. Management Events

• For discharge to a shore-based facility or another vessel for treatment select "Discharge to facility" in the Discharge Events section above.

• For ballast water from a US Public Water System select "Source from PWS" in the Source Events section below.

• If ballast water management was NOT CONDUCTED, skip to the Source Events section below.

• OTHERWISE, select a management event:

Event:   Select "Empty-refill exchange", "Flow-through exchange", "Onboard treatment" or "Salt Water Flush" from the "Select event" pull-down menu.

NOTE: "Salt Water Flush" is a US Coast Guard's Best Management Practice for vessels with empty ballast water tanks entering the Great Lakes and Hudson River (north of the George Washington Bridge). Salt water flushing is defined as the addition of mid-ocean water to empty ballast water tanks; the mixing of the flush water with residual water and sediment through the motion of the vessel; and the discharge of the mixed water.

Date:   For "Onboard Treatment" enter the date treatment was started. For "Empty-refill exchange", "Flow-through exchange" or "Salt Water Flush" enter the date on which BW Management was completed.

Location(s):   Do not include locations for "Onboard Treatment". If BW was managed by "Empty-refill exchange", "Flow-through exchange" or "Salt Water Flush" while underway, enter the latitude and longitude of both the start point and end point, separated by a "/".

Volume:   Enter the full volume of ballast water that was pumped and/or gravitated INTO the tank during "Empty-refill exchange", "Flow-through exchange" or "Salt Water Flush". For "Onboard Treatment" enter the volume treated.

3. Source Events

Event:   Select either "Source" or "Source from PWS" from the "Select event" pull-down menu. "Source from PWS" indicates that a US public water system was used.  If there were multiple sources for a tank, list each one on a separate event line.

Date:   Enter the date on which the ballast water was taken into the tank (DD/MM/YYYY format).

Location:   Enter the port or place name (with state or territory, and country) or latitude and longitude where ballast water was taken into the tank.

Volume:   Enter the volume of water that taken into the tank from the source location.

NOTE: If there was more than one source for a tank, fill out BW Source Event lines for the largest sources, up to three. If the five lines in a tank block are not enough to report all of the BW Events for a single tank, please use the on-line reporting application, which supports unlimited tank events.

If BW Management was *not* conducted for this tank, select one of the following reasons: If ballast water management did not occur on water discharged into the waters of the United States, select from "Equipment failure", "Regulatory exemption", "Route exemption", "Safety - weather", "Safety - design limit" or "Mid-ocean source".

 

CERTIFICATE OF ACCURATE INFORMATION

Certificate of accurate information:   By checking this box, you attest to the accuracy of the information provided and that the activities were in accordance with the ballast water management plan required by CFR 151.2050(g).

Responsible Officer's name and title:   Type the name and title of the individual (i.e., master, owner, operator, agent or person in charge) responsible for the information provided on this form. A typed name in combination with the certificate of accurate information constitutes an official signature.

Report type:   Choose "New report" or "Corrected report" from the pull-down menu. Choose "New report" for the initial report for a particular arrival. Choose "Corrected Report" if a prior report was already submitted for this arrival, including instances of port rotations, information updates or error corrections. If an arrival is CANCELLED after a report is sent to NBIC, please email nbic@ballastreport.org, noting the vessel ID, arrival port and arrival date of the report to cancel.

Submitted by and Contact information:  Enter the name of and contact information for the individual (i.e., master, owner, operator, agent, person in charge) submitting the BWMR to the NBIC.

SUBMIT THE BWMR FORM TO NBIC

Send the completed Ballast Water Management Report to NBIC using one of the following methods:

Option #1:   The "Submit report via e-mail" button on the first page of the form will automatically prepare an e-mail with an attachment that contains the data you entered. This attachment is much smaller than the form itself -- just 10 to 15 KB. NOTE: this button may not work with all shipboard e-mail systems.

Option #2:   Clicking the "Submit report on-line" button will send the data from the report directly to NBIC, and return a PDF-format receipt.

Example Forms

1. Illustrated examples of how to report ballast water history are shown in this BW History Sample PDF.

 

 

Paperwork Reduction Act Notice

An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number.

The Coast Guard estimates that the average burden per response is 40 minutes for a Ballast Water Management Report. You may submit any comments concerning the accuracy of this burden estimate or any suggestions for reducing the burden to: Commandant (CG-OES), U.S. Coast Guard Stop 7509, 2703 Martin Luther King Jr Ave SE, Washington, DC 20593-7509 or Office of Management and Budget, Paperwork Reduction Project (1625-0069), Washington, DC 20503.

Privacy Act Statement

Authority: 16 U.S.C. 4711; Pub. L. 104-332; 33 CFR 151 subpart D §§ 151.2060 and 151.2080.

Purpose: The Coast Guard will use the information provided on ballast water reporting forms to evaluate vessel ballast water management practices.

Routine Uses: Authorized Coast Guard personnel will use this data in efforts to reduce discharge of aquatic nuisance species into U.S. waters from vessels and to prevent future damage caused by such discharges. Any external disclosures of information within this record will be made in accordance with DHS/USCG-013, Marine Information for Safety and Law Enforcement (MISLE), 74 Federal Register 30305 (June 25, 2009).

Disclosure: Furnishing this information is mandatory; failure to furnish the requested information is a violation and may incur civil penalties.

 

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