Form Cg-16700 - Norh American Ice Service Customer Survey Form

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OMB No. 1625-0087
U.S. Coast Guard
Expires: 12/31/2016
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 for this report is 24 minutes. You may submit any comments concerning the accuracy of this estimate or any suggestions
for reducing the burden to: Commandant (CG-WWM-3), U.S. Coast Guard, Washington, D.C. 20593-0001 or Department of Homeland Security Desk Officer, Office of
Management and Budget, Office of Information and Regulatory Affairs, Washington, D.C. 20503.
Please indicate the organization you are affiliated with
Employment (Please check one)
Ship Captain/Crew
Vessel Name: _____________________ Call Sign: _____________________
Home Port: ________________________
Shipping Agent
Insurance Company Agent
Member of Scientific Community
Employee of Government Agency
Specify: _______________________________________________
Please check all the following communications equipment that you have access to
HF Facsimile
Internet Access
HF Radio Transceiver
VHF Radio Transceiver
Other: _____________________________________________________________________________
Do you utilize the following NAIS iceberg products in a pilothouse or operations center? (Select all that apply)
NAIS Iceberg Bulletin
NAIS Iceberg Chart
NAVAREA IV Warnings or Notices to Shipping for icebergs outside the Iceberg Limit
Please respond to the questions below by checking the appropriate answer.
Do you attempt to receive NAIS Iceberg Bulletins via SafetyNET?
Do you attempt to receive NAIS Iceberg Bulletins via SITOR?
Do you attempt to receive NAIS Iceberg Bulletins via NAVTEX?
Do you attempt to receive NAIS Iceberg Charts via HF Facsimile?
Do you attempt to record the NAIS Iceberg Limit from voice broadcasts? (list radio stations received from
Do you access NAIS iceberg products via the Internet?
Are you registered to receive NAIS iceberg products via the NAIS list server?
Do you modify your operational procedures in the vicinity of the NAIS Iceberg Limit? (i.e., change course and/or
speed, post additional look-out personnel, etc.)
Does your voyage require that you pass inside the Iceberg Limit? (i.e., required trips to St. John’s, Newfoundland)
Other: ____________________________________________________________________________________
What information do you plot on your navigational charts? (Select all that apply)
Iceberg Limit
Western Iceberg Limit
Sea Ice Limit
Radar Targets
What method do you use to make iceberg reports to Canadian Coast Guard MCTS centers? (Select all that apply)
INMARSAT (Code 42)
Other: ____________________________
No reports made
CG-16700 (07/13)
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