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| For US Waters Under Keel Clearance Ref. Regulations 33 CFR 157.455 |
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| Prior to completing this form 33 CFR 157.455 must be read and thoroughly understood. |
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| Under Keel Clearance Calculation |
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| Port |
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| Time |
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| Section 1 – Deepest Navigational Draft |
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Facility |
Anchorage |
Transit Area |
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| 1 |
Mean Draft |
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Metres/Feet |
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| 2 |
Trim |
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Metres/Feet |
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| 3 |
Increase Draft Due List |
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Metres/Feet |
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| 4 |
Intended Transit Speed |
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Knots |
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| 5 |
Anticipated Squat |
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Metres/Feet |
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| 6 |
FW/DW Allowance |
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Metres/Feet |
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| 7 |
Corrected Maximum Draft |
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Metres/Feet |
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| Section 2 – Anticipated Controlling Depth |
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Facility |
Anchorage |
Transit Area |
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| 8 |
Chart Depth |
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Metres/Feet (Min) |
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| 9 |
Height of Tide |
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Metres/Feet (+ or -) |
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| 10 |
Sea State |
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Metres/Feet (+ or -) |
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| 11 |
Past Weather Impact |
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Metres/Feet (+ or -) |
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| 12 |
Controlling Depth |
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Metres/Feet |
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| * or listed controlling depth from latest Data |
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| Section 3 – Anticipated Under Keel Clearance |
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Facility |
Anchorage |
TransitArea |
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| 7 |
Maximum Draft |
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Metres/Feet |
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| 12 |
Controlling Depth |
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Metres/Feet |
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| 13 |
Under Keel Clearance |
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Metres/Feet |
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Port UKC Requirements |
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Metres/Feet |
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Complies |
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Yes/No |
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| Master |
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Pilot |
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Date |
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