Incident Reporting Form
What needs to be reported? All material incidents and accidents, whether in the boathouse or on the water, need to be reported. Material incidents include situations where someone has been injured or equipment damaged. We also want to hear about near misses which could have resulted in injury or equipment damage. We can learn from such situations.
Category
*
Off Water Incident
On Water Incident/Collision
On Water Near Miss
Date damage occured or today if unknown
*
-
Month
-
Day
Year
Date
Time damage occured or current time if unknown
*
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Who is reporting the incident
*
First Name
Last Name
Your Mobile Phone Number
*
Your Email
*
example@example.com
If it was a collision who was incontrol (or not) of the other boat?
First Name
Last Name
Role
Where did the incident take place?
Which club was the other boat from?
Was there any damage to their boat? (If yes provide a brief description)
Was a 3rd person involved in the incident
First Name
Last Name
Role
Was a 4th person involved in the incident
First Name
Last Name
Role
Was First Aid required
*
Yes
No
Did anyone require hospitalisation
*
Yes
No
What happened including details of any first aid or hospitalisation.
Which Boat needs to be repaired - Boat Name (NA is no boat involved)
*
Describe the damage and what needs to be done.
Upload any Photos or other files
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