Accident Report Form

Accident Report Form

Please return this form within 24-hours of an event involving injuries, deaths, and/or damage to a Club boat or by a Club boat. Member Programs: Skipper and each crew are to complete their own incident form. Lessons / Racing Programs / Clinics: Instructor and each injured crew are to complete their own reports.
Full Name
Position on board

Other
PHONE
Format: (000) 000-0000.
EMAIL
example@example.com
Address: Street, Apt/Suite, City, State, Zip
Accident Date:

MonthDayYear
Date
Accident Time

Hour Minutes

AM/PM Option
Location of the accident. Please provide coordinates if available.
Boat/s Involved in the Accident
Which Club boat were you on when the accident occurred?
Was another boat involved in the accident? If yes, please provide their information in the field below.
Boats involved in the accident. Include the full name of the owner/skipper, phone, email, boat make/model & name. Description of damage to this boat.
Operations at the time of the incident:

Other
Causes of the incident:

Other
Description of the event before, during, and after. Include things such as wind speed & direction, visibility, direction of boats (if collision occurred), speed of the boat, point of sail, grounding type (hard/soft), location, and details about the event.
Please upload photos of damages or broken parts on the vessel.
Did the event occur during one of the following?

Other
Injuries or Deaths Onboard
How many people were injured on board?
Were there any deaths on board?
Add the information below for each person who was injured/deceased on board. If there were more than 3 people, please send a follow up with the remaining information.
Was first aid administered?
Was emergency response called?
Post-Accident
What recommendations do you have to prevent incidents of this type in the future?
The information provided on this report is true to the best of my knowledge.
Date

MonthDayYear
Date
Should be Empty: