Incident Report Form

Please note that all collisions must be reported. Data from all incident reports, including near-misses, are used to look at trends and to help improve safety on the water. Individuals can either fill out the form below or email a copy of the form to safety@rowingact.org.au

Name of Individual reporting incident

Club or School you are from *

Role of person reporting incident *

Email *

Best contact number *

What is the email of your club safety officer or committee? *

Enter the best contact email for your CLUB or SCHOOL. This ensures that they receive a copy of the report.

What was the date of the incident? *

What club or third parties were involved (if known)? *

Types of boat involved *

E.g. 8+, 4-, 2x, 1x etc

Were the boats: *

Training
Racing
Recreational

Where did the incident occur? *

If possible link to a marker on an online map.

Please give a full description of the incident; this should include weather, water, and other other conditions which contributed to the incident: *

If at night or in poor visibility conditions, what lights were being shown by all parties?

List any injuries sustained: *

Please put N/A where no injuries were sustained

List any damage sustained to boat(s) or property: *

Please put N/A where no damage was sustained

Were emergency services contacted? *

No
Police
Ambulance
Fire Brigade

Please add any further comments or additional information you think could be useful, eg list of witnesses (including contact details):

What further actions have been or will be implemented to avoid a repeat of the incident? *

Have you advised your club of this incident? *

If No please ensure that your club is informed as soon as possible. Whilst clubs will receive a copy of this report, it is also your duty to report this to them,

Print name *

I acknowledge that the above incident occurred and I have described this to the best of my ability.

Phone

RA defines an incident or near incident as an event causing or involving: the loss of a person from a boat; the death of, or grievous bodily harm to, a person caused by a boat’s operations; the loss or presumed loss or abandonment of a boat; a collision with a boat; the stranding of a boat; material damage to a boat; material damage caused by a boat’s operations; danger to a person caused by a boat’s operations; danger of serious damage to a boat; and, danger of serious damage to a structure caused by a boat’s operations.

Incident Report Form

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