ANUBC 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.

Name of Individual reporting incident

Name of club/school reporting incident *

Role of person reporting incident *

Email *

Best contact number *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

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

Date & Time of incident *

Date

Time

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

Picture/file upload

Click or drag files to this area to upload. You can upload up to 12 files.

Please upload any relevant photos for this incident.

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? *

Please note that this form will be submitted to your club.

Print name *

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

Website

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.

ANUBC Incident Report Form

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