The version of the browser you are using is no longer supported. Please upgrade to a supported browser.Dismiss

Send
Section 1 of 1
Incident reporting form
Please include as much detail as possible.
We will use this information to advise members and improve safety for everyone. Please report incidents such as rescues, injuries, issues with other water users, pollution/health issues, general river safety etc. as well as major incidents or accidents and near misses.
Email
This form is collecting emails.Change settings
Loading...
Loading…
Your name: 
Question Type
Loading image…
Answer key
(0 points)
Loading...
Loading…
Personal Details
Loading...
Loading…
Are you a member of Whitewater NZ or an affiliated club
Question Type
Loading image…
Yes
No
Add option
or
add "Other"
Answer key
(0 points)
Loading...
Loading…
Please state your role or connection with the incident
Question Type
Loading image…
1.
Group member
2.
Add option
Answer key
(0 points)
Loading...
Loading…
Incident details
Loading...
Loading…
Question Type
Loading image…
Answer key
(0 points)
Loading...
Loading…
Date:
Question Type
Loading image…
Answer key
(0 points)
Loading...
Loading…
Was a rescue required from Search and Rescue / Fire and Emergency NZ?
Question Type
Loading image…
No
Yes
Add option
or
add "Other"
Answer key
(0 points)
Loading...
Loading…
On what kind of water did this happen?
Question Type
Loading image…
1.
Whitewater river
2.
Artificial whitewater course
3.
Lake / estuary
4.
Ocean
5.
Swimming pool / polo
6.
On the bank / approaching or exiting the river
7.
Other
8.
Add option
Answer key
(0 points)
Loading...
Loading…
What water crafts were on the trip?
Question Type
Loading image…
Kayaks
Open canoes
Rafts
Sit on tops
Pack rafts
Stand up paddle boards
Boogie boards / sledges
Other…
Add option
Answer key
(0 points)
Loading...
Loading…
Where did this happen? (i.e. Which river, section, area?)
Question Type
Loading image…
Answer key
(0 points)
Loading...
Loading…
Incident type
Question Type
Loading image…
1.
Fatality
2.
Injury
3.
Medical condition
4.
Near drowning
5.
Equipment failure
6.
Health hazard (pollution)
7.
Near miss (no actual injuries or emergencies)
8.
Other
9.
Add option
Answer key
(0 points)
Loading...
Loading…
Please carefully describe the incident. Include any relevant conditions such as weather, river levels, temperature, etc.
Question Type
Loading image…
Answer key
(0 points)
Loading...
Loading…
Why did this happen?
Question Type
Loading image…
Answer key
(0 points)
Loading...
Loading…
What can be learned from this?
Question Type
Loading image…
Answer key
(0 points)
Loading...
Loading…
Use of personal data
Whitewater NZ is a privacy conscious organisation and is strongly committed to an individual’s right to privacy. All data gathered following the completion of this form will only be utilised to administer the incident report. Any personal data will be processed and stored in compliance with the Whitewater NZ Privacy Policy and in accordance with all applicable Data Protection laws in effect at the time of publication of this form, including but not limited to, the Privacy Act 1993. Data may be shared securely with statutory authorities for the purposes of investigating the incident, or with other third parties where we are legally required to do so. In all other circumstances, data will be anonymised before sharing.
Loading...
Loading…
Link to Sheets
Message for respondents
This form is no longer accepting responses
Insights
Total points distribution
Loading...
Loading responses…
Your name: 
Copy
No responses yet for this question.
Personal Details
Are you a member of Whitewater NZ or an affiliated club
Copy
No responses yet for this question.
Please state your role or connection with the incident
Copy
No responses yet for this question.
Incident details
No responses yet for this question.
Date:
No responses yet for this question.
Was a rescue required from Search and Rescue / Fire and Emergency NZ?
Copy
No responses yet for this question.
On what kind of water did this happen?
Copy
No responses yet for this question.
What water crafts were on the trip?
Copy
No responses yet for this question.
Where did this happen? (i.e. Which river, section, area?)
Copy
No responses yet for this question.
Incident type
Copy
No responses yet for this question.
Please carefully describe the incident. Include any relevant conditions such as weather, river levels, temperature, etc.
No responses yet for this question.
Why did this happen?
No responses yet for this question.
What can be learned from this?
No responses yet for this question.
Use of personal data
Settings
Responses
Manage how responses are collected and protected
Presentation
Manage how the form and responses are presented
Defaults
Form defaults
Settings applied to this form and new forms
Question defaults
Settings applied to all new questions
.