West End Rowing Club Accident/Incident and near-miss investigation report
To be complete for all incidents or near miss incidents that could have resulted in an injury or boat damage. Confidential and legally privileged – prepared in contemplation of legal advice
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Type of Incident
Accident with
Clear selection
Near miss which could have resulted in
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Name of person reporting the Accident/Near miss incident. *
Details of Accident/Near miss Incident
Date of Accident/Near miss Incident *
MM
/
DD
/
YYYY
Time of Accident/Near miss Incident *
Time
:
Squad involved *
Name of Boat/s and/or Equipment involved
Location of the accident/near miss incident *
Environmental conditions at the time of the accident/incident
Wind strength
Clear selection
Visibility
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Tide
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Full description of the Accident/Incident
Injury Accident
Complete if the accident involved a personal injury. It is important that the Club Captain or Rowing Manager are contacted ASAP after the accident.
Person/s injured in the accident
How did the injury occur
Nature of the injury
After the accident what form of first aid was provided
Clear selection
Accident involving Boat damage
How did the damage occur
Description of the damage
Can the boat still be rowed
Clear selection
Has the Club Captain/Rowing Manager been notified of boat damage
Submit
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