Incident, Injury and Damage Reporting Form

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Please complete this form to report any injury, incident or accident between members, members of the community, the Larkspur ferry, and/or creek obstacles (pilings, docks, shoreline, etc). These are incidents that might take place on the water or on the MRA grounds.

Email *

Date of incident *

YYYY

Time of incident *

Time

Name of Staff or Member making the report *

What are the member names of those involved in the incident? *

Where there any third parties involved? If so, who (i.e. ferry, private boaters) *

What were the weather and water conditions? *

What was the tide and tidal direction? *

What equipment was involved? Please name the boats. *

List damage to all equipment: *

Please give a full and detailed description of the incident, including why you believe it happened. Please include information regarding traffic pattern, right-of way, ferry protocol violations, etc: *

List any and all injuries to individuals and any treatments administered. *

In which section did the water incident take place? SEE DIAGRAM BELOW. *

Corte Madera Creek Incident Mapping by Letter

A copy of your responses will be emailed to the address you provided.

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