Cure Boating Club on-water incident / near-miss report
This form is to be used to log on-water rowing related incidents and near misses as concerns Club members and the activities of the Club.

Logged incident and near-misses will be responded to by the Club Safety Officer and further shared with the Canterbury Rowing Association.

Incidents will be evaluated and if required will be notified to Maritime New Zealand.
Email address *
Full Name *
Contact Number *
To be used if the Safety Officer needs to clarify information
Where you were when the incident/near miss occurred? *
Required
Your role during the accident or incident (optional) *
Contact details of individuals involved (if known)
Date of incident *
MM
/
DD
/
YYYY
Time (approx) *
Time
:
Location *
Required
Who was involved? *
Type of Incident *
Required
If capsize related, how were the individual(s) involved recovered from the water?
If capsize related, were PDFs involved in the rescue?
Clear selection
Provide a summary of the event and the causes. *
How many people were injured? *
Please describe the injuries sustained (optional).
Describe any damage to property, plant or equipment?
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy