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.
* Required
Email address
*
Your email
Full Name
*
Your answer
Contact Number
*
To be used if the Safety Officer needs to clarify information
Your answer
Where you were when the incident/near miss occurred?
*
On board a vessel or craft involved
Observing from a distance or on board a vessel or craft not involved
Not at the scene
Required
Your role during the accident or incident (optional)
*
Crew members (coxswain)
Crew member (rower)
Crew member (other craft, e.g. safety boat)
Witness
Other
Contact details of individuals involved (if known)
Your answer
Date of incident
*
MM
/
DD
/
YYYY
Time (approx)
*
Time
:
AM
PM
Location
*
Kerrs Reach
Waimakariri River
Selwyn River
Lake Ruataniwha
Salt Water Creek (Timaru)
Lake Opua
Kaiapoi River
Other:
Required
Who was involved?
*
Your answer
Type of Incident
*
Capsize
Collision
Near miss
Other
Required
If capsize related, how were the individual(s) involved recovered from the water?
Your answer
If capsize related, were PDFs involved in the rescue?
Yes
No
Clear selection
Provide a summary of the event and the causes.
*
Your answer
How many people were injured?
*
None
1
2
More than 2
Please describe the injuries sustained (optional).
Your answer
Describe any damage to property, plant or equipment?
Your answer
A copy of your responses will be emailed to the address you provided.
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