Professional Documents
Culture Documents
Sub-Aqu
Scottis
lub
aC
Incident/Accident
Report Form
Please return completed form to:
Details of Incident
Date
Location:
Time
UK
Sea
Overseas
Lake/Quarry
Place
Organisation of Dive:
Private
River/Canal
Club
Swimming Pool
Holiday
On Land
Country (If not UK)
Commercial
Date
Time of surfacing
Duration
Depth
Decompression Conducted:
Depth(s)
Time(s)
Surface interval since previous dive (if applicable)
Date
Time of surfacing
Duration
Depth
Decompression Conducted:
Depth(s)
Time(s)
Surface interval since previous dive (if applicable)
Type of Incident and factors involved. Please mark all relevant boxes.
01 Fatality
30 Rough water
56 Wreck dive
02 Embolism
31 Cold water
57 Cave dive
03 Decompression illness
32 Water current
58 Night dive
04 Unconsciousness
59 Snorkel dive
05 Injury
60 Boat dive
06 Illness
61 Shore dive
07 Narcosis
35 Bad seamanship
08 Oxygen Poisoning
36 Good seamanship
09 Ear problems/damage
37 Carelessness
62 Coastguard
10 Hypothermia
38 Ignorence
63 Lifeboat
11 Breathlessness
39 Disregard of rules
64 Helicopter
12 Panic
40 Malice
65 Ambulance
13 Cramp
66 Hospital
14 Resusitation involved
42 Inadequate training
67 Police
43 Entangled/trapped
68 Fire Brigade
44 Fire/explosion
69 Recompression
16 Nitrox
45 False alarm
Decompression Incidents
17 Trimix
18 Rebreather
19 Aborted dive
20 Ascent using Alternative Air Source
21 Buoyant ascent
22 Free ascent (without air supply)
23 Controlled Buoyant Lift
24 Rapid ascent
25 Diver too buoyant
26 Diver too heavy in water
27 Out of air
28 Foul air
29 Incorrect Gas Mixture
Devised by the British Sub-Aqua Club
46 Good practice
47 Solo diving
48 Trio diving
49 Separation
specify:
50 Lost diver(s)
51 Drift diving
52 Training drill
77 Re-entry decompression
54 Divers underwater
78 Repeat diving
Person A
Person B
Person C
Person D
Surname ..........................................................................................................................................................................................................................................................................................................................................................................................
First name .......................................................................................................................................................................................................................................................................................................................................................................................
Gender (M)ale (F)emale ...........................................................................................................................................................................................................................................................................................................................................................
Age ....................................................................................................................................................................................................................................................................................................................................................................................................
Any known relevant prior medical condition.....................................................................................................................................................................................................................................................................................................................
......................................................................................................................................................................................................................................................................................................
......................................................................................................................................................................................................................................................................................................
Diving affiliation (Please specify e.g. BSAC , SAA, PADI) .......................................................................................................................................................................................................................................................................................................
Branch name ..................................................................................................................................................................................................................................................................................................................................................................................
Branch number..............................................................................................................................................................................................................................................................................................................................................................................
BSAC Membership number ......................................................................................................................................................................................................................................................................................................................................................
Gas mixture being used:
Indicate D
if used for the
(D)ive,
orS if only for
decompression
(S)tops.
Air ...............................................................................................................................................................................................................................................................................................................................................
Nitrox 32 (32% O2) ..............................................................................................................................................................................................................................................................................................................
Nitrox 36 (36% O2) ...............................................................................................................................................................................................................................................................................................................
Nitrox 50 (50% O2) ...............................................................................................................................................................................................................................................................................................................
Other (please specify) ........................................................................................................................................................................................................................................................................................................
Cylinder
Regulator
Pressure gauge
Hose
BC
ABLJ
Drysuit
Undersuit
Wetsuit
Dump valve
Inflation valve
Hood
Gloves
Weights/weightbelt
93 Ankle weights
94 Face mask
95 Full face mask
96 Snorkel
97 Fins
98 Knife
99 Watch
100 Compass
101 Dive computer
92
102
103
104
105
106
107
108
109
110
SMB
Delayed SMB
SMB reel
Lifting bag
Rope
Torch
Camera
Tools
Other Please state _________________________
111
112
113
114
115
116
117
118
119
Engine failure/malfunction
Out of fuel
Incorrect or dirty fuel
Boat malfunction
Boat swamping
Boat capsize
VHF radio failure
Propellor
Other - please state _________________________
Equipment details
If equipment failure/malfunction/design was IMPLICATED in this incident please provide details
I tem ______________________________________________________________________________________
Make _____________________________________________________________________________________
Model ____________________________________________________________________________________
Serial number ______________________________________________________________________________
Approximate age ___________________________________________________________________________
Please provide a written description of the events of this incident. Use additional pages if necessary.
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Name
Address
Date
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