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Pocock Rowing Center Incident Report Form
Individuals Involved
Name of Individual Making Report
*
First Name
Last Name
Your Email Address
*
Verify Email
*
Date of Incident
*
When did the incident occur?
Time of the Incident
*
Approximate time is ok (9-10am, after 6pm)
Was Harbor Patrol, 911 or other Emergency Medical Service contacted?
*
Yes
No
Name of Individual Involved
First Name
Last Name
Names of Other Individuals Involved
Particulars of the Incident
Nature of the Incident
*
Please select the most appropriate option:
Collision between two rowing vessels
Collision between rowing vessel and fixed structure (bank, dock, bridge)
Collision between rowing vessel and powered vessel
Rowing vessel not obeying rules of the water
Powered vessel not obeying rules of the water
Obstruction present in the water
Equipment malfunction leading to damage or injury
Collision between individual and vehicle/bicycle
Other
Contributing Factors
Please select all that apply.
Strong Current
Decreased visibility: rain/fog/sleet
Strong Wind
Darkness
Lack of navigational safety lights
Rough water
Excessive speed
Other
Where did the incident occur?
*
Water
Boat Bays
Fitness Room
Locker Room
Parking Lot
South Passage Park
Other
Description of the Incident
*
Please describe the incident, including: location, types of hulls (size, names, registration numbers), descriptions of involved individuals/clubs and any other pertinent information.
Injuries and Equipment Damage
Personal Injuries
*
Describe in detail any injuries and applied treatment (e.g., first aid, ambulance called). List none if no injuries occurred.
Equipment Damage
*
Describe in detail any damage to equipment (including PRC boats, personal boats, other club's equipment). List none if no equipment damage occurred.