Your Name
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Your Email
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Your Phone
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Date of Occurance
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Approximate Time of Occurance
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Boat A (your) Club/Team/School Affiliation
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Boat B (other) Club/Team/School Affiliation
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Boat A (your) Type
Launch Launch Single (1x) Single (1x) Double (2x) Double (2x) Pair (2-) Pair (2-) Pair with (2+ Pair with (2+ Quad (4x) Quad (4x) Four (4-) Four (4-) Four with (4+) Four with (4+) Eight (8) Eight (8) Dragon Boat Dragon Boat
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Boat B (other) Type
Launch Launch Single (1x) Single (1x) Double (2x) Double (2x) Pair (2-) Pair (2-) Pair with (2+ Pair with (2+ Quad (4x) Quad (4x) Four (4-) Four (4-) Four with (4+) Four with (4+) Eight (8) Eight (8) Dragon Boat Dragon Boat
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Where in the boat or at the incident were you?
Not in Boat - On affiliated launch as coach Not in Boat - On affiliated launch as coach Not in Boat - On affiliated launch as support Not in Boat - On affiliated launch as support Not in Boat - On unaffiliated launch for assistance/rescue Not in Boat - On unaffiliated launch for assistance/rescue Not in Boat - Came on Scene After Incident Not in Boat - Came on Scene After Incident Bow / Single Bow / Single Cox Cox Stroke Stroke 7 Seat 7 Seat 6 Seat 6 Seat 5 Seat 5 Seat 4 Seat 4 Seat 3 Seat 3 Seat 2 Seat 2 Seat
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Where On the River Did This Occur
Boathouse Row Boathouse Row Dam Safety Line Dam Safety Line Below Girard Avenue Bridge Below Girard Avenue Bridge Between Penn RR and Girard Bridges Between Penn RR and Girard Bridges Below Three Angles Below Three Angles Below Columbia RR Bridge Below Columbia RR Bridge At Columbia RR Bridge At Columbia RR Bridge Below Peters Island Below Peters Island Along Peters Island Along Peters Island Below St. Joes. Boathouse/ 1000 Meter Mark Below St. Joes. Boathouse/ 1000 Meter Mark Below 500 Meter Mark/ Lane Markers Below 500 Meter Mark/ Lane Markers Below Strawberry Mansion Bridge Below Strawberry Mansion Bridge At Strawberry Mansion Bridge At Strawberry Mansion Bridge Along 1500 Meter Mark Along 1500 Meter Mark Below 2000 Meter Start Below 2000 Meter Start Below Twin Bridges Below Twin Bridges Above Twin Bridges Above Twin Bridges
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How far across river did this occur?
East (Down River) Side - close to bank East (Down River) Side - close to bank East (Down River) Side - mid coarse East (Down River) Side - mid coarse Mid river Mid river West (Up River) Side - mid coarse West (Up River) Side - mid coarse West (Up River) Side - close to bank West (Up River) Side - close to bank Peter's Island Side of Coarse Peter's Island Side of Coarse Peters Island Side of Up River Peters Island Side of Up River Lane #0 Lane #0 Lane #1 Lane #1 Lane #2 Lane #2 Lane #3 Lane #3 Lane #4 Lane #4 Lane #5 Lane #5 Lane #6 Lane #6 Girard Ave. Bridge East Arch Girard Ave. Bridge East Arch Girard Ave. Bridge Central Arch Girard Ave. Bridge Central Arch Girard Ave. Bridge West Arch Girard Ave. Bridge West Arch RR Bridge East Arch RR Bridge East Arch RR Ave. Bridge Mid/East Arch RR Ave. Bridge Mid/East Arch RR Ave. Bridge Mid/West Arch RR Ave. Bridge Mid/West Arch RR Ave. Bridge West Arch RR Ave. Bridge West Arch Columbia Ave. Bridge East Arch Columbia Ave. Bridge East Arch Columbia Ave. Bridge Near East Arch Columbia Ave. Bridge Near East Arch Columbia Ave. Bridge Central East Arch Columbia Ave. Bridge Central East Arch Columbia Ave. Bridge Central West Arch Columbia Ave. Bridge Central West Arch Columbia Ave. Bridge Near West Arch Columbia Ave. Bridge Near West Arch Columbia Ave. Bridge West Arch Columbia Ave. Bridge West Arch Strawberry Mansion Bridge East (Lane 0) Arch Strawberry Mansion Bridge East (Lane 0) Arch Strawberry Mansion Bridge Central East (Lane 1,2,3) Arch Strawberry Mansion Bridge Central East (Lane 1,2,3) Arch Strawberry Mansion Bridge Central West (Lane 4,5,6) Arch Strawberry Mansion Bridge Central West (Lane 4,5,6) Arch Strawberry Mansion Bridge West Arch Strawberry Mansion Bridge West Arch
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Was Boat A (you) moving?
Yes, on the paddle Yes, on the paddle Yes, on a piece Yes, on a piece Yes, turning around Yes, turning around No No
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Was Boat B (other) moving?
Yes, on the paddle Yes, on the paddle Yes, on a piece Yes, on a piece Yes, turning around Yes, turning around No No
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What direction was Boat A (yours) headed?
Up stream Up stream Down stream Down stream Toward Kelly Drive Bank Toward Kelly Drive Bank Toward West River Drive Bank Toward West River Drive Bank
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What direction was Boat B (other) headed?
Up stream Up stream Down stream Down stream Toward Kelly Drive Bank Toward Kelly Drive Bank Toward West River Drive Bank Toward West River Drive Bank
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Who Entered Water?
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How much time were they in the water?
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Specific Additional Details about Incident
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Any Recommendations?
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