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Accident Report Form

Instructions for Accident Reporting

To Be Filled Out and Submitted As Soon As Possible. Required By Your Insurance Carrier To

Keep Your Policy In Effect.

This accident report and the information which is enclosed in this report is considered to be

privileged and specifically for the use of legal counsel.

While it does not necessarily follow that each accident or incident involving a NAUI member

will result in some form of legal action, the possibility does exist that a legal claim could occur.

By submitting this report immediately you will help us prepare to defend you and your

association against loss.

If an accident does occur during the time that you have responsibility for students and/or divers,

there are several steps you should follow in addition to completing this accident report:

• Render aid to the best of your ability, but do not attempt to perform medical procedures

which exceed your skill and your training.

• Do not volunteer to anyone an opinion as to why the accident occurred. Limit your

discussion to the facts as you know them. Do not make conjectures and do not attempt to

assess “blame” on anyone. Do not tell people that “it’s all my fault,” or words to that effect.

Even if you have a feeling of guilt, do not discuss it with others!

• Cooperate with all law enforcement personnel who may be called to assist. While answering

their questions, follow the instructions outlined above (in bullet # 2). Limit your answers to

the facts as you know them.

• Be certain to obtain the names, addresses and telephone numbers of all witnesses. This

includes even those who you may consider to be “hostile” ones. For your protection, we

need to know all those who are in any way connected with the accident.

• It is essential that you keep track of any equipment which may be involved in the accident.

This does not mean you need to keep the equipment, but rather, know and report to us where

it went and who had control of it when you last saw it.

• Be certain that you include a copy of all waiver and release forms that you had the victim

complete if the victim was under your supervision.

• Please ensure that a clear and complete accounting of the accident is submitted.

• After you have prepared this report to the best of your ability, it should be submitted as soon

as possible to:

NAUI Legal Services

(813) 384-3992 Fax

If you have questions or problems relating to an accident or in filing this report, please call. Toll

free in the U.S. 800-553-6284, outside the U.S. 01-813-628-6284. There is voice mail for calls

received after business hours. Do Not Hesitate To Call!

Do not provide this report to any other party.

Naui Accident Report Form