Naui Accident Report Form Page 4
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5VICTIM’S EQUIPMENT:
Of the following items, indicate those that apply:
___ Mask
___ SPG
___ Fins
___ Depth Gauge
___ Snorkel
___ Knife
___ Regulator
___ Underwater Light
___ BC- Type & Size____________________________________________________
___ Protective Suit- Type_________________________________________________
___ Alternate Air Source- Type____________________________________________
___ Weighting system- Amount___________________________________________
___ Tank- Size & Type___________________________________________________
___ Surface Float- Type_________________________________________________
___ Dive Computer- Brand & Model_________________________________________
___ Other: ______________________________________________________________
Were there apparent equipment problems? ___ YES ___ NO
Describe______________________________________________________________
Was the equipment rented? ___ YES ___ NO
*If YES, from where?
_______________________________________________________________________
Amount of air in tank after incident_____________
Current location of equipment_______________________________________________
Is equipment being tested? ___ YES ___ NO
If YES, by whom?_______________________________________________________
DIVING INFORMATION:
Mode of entrance: ___ Shore ___ Boat ___ Other____________________________
Incident occurred: ___ On surface ___ Below at depth of________________________
Water conditions: ___ Calm ___ Rough ___ Wave Height
___ Water Temperature ___ Visibility
Victim was: ___ Alone ___ With buddy ___ Buddy contact broken
___ Entangled- In what?______________________
Type of diving: ___ Deep dive ___ Current dive ___ Wreck dive ___ Boat dive
___ Night dive ___ Photography dive ___ Limited visibility dive ___ Cavern dive
___ Other_____________________________________________
Do not provide this report to any other party.
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Parent category: Business