MARLOW-HUNTER MH31, Operator'S Manual

Page: 35 / 267

Documents and Forms
For each question below, please provide answers IF APPLICABLE AND IF KNOWN, otherwise leave blank.
ACCIDENT DETAILS
–
YOUR BOAT-
INJURED PEOPLE RECEIVING OR IN NEED OF TREATMENT BEYOND FIRST AID
5HSRUWRQO\
injured people on, struck by, or being towed by
\RXUERDW
, receiving
RULQQHHGRI
treatment beyond first aid.
'RQRWUHSRUW
injured people on, struck by, or being towed by
DQRWKHUERDWRUQRERDW
(e.g., swimmers, people on a dock).
,IPRUHWKDQRQH
injured person
to report, attach additional copies of this page.
,IQRQH
, SKIP INJURED PEOPLE section.
INJURED PERSON
First Name MI Last Name
Street
City State Zip
Phone Date of Birth
PPGG\\\\
Age
INJURY DETAILS
Injury caused when person
VHOHFWDOOWKDWDSSO\
Nature of most serious injury
VHOHFWRQH
Struck the
HJERDWZDWHU
Scrape/bruise Dislocation
Was struck by a
HJERDWSURSHOOHU
Cut Internal organ injury
Was exposed to carbon monoxide poisoning Sprain/strain Amputation
Received an electric shock Concussion/brain injury Burn
Other
GHVFULEH
Spinal cord injury Other
GHVFULEH
Person was wearing lifejacket? Yes No Broken/fractured bone
Person received treatment beyond first aid? Yes No Body part of
PRVWVHULRXV
injury
HJKHDGWUXQNOHJ
Person was admitted to a hospital?
Yes No
ACCIDENT DETAILS
–
YOUR BOAT
–
DEATHS/DISAPPEARANCES
2QO\
report deaths/disappearances of people on, struck by, or being towed by
\RXUERDW
.
If more than one death/disappearance to report, attach additional copies of this page.
,IQRQH
, SKIP DEATHS/DISAPPEARANCES section.
PERSON WHO DIED/DISAPPEARED
First Name MI Last Name
Street
City State Zip
Phone Date of Birth
PPGG\\\\
Age
DETAILS OF DEATH/DISAPPEARANCE
Injury caused when person
VHOHFWDOOWKDWDSSO\
Nature of death/disappearance
VHOHFWRQH
Struck the
HJERDWZDWHU
Death – by drowning
Was struck by a
HJERDW
SURSHOOHU
Death – other likely cause
GHVFULEH
Was exposed to carbon monoxide poisoning
Received an electric shock Disappeared and not yet recovered
Other
GHVFULEH
Person was wearing lifejacket?
Yes No
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