
Appendix D
Boating Accident Report
D-4
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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Summary of Contents for C49
Page 1: ...2022 STANDARDS OPTIONS 2022 OWNERS MANUAL ...
Page 4: ...This page intentionally left blank ...
Page 8: ...Safety Information ii 43 LS Operator Notes ...
Page 13: ...Safety Labels 3 43 LS 10 19 18 17 11 37 7 12 12 27 28 2 2 22 12 15 14 13 6 23 4 5 ...
Page 28: ...Section 1 Propulsion Systems 1 4 43 LS Operator Notes ...
Page 42: ...Section 3 Fuel Systems 3 8 43 LS Operator Notes ...
Page 66: ...Section 5 Plumbing Systems 5 12 43 LS Operator Notes ...
Page 78: ...Section 7 Exterior Equipment 7 10 43 LS Operator Notes ...
Page 98: ...Section 10 Operation 10 10 43 LS ...
Page 106: ...Section 11 Routine Maintenance 11 8 43 LS Operator Notes ...
Page 112: ...Section 12 Seasonal Maintenance 12 6 43 LS Operator Notes ...
Page 118: ...Appendix A Glossary of Terms A 6 Operator Notes ...
Page 120: ...Appendix B Maintenance Guides B 2 Operator Notes ...
Page 122: ...Appendix C Maintenance Schedule C 2 Date Hours Dealer Service Repairs ...
Page 123: ...Maintenance Schedule Appendix C C 3 Date Hours Dealer Service Repairs ...
Page 124: ...Appendix C Maintenance Schedule C 4 Date Hours Dealer Service Repairs ...
Page 131: ...Float Plan Appendix E E 1 Float Plan ...
Page 132: ...Appendix E Float Plan E 2 ...
Page 134: ...Appendix E Float Plan E 4 Operator Notes ...
Page 138: ...Appendix F Troubleshooting Guide F 4 Operator Notes ...
Page 139: ...Schematics Appendix G G 1 Schematics ...
Page 140: ...Appendix G Schematics G 2 ...
Page 141: ...Schematics Appendix G G 3 ...
Page 142: ...Appendix G Schematics G 4 ...
Page 143: ...Schematics Appendix G G 5 ...
Page 144: ...Appendix G Schematics G 6 ...
Page 145: ...Schematics Appendix G G 7 ...
Page 146: ...Appendix G Schematics G 8 ...
Page 147: ...Schematics Appendix G G 9 ...
Page 148: ...Appendix G Schematics G 10 ...
Page 149: ...Schematics Appendix G G 11 ...
Page 150: ...Appendix G Schematics G 12 ...
Page 151: ...Operator Notes ...
Page 152: ...725 E 40th Street Holland MI 49423 616 392 7163 tiarayachts com ...