Tiara Yachts C49, Owner'S Manual

Page: 129 / 152

Boating Accident Report Appendix D
D-5
For each question below, please provide answers IF APPLICABLE AND IF KNOWN, otherwise leave blank.
ACCIDENT DETAILS
–
YOUR BOAT OPERATOR
OPERATOR INSTRUCTION OPERATOR SAFETY MEASURES
Boating safety instruction completed
VHOHFWDOOWKDWDSSO\
On board, prior to accident, was operator wearing:
None A lifejacket? Yes No
State course
An engine cut-off switch /DQ\DUGRUZLUHOHVV
GHYLFH if equipped?
Yes No
USCG Auxiliary course
On board, prior to accident, was operator using:
Alcohol? Yes
No
US Power Squadrons course
Internet QDPHRIVSRQVRULQJRUJDQL]DWLRQ
Drugs? Yes No
Other GHVFULEH
Operator arrested for Boating Under the Influence? Yes No
Weather reports consulted prior to accident? Yes No
OPERATOR EXPERIENCE
Experience operating this type of boat
VHOHFWRQH
0 to 10 hours Over 10, up to 100 hours Over 100, up to 500 hours Over 500 hours
ACCIDENT DETAILS
–
OTHER KEY PEOPLE
2QO\UHSRUW other key people QRWDOUHDG\GRFXPHQWHG as injured, died, disappeared or operator/owner of \RXU boat.
If more than two other key people to report, attach additional copies of this page.
NAME/ADDRESS
This other key person was a(n)
VHOHFWDOOWKDWDSSO\
2WKHU boat operator 2WKHU boat owner Owner of RWKHU damaged property Passenger on \RXU boat Witness
First Name MI Last Name
Street
City State Zip Phone
2WKHU boat name LIDQ\ 2WKHU boat registration # LIDQ\
NAME/ADDRESS
This other key person was a(n )
VHOHFWDOOWKDWDSSO\
2WKHU boat operator 2WKHU boat owner Owner of RWKHU damaged property Passenger on \RXU boat Witness
First Name MI Last Name
Street
City State Zip Phone
2WKHU boat name LIDQ\ 2WKHU boat registration # LIDQ\
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