Tiara Yachts Tiara 43, Owner'S Manual

Page: 131 / 160

Boating Accident Report Appendix E
E-1
Boating Accident Report
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RECREATIONAL BOATING ACCIDENT REPORT
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INSTRUCTIONS
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Privacy Act Notice
Authority:
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Purpose:
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REPORT SUBMISSION
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died
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totaled (or likely totaled)
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(describe)
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To be submitted within:
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(if boat/property damage only)
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(Local State Reporting
Authority)
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For State Agency Use Only
First Name Last Name
Phone
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Primary Cause of Accident
ACCIDENT SUMMARY
WHEN ACCIDENT DESCRIPTION
Briefly
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(attach extra pages if necessary) 'DWH
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(mm/dd/yyyy) (select one)
WHERE
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(on water)
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DAMAGE TO YOUR BOAT
Briefly
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YOUR BOAT
–
PEOPLE DAMAGE TO YOUR OTHER PROPERTY: (NOT BOAT)
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(not boat)
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on board (including operator)
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being towed (e.g., on tubes, skis)
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wearing lifejackets (on board or towed)
OTHER BOATS INVOLVED IN ACCIDENT
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other
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