Accident Reporting

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Accident Reporting
IN CONFIDENCE.
Please fill in as much of the form as possible, continue on separate sheets if required. Return
to the University Diving Officer and the University Safety Office as soon as practicable.
Under UK legislation the reporting of dangerous occurrences in respect of diving will cover
any of the following incidents.
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The failure or the endangering of any lifting equipment associated with the diving
operation, or life support equipment, including control panels, hoses and
breathing apparatus which puts a diver at risk. The expression "at risk" is
qualified by the potential for a fatality, major injury or reportable disease. So this
includes any incident where the breathing apparatus malfunctions whether there
was the potential for harm or not.
Any damage to, or endangering of, the dive platform, or any failure of the dive
platform to remain on station, which puts a diver at risk. In this respect the dive
boat is classed as the platform.
The trapping of a diver.
Any explosion in the vicinity of a diver.
Any uncontrolled ascent or any omitted decompression which puts the diver at
risk.
Although there are only three reportable occupational diseases (DCI, barotrauma resulting in
lung or other organ damage, and dysbaric osteonecrosis) the list of major injuries requiring to
be reported is somewhat larger, and includes :
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any fracture, other than to the fingers, thumbs or toes;
any amputation;
dislocation of the hip, knee, or spine;
loss of sight (whether temporary or permanent);
a chemical or hot metal burn to the eye, or any penetrating injury to the eye;
any injury leading to hypothermia, heat induced illness or unconsciousness or
requiring resuscitation or admittance to hospital for more than 24 hours;
any loss of consciousness caused by asphyxia or by exposure to a harmful
substance by inhalation, ingestion or through the skin;
any other loss of consciousness;
any acute illness which requires medical treatment where there is a reason to
believe that this resulted from exposure to a biological agent or its toxins or
infected material;
any other acute illness requiring medical treatment.
Accident Report Form
IN CONFIDENCE.
NB: Copies to University Diving Officer and University Safety Office as soon as practicable
Date/time of incident. ____/____/____
Location.
_______
________________________________________________________
________________________________________________________
Casualty
Name
___________________________________
Sex. M / F
Date of Birth.
____/____/____
Address.
________________________________________________________
________________________________________________________
________________________________________________________
Telephone number.
_________________________
Any previous known, relevant, physical ailments, disabilities, or impairments.
________________________________________________________
________________________________________________________
Details of any medications or drugs taken (prescribed or not), in the last 48 hours.
________________________________________________________
________________________________________________________
Number of years diving.
____
Number of dives.
____
Date of last medical. Commercial/sport.
____/____/____
Informant
Name
___________________________________
Address.
________________________________________________________
________________________________________________________
________________________________________________________
Telephone number.
_________________________
Contractor
Name
___________________________________
Address.
________________________________________________________
________________________________________________________
________________________________________________________
Telephone number.
_________________________
Supervisor . Marshall
Name
___________________________________
Address.
________________________________________________________
________________________________________________________
________________________________________________________
Telephone number.
_________________________
Incident
Did the incident cause any injury to the casualty? If so, describe the injury/injuries signs and
symptoms, in chronological order (24 hour clock), as far as possible.
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
What first-aid treatment was undertaken ?
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
Type of Diving. Self-Contained/Surface Demand/Other (specify).
________________________________________________________
________________________________________________________
Breathing Mixture.
________________________________________________________
Qualifications of diving team.
Casualty.
________________________________________________________
________________________________________________________
Supervisor.
________________________________________________________
________________________________________________________
Standby diver 1.
________________________________________________________
Standby Diver 2.
________________________________________________________
Dive Details
Dive Details for the previous 48 hours. (Time of leaving surface, time leaving bottom, time of
arrival at surface, maximum depth, details of any safety or decompression stops, dive profile).
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
Tables\type of computer used.
________________________________________________________
________________________________________________________
Purpose of dive.
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
Dive partner record at time of incident.
________________________________________________________
In water alone/diving with one buddy/ diving with more than one buddy/roped diver to
surface operations/surface marker buoy used/ buddy line used, diver to diver/distance to
nearest standby diver
________________________________________________________
________________________________________________________
________________________________________________________
Vessel involved ? If so, give details.
________________________________________________________
________________________________________________________
________________________________________________________
Coastguard contacted? If so, state station/unit.
________________________________________________________
Any other emergency services contacted ? If so, which?
________________________________________________________
Environmental Conditions
Water:
Visibility.
________________________________________________________
Temperature.
________________________________________________________
Tide.
________________________________________________________
Current.
________________________________________________________
Swell.
________________________________________________________
Surface:
Wind.
________________________________________________________
Weather.
________________________________________________________
Temperature.
________________________________________________________
Visibility.
________________________________________________________
Further information
Details of casualty's diving equipment, condition pre and post dive, and whether recovered
with the casualty.
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
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Detailed description of incident/accident.
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
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