DAN: Diving Incident Report Form

Diving Incident Report Form

Thank you for providing us with this valuable information. All the following questions relate to the particular dive involved in an incident. These questions do not, however, have to be filled out by the diver involved, but can also be reported by a person observing the incident.

The Incident
Describe the incident below. You may include the date and the year of the incident, location, weather conditions, or any other information that you feel may be helpful. Feel free to write in as much detail as you wish

Description:

Whose incident was it?

When was it detected?

Please check the type(s) of events involved in the incident.

None of these
Equalization problem on descent
Loss of buddy contact
Marine animal
Giddiness or vertigo
Out of air situation
Misreading of
decompression tables/computer

Rapid ascent
Equalization problem on ascent
Buoyancy problem at decompression stop
Omission of decompression stops
Problem at safety stop

Multiple ascents/descents or bounce diving
Flying/altitude after diving

Geographical location of incident:
Telephone:
(Please include country code and area code)

Did harm result to anyone?

What influence did the incident have on the dive plan?

Contributing Factors
Do you think any of the following factors contributed to the incident?
You can check more than one if needed.

None

Weather conditions

Error in judgment/Incorrect decision
Haste
Inattention
Poor dive planning
Not familiar with diving conditions
Poor communication
Lack of buddy check
Inadequate supervision
Inexperience in diving

Failure to check equipment
Poor servicing of equipment
Poor maintenance of equipment
Malfunction or failure of equipment

Poor physical fitness
Drug or alcohol intake
Seasickness
Lack of medical clearance to dive
Anxiety about the dive
Insufficient training
Failure to understand equipment
Failure to understand dive table

Training
Tell us about the experience level of the person involved.

The Diver was:

Certification:

In which Country did the diver train?

Did the incident occur while under training?

Diver's gender:

Diver's age:

Air Supply
If the diver's air supply was related to this incident, please fill in the sections below.

Air Usage:

If there had been an alternative air source (i.e. Pony Bottle, 'Spare Air'),
would it have helped in this situation?

Air issues:

Air supply Not involved
Didn't check contents gauge regularly
Contents gauge inaccurate/failed
Unable to read contents gauge at depth
Air supply not turned on
First stage problem
Hose rupture
Second stage problem
Problem with regulator despite frequent servicing

City where normally serviced:
Telephone:
Air consumption this dive greater than previous dives?

Buoyancy
If there were buoyancy problems, please fill in the sections below.

Buoyancy Problem:

Buoyancy compensator or jacket used:

Name/model:

Dive Tables/Computers
If there were Dive table or Dive Computer problems, please fill in the sections below.

Dive tables:

None Used
NAUI
US Navy
DCIEM
RN
BASSETT
BSAC/RNPL
PADI
Other:

Computer:

Name/model: