Diving Incident Report Form

All the following questions relate to the particular dive involved in the incident. They do not, however, have to be filled out by the diver involved, but by the person observing the incident.

The Incident

1. 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.

2. Whose incident was it? Yours Your Buddy's Someone Else's

3. When was it detected? Preparation During dive Descent Entry Ascent After exit

4. Did any harm result to anyone? No Yes

5. Do you think any of the following factors contributed to the incident? (You may need to check more than one.)

None	Anxiety about the dive	Inexperience in diving
Weather conditions	Poor physical fitness	Failure to check equipment
Haste	Inattention	Poor dive planning
Poor servicing of equipment	Seasickness	Insufficient training
Not familiar with diving conditions	Error in judgment/Incorrect decision	Poor communication
Lack of buddy check	Drug or alcohol intake	Failure to understand equipment
Lack of medical clearance to dive	Inadequate supervision	Failure to understand dive table
Poor maintenance of equipment	Malfunction or failure of equipment

6. Did the incident occur while under training? No Yes

7. What influence did the incident have on the dive plan? None Delayed the dive Aborted dive Changed the plan

8. Did the incident involve (you may need to check more than one):

None of these	Out of air situation	Rapid ascent
Omission of decompression stops	Misreading of decompression tables/computer	Multiple ascents/descents or bounce diving
Loss of buddy contact	Marine animal	Equalization problem on ascent
Equalization problem on descent	Giddiness or vertigo	Flying/altitude after diving
Problem at safety stop	Buoyancy problem at decompression stop

9. Was the diver involved: A diving student Untrained Certified Diver

10. Diver certification level: Basic Open-water Advanced Instructor Divemaster Commercial Not known

11. Diver's gender: Male Female Diver's age:

12. Which country did the diver train in?:

Telephone Number (Please include country & area code):

13. Please indicate geographical location of incident:

Telephone Number:

Air Supply

1. Air consumption: Ran low Octopus used Out of air Not known Not a problem Buddy breathing

2. If there had been an alternative air source (i.e. Pony Bottle, "Spare Air"), would it have helped in the situation?: Yes No Not known

3. Regulator and air supply:

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

City where normally serviced:
Telephone number:
Air consumption this dive greater than previous dives? No Yes

Buoyancy

1. Buoyancy problem: No problem Yes, overweighted Yes, underweighted Yes, air used frequently to maintain buoyancy Yes, weight belt problem

2. Buoyancy jacket: Not involved in incident Not Worn Inflation device failed Inflation device not connected correctly Unable to vent vest to slow down Vest leaked Vest provided inadequate buoyancy Vest uncomfortable to wear Unfamiliar with its use Incorrect use

Name/model of vest:

Dive Tables/Computers

1. Dive tabled used:

None	NAUI	US Navy
DCIEM	RN	BASSETT
BSAC/RNPL	PADI

Other:

2. Was a dive computer used?:

Not used Used, but stop working Used, but inaccurate Used, but unable to read number Used, but forgot to activate it
Make and model of table/computer: