Fillable RECREATIONAL BOAT ACCIDENT REPORT ADDITIONAL BOAT INVOLVED IN (State of Idaho)

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RECREATIONAL BOAT ACCIDENT REPORT ADDITIONAL BOAT INVOLVED IN (State of Idaho)

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RECREATIONAL BOAT ACCIDENT REPORT
ADDITIONAL BOAT INVOLVED IN THE ACCIDENT
AGENCY CASE # BARD #
BOAT #
Owner Information
Last name: First: MI:
S
treet:
City:
State: Zip: Phone number:
Boat Information
Registration number: State (where registered):
H
ull number (HIN):
Boat name:
M
anufacturer:
Model: Year:
Length: ft. In. Rented: Yes No
Boat Type
(select one):
Cabin motorboat
Open motorboat
Auxiliary sail
Pontoon boat
Inflatable
House boat
Sail (only)
Kayak
Canoe
Rowboat
Airboat
Jet Boat
Personal watercraft (PWC)
Unknown
Other (describe):
Propulsion (select all that apply):
Propeller
Water jet
Air thrust
Manual
Sail
Other (describe):
Hull Material
Fiberglass Steel Rigid Hull Inflatable
Aluminum Rubber/vinyl/canvas Kevlar
Wood Plastic Other (describe):
Engine
Number of engines:
M
anufacturer:
Total horsepower:
Engine type (select one):
Outboard
Inboard
Stern drive (I/O)
None
Fuel type (select all that apply):
Gasoline
Diesel
Electric
Safety Measures
Received PWC rental education? Yes No
Instructions in boat safety (select one):
None US Power Squadron
State course Internet Course Unknown
US Coast Guard Auxiliary American Red Cross Other (describe):
N
umber of life jackets used:
Number of fire extinguishers on board:
N
umber of fire extinguishers used:
T
ype of fire extinguishers used (e.g., B-I, B-II):
Damage to the boat
Briefly summarize any damage to the boat:
E
stimated amount of damage to the boat:
Was the boat a total loss? Yes No
Insurance Company:
B
riefly summarize any damage to other property (not the boat) (e.g., fishing gear):
Estimated amount of damage to other property:
1
RECREATIONAL BOAT ACCIDENT REPORT
BOAT # continued
Point of impact
(indicate all that
apply):
11 – Below water line
12 – Lower Unit
13 – Windsheild
14 – Burned
15 – Sunk
16 – Injuries – No
Damage
Positions
Indicate the positions in boat for Operator (O),
Passenger (#), Seated (S), Stand (A), and other (N).
Post acceleration to boat:
R – Remains aboard
F – Fall
E – Ejected
L – Leaves boat voluntarily
T – Trapped in overturned boat
Examples below:
OAR
– Operator, stand, remains aboard
2SF – Passenger #2, seated, fall overboard
Operator/Passenger Activities
Operator/Passenger activities on the boat at time of accident:
Activities were (select one):
Recreational
Commercial
Number of people on board:
Number of people being towed:
Activity at Time of Accident
Fishing Racing
Fishing tournament White water sports
Hunting Fueling
Swimming/Diving Starting engine
Making repairs Non-Recreational
Water skiing/Tubing Scuba Diving/Snorkeling
Other (list): Relaxing
Operation at Time of Accident
Cruising
Changing direction
Changing speed
Drifting
Towing another
Vessel
Being towed
Rowing/paddling
Sailing
Launching
Docking/undocking
At anchor
Tied to
dock/mooring
Other (list):
Estimated Speed: Drifting Under 10 mph 10 – 20 mph Over 20 mph Over 40 mph None
Key People/Operator
Name/address boat operator Same as the owner
Last: First: MI:
Street:
City:
State:
Zip: Phone:
Male Female DOB: DL#: State:
Was life jacket worn? Yes No If yes, what type: Before As a result of
Was operator injured beyond first aid? Yes No Fatal? Yes No
Operator report status (select one):
No operator Complete Incomplete None
Was a boating citation issued? Yes No If yes, indicate violation and code section :
Was alcohol involved? Yes No OUI arrest? Yes No BAC level:
Operators experience: 0 to 10 hours Over 10, up to 100 hours Over 100, up to 500 Over 500 hours
2
RECREATIONAL BOAT ACCIDENT REPORT
BOAT # continued
Other key people
Other key person was (select all that apply): Passenger on boat Person being towed by boat Witness
Name/address of other key person
Last:
First: MI:
Street:
City:
State:
Zip: Phone:
Male Female DOB: DL#: State:
Was life jacket worn? Yes No If yes, what type: Before As a result of
Was this person injured beyond first aid? Yes No Fatal? Yes No
Other key people
Other key person was (select all that apply): Passenger on boat Person being towed by boat Witness
Name/address of other key person
Last:
First: MI:
Street:
City:
State:
Zip: Phone:
Male Female DOB: DL#: State:
Was life jacket worn? Yes No If yes, what type: Before As a result of
Was this person injured beyond first aid? Yes No Fatal? Yes No
Other key people
Other key person was (select all that apply): Passenger on boat Person being towed by boat Witness
Name/address of other key person
Last:
First: MI:
Street:
City:
State:
Zip: Phone:
Male Female DOB: DL#: State:
Was life jacket worn? Yes No If yes, what type: Before As a result of
Was this person injured beyond first aid? Yes No Fatal? Yes No
3
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RECREATIONAL BOAT ACCIDENT REPORT ADDITIONAL BOAT INVOLVED IN (State of Idaho)

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Completed 20 July 2020

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