Owner`s manual

C-2
Appendix C Boating Accident Report
DC 325
If more than 3 fatalities and/or injuries, attach additional form(s)
DECEASED
NAME ADDRESS DATE OF
BIRTH
WAS VICTIM?
 Swimmer
 Non Swimmer
DEATH CAUSED BY
 Drowning

Other
WAS PFD WORN?
 Yes  No
What type?
 DISAPPEARANCE
NAME ADDRESS DATE OF
BIRTH
WAS VICTIM?
 Swimmer
 Non Swimmer
DEATH CAUSED BY
 Drowning

Other
WAS PFD WORN?
 Yes  No
What type?
 DISAPPEARANCE
NAME ADDRESS DATE OF
BIRTH
WAS VICTIM?
 Swimmer
 Non Swimmer
DEATH CAUSED BY
 Drowning

Other
WAS PFD WORN?
 Yes  No
What type?
 DISAPPEARANCE
INJURED
NAME
ADDRESS DATE OF
BIRTH
NATURE OF INJURY MEDICAL TREATMENT
NAME
ADDRESS DATE OF
BIRTH
NATURE OF INJURY MEDICAL TREATMENT
NAME
ADDRESS DATE OF
BIRTH
NATURE OF INJURY MEDICAL TREATMENT
ACCIDENT DESCRIPTION
DESCRIBE WHAT HAPPENED (Sequence of events. Include Failure of Equipment. If diagram is needed, attach separately. Continue on
additional sheets if necessary. Include any information regarding the involvement of alcohol and/or drugs in causing or contributing to
the accident. Include any descriptive information about the use of PFD’s.)
VESSEL No. 2 (if more than 2 vessels, attach additional form(s)
Name of Operator Address Boat Number
Telephone Number Boat Name
Name of Owner Address
WITNESSES
Name Address Telephone Number
Name Address Telephone Number
Name Address Telephone Number
WITNESSES
SIGNATURE Address Telephone Number
QUALIFICATION (Check One)

Operator

Owner

Investigator

Other
Date Submitted
(do not use)- FOR REPORTING AUTHORITY REVIEW (use agency date stamp)
Causes based on (check one)
 This report Investigation and
this report
 Investigation  Could not be
determined
Name of Reviewing Office Date Received
Primary Cause of Accident Secondary Cause of Accident Reviewed By