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DAN DIVING INCIDENT REPORT

Definition: A Diving incident is any error or unplanned event that could, or indeed did, reduce the safety margin for a diver on a particular dive. The error may have been made by anyone involved with the dive. It may also include equipment problems. The incident may have been preventable or unpreventable. Most incidents don't cause harm, but reporting such incidents will give valuable information when considered with other incidents.

Anonimity: Please DO NOT identify any person involved unless it is yourself.
This form will not be available to any legal process.
Anonymity is assured.

Quality: Please DO NOT report hearsay incidents.

Instructions: Please read all questions carefully. In addition to selecting one or more options under each heading, write simply in your own words a description of what happened. This is the most important component of the report so please ensure you complete this part. Some questions will not be applicable, leave these blank.

DAN Asia-Pacific will collect and collate the information provided in these diving incident reports. Please complete this form with as much detail as possible and then press the submit report button at the bottom.

CONTACT DETAILS


This section is completely optional, but it can be useful to DAN if we wish to seek clarification on the incident.
If you wish to remain anonymous, simply do not enter your contact details.










THE INCIDENT



Q1: Who was the involved person?



Q2: Did the incident cause harm?



Q3: Location?

Australia Other

Q4: What month did the incident occur?



Q5: Did the incident occur during training?



Q6: At what point of the dive did the incident occur?



DEPTHS



Q7: Depth when incident occured?



Q8: Planned depth for dive?



Q9: Maximum depth reached on dive?



DESCRIPTION OF INCIDENT


Q10: Please Describe the incident in detail.

Include ANY factors which you believe may have contributed to, or minimised the incident.
If more than one incident occured please fill out a seperate form.


Q11: Do you think the incident was preventable?





HEALTH AND MEDICATIONS


Q12: Did the diver have any health problems prior to incident?


Specify:

Q13: Does the diver take any medication?


Specify

EXPERIENCE AND QUALIFICATIONS



Q14: Total number of dives ever, by diver?



Q15: Total years diving, by diver if known?

years

Q16: Diver's Qualificaiton?

Recreational
Non-Recreational (may tick more than one)





Specify


FIRST AID and OXYGEN


Q17: First aid provision?



Specify


Q18: Availability of oxygen?


Q19: How was the oxygen supplied?



GAS SUPPLY ISSUES DURING DIVE


Q20: Gas supply in use during dive?



Q21: Greater than expected consumption?


Q22: Issues with gases other than air: (may tick more than one)





CYLINDER CONFIGURATION


Q23: Single cylinder?


Q24: Twin cylinder?


Q25: Where Sling or Stage cylinders used?


Number of sling or stage cylinders used?
Q26: Describe the cylinder configuration and contents:



CONTRIBUTING FACTORS


Q27: Diver related: (tick as many as you feel relevant)













Q28: Equipment Related: (tick as many as you feel relevant)







Q29: Health Related: (tick as many as you feel relevant)







DID THE INCIDENT INVOLVE THE FOLLOWING



Q30: Gas supply issue: (tick as many as you feel relevant)






Q31: Equalisation issue: (tick as many as you feel relevant)


Q32: Altitude issue: (tick as many as you feel relevant)


Q33: Environmental issue: (tick as many as you feel relevant)




Q34: Ascent issue: (tick as many as you feel relevant)








Q35: Buddy issue: (tick as many as you feel relevant)




Q36: Other issue: (tick as many as you feel relevant)



EQUIPMENT INVOLVED IN THE INCIDENT



Q37: Equipment owner?



Q38: Exposure suit worn?



Were there equipment issues involved in the incident?

Q39: Equipment issues: (tick as many as you feel relevant)







Q40: Exposure suit issues: (tick as many as you feel relevant)




Q41: Cylinder issue: (tick as many as you feel relevant)





Q42: Gas or regulator issue: (tick as many as you feel relevant)


























Q43: BCD issue: (tick as many as you feel relevant)























Other BCD issues:


Q44: Dive Table/computer/gauge issue: (tick as many as you feel relevant)














Q45: Mask/Fins issue: (tick as many as you feel relevant)









Q46: Weights: (tick as many as you feel relevant)












Was the involved person using a rebreather?

REBREATHER



Q47: Rebreather type?



Q48: Rebreather build?



Q49: Rebreather control?



Q50: Rebreather brand?



Q51: Rebreather issue: (tick as many as you feel relevant)











Other:


Q52: Rebreather gases used: (tick as many as you feel relevant)







Q53: Rebreather bailout to OC?



Q54: Rebreather bailout inadequate?



Describe: