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.
Q1: Who was the involved person?
Q2: Did the incident cause harm?
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?
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?
Q13: Does the diver take any medication?
EXPERIENCE AND QUALIFICATIONS
Q14: Total number of dives ever, by diver?
Q15: Total years diving, by diver if known?
Q16: Diver's Qualificaiton?
Non-Recreational (may tick more than one)
FIRST AID and OXYGEN
Q17: First aid provision?
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)
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:
Q27: Diver related: (tick as many as you feel relevant)