Accident Reporting Form

Accident Report Form

Please use this from to report any accident which occurs at Manvers Waterfront Boat Club. Please give as much information as possible - this will help us to investigate and put into place any actions required to keep everyone at the club safe. Please fill in a separate form for each person involved in the accident.

Details about the person who had the accident

* Indicates required field

Name of person who had the accident *

Contact Number for person who had the accident *

Email address for person who had the accident *

Address of person who had the accident *

Details about the person completing this report

Name of person reporting the accident *

Contact Number for person reporting the accident *

Email address for person reporting the accident *

Address of person reporting the accident *

About the accident

Time That The Accident Occurred *

Date of Accident *

Where The Accident Occurred *

How The Accident Took Place *

Details of Any Injuries & First Aid Administered *

Submit