DOUGLAS MARITIME INSURANCE

A DIVISION OF BRAHSEARS INSURANCE AGENCY, LP

ACCIDENT/INCIDENT REPORT

GENERAL INSTRUCTIONS: This information sheet is to be completed on all cases wherein a complaint is made of a fall, trip, slip or obvious injury.  Get as much information as possible from the person who made that crewperson aware of the matter.  WITNESSES ARE IMPORTANT!  We need more than just a description from them – we need witnesses’ NAMES, ADDRESSES & PHONE NUMBERS! This information is to be as complete as possible and is the Skipper’s responsibility

to gather for the vessel’s owners and underwriters.  Do not hesitate to bring a passenger back to the landing after any complaint of injury – a person in need of medical care may not be aware of how serious it may be.  The Skipper should always advise the proper authorities in the event of an incident that may even remotely require medical attention. Also, see our guidelines in the event of a loss.