1625-0003 Final Report on BAR

Terms of Reference, Design Principles, and Recommendations:
Revised Boating Accident Report (BAR) Form
L. Daniel Maxim, PhD, and Deborah J. Mayhew, PhD

Submitted to
United States Coast Guard
Office of Boating Safety (CG-3PCB)
2100 Second Street, SW,
Washington, DC 20593
September, 2007
By
Coast Guard Auxiliary Association, Inc.
Coast Guard Auxiliary Center
9449 Watson Industrial Park
St. Louis, MO 63126
and
Deborah J. Mayhew & Associates
88 Panhandle Road (PO Box 248)
West Tisbury, MA 02575

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Table of Contents
Introduction
Summary
Recommended Way Forward
Background
Possible benefits of a “user-friendly” form
Who submits the BAR form?
What information is required to be on the BAR form?
Language
Computerized forms
Design principles used
- Consistent and simple terminology
- Easy to understand instructions
- Improved layout
- Brevity
Comments of key partners
Usability test
Summary
The Way Forward
Acknowledgements

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FIGURE
Figure 1:

Principles for improved forms design

12

TABLES
Table1:
Table 2:

Required contents of BAR form
Requested EEIs on present form not required per CFR

APPENDICES
Appendix A:
Appendix B:
Appendix C:

The Present BAR Form
The Recommended BAR Form
Illustrative State BAR Forms

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Terms of Reference, Design Principles, and Recommendations:
Revised Boating Accident Report (BAR) Form
L. Daniel Maxim, PhD, and Deborah J. Mayhew, PhD

Introduction
The Coast Guard Auxiliary Association (CGAuxA) was awarded a grant from the
United States Coast Guard (Coast Guard) to examine and recommend appropriate
changes to the present Boating
Accident Report (BAR) Form
(CG-3865
[Rev.
12-06],
Office of Management and
Budget (OMB) No. 16250003). The latest version of
the present BAR form 1 is
reproduced in Appendix A.
The new BAR form developed
as part of this effort is
reproduced in Appendix B.
This report explains the terms
of reference, the principles used in the design of the recommended form, and
recommendations for further work to improve the coverage and accuracy of recreational
boating accident reporting.
Summary
We developed a new and easier-to-use BAR form. The recommended form:
•
•

•
•
•

Captures the requirements now contained in the Code of Federal Regulations
(CFR),
Incorporates many of the suggestions offered by key partners such as members of
National Association of State Boating Law Administrators (NASBLA), 2 the
National Boating Safety Advisory Council (NBSAC), and the United States
Power Squadrons (USPS®) who read this report in draft,
Is based on proven design principles to increase form readability and userfriendliness,
Reflects lessons learned in the usability test, and
Is slightly longer (largely because of increased white space and a more organized
and consistent layout), but significantly easier to read and understand than the
present form.

1

This is the federal form. Most states use a form that is similar (in some cases identical) in
appearance to this form and which captures (at least) the same required information. Appendix C contains
samples of BAR forms from Alaska, California, Colorado, Connecticut, Massachusetts, Nevada, New
Mexico, Ohio, Rhode Island, Utah, and Washington.
2
More specifically, members of the Boating Accident Investigation, Reporting & Analysis (BAIRAC)
Committee of NASBLA.

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This recommended form (after incorporation of Coast Guard comments) will be
submitted for public comment and later revision by the Coast Guard.
Recommended Way Forward
We also made several suggestions for further work as part of the Coast Guard’s
ongoing efforts to improve the coverage, validity, and accuracy of recreational boating
accident statistics. We believe these suggestions have merit and, moreover, that it is
appropriate to act on these in a timely fashion. These are discussed in detail in the report.
These recommended topics for more thorough examination include:
•

•

•

•
•

Review the existing and projected uses of boating accident data and define the
essential elements of information (EEIs) based on these uses. (This and following
recommendations might require modifications to the code of federal regulations
[CFR].)
Investigate the suitability of a “two-tier” system in which the operator/owner of a
recreational boat involved in a reportable accident would complete a much
simplified form and state officials could follow up on all or a statistical sample of
these accidents to provide required data to the Coast Guard. Such a system might
increase the accuracy of reporting and lower the non-response rate.
Consider the use of so-called “smart forms” that could be filled out on a computer
via the Internet. Smart forms reduce the burden of form preparation and would
probably increase the accuracy of the completed form. This idea has merit
whether or not a two-tier system is adopted.
Consider providing forms in other languages besides English to assist non-native
speakers in the event that it is decided to retain the requirement that the
operator/owner fill in the BAR form.
Several possible ideas are identified in the report designed to decrease the nonresponse rate for completing BAR forms for otherwise reportable accidents,
including those related to education, incentives for timely completion, and more
traditional responses.

Background
By federal law (33 CFR §173.55), a BAR form must be submitted by the operator
(owner if the operator cannot) whenever a recreational vessel has a “reportable”
accident. 3 The Coast Guard and others use accident data for several purposes. These data
are used for (among other things):
•

Preparation of annual statistical summaries of these accidents to identify major
causes of accidents and trends in accidents, injuries, and fatalities.

3

Under Federal law, a reportable accident is defined as an occurrence that involves the vessel or its
equipment if (1) a person dies; or (2) a person is injured and requires medical treatment beyond first aid; or
(3) damage to the vessel and other property totals $2,000 or more or there is a complete loss of the vessel;
or (4) a person disappears from the vessel under circumstances that indicate death or injury. Some states
have a lower threshold of damage for reporting. For example, Arizona, Nevada, North Carolina, Ohio,
South Carolina, Tennessee, Washington, and West Virginia have a $500 threshold and Indiana has a $750
threshold for a reportable accident.

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•
•
•

Identification of accidents to be investigated in more detail by state or federal
authorities to learn root causes and contributing factors.
Identification of areas (and times) of high accident frequency so that the
efficiency of enforcement or search and rescue efforts can be increased.
Estimating costs and benefits of various strategies to reduce injuries or accidents.

Several studies show that nearly all fatal recreational boating accidents are
reported, but less severe accidents are underreported. Underreporting is particularly
common for accidents that involve minor injuries or property damage only (PDO). 4 This
underreporting is problematic for several reasons.
Perhaps most important,
underreporting means that the social costs of these accidents are not correctly estimated.
In consequence, initiatives to reduce recreational boating accidents may likewise be
undervalued and/or misdirected.
The Coast Guard and other organizations, notably NASBLA, have worked to
increase response rates and to improve the BAR form to ensure collection of useful and
accurate data.
The BAR form has been revised as new recreational boating safety issues have
emerged and/or new uses for the data have been developed. Although well intentioned,
these changes were not always “user friendly.” 5 As noted by Design Research
Engineering, a firm that offered many useful comments 6 on the BAR form design:
“We recognize that revising the form is not an easy task. Over time, the
form’s contents evolved like a coral reef, accumulating layer-upon-layer
of information to address dynamic issues in boating safety. We believe
that revising the form is made all the more arduous because it has
attempted historically to meet the diverse needs and knowledge level (sic)
of two populations that complete the form—vessel operators/owners and
law enforcement officers. In trying to meet the needs of both, neither is
well served.”
The Coast Guard, NASBLA, and other partners have a continuing long-term
objective to increase the coverage, accuracy, and utility of recreational boating accident
data. One important first step in this process is to ensure that the BAR form is easy to
understand and complete. 7 This alone is unlikely to eliminate underreporting, but an
easy-to-use form is certain to help.
4

Completion of the BAR form is legally required (33 CFR §173.55) for reportable accidents.
“User-friendly” means easy to use or to learn to use, see http://www.answers.com/topic/userfriendly?cat=biz-fin.
6
See letter from Erik Murphy and Barbara Moroski-Browne, Design Research Engineering, to Rear
Admiral R. T. Hewitt dated January 19, 2007 (hereinafter, Design Research Engineering, 2007).
7
In the longer term many other initiatives are being considered, such as developing two different
forms; a much simplified form to be completed by the operator or owner and a more comprehensive form
to be completed by a qualified accident investigator. The purpose of the first form would be to collect
basic statistical information and define a “population” of accidents, some of which would be followed up
by professional investigators.
5

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As noted above, the Coast Guard awarded a grant to CGAuxA to assist in this
process. CGAuxA worked with a nationally known expert in forms design, Dr. Deborah
J. Mayhew, to recommend changes to the present BAR form. This report provides the
terms of reference used in developing the form and the main principles used in forms
redesign generally and for this form in particular. (We believe it advisable to modify
these terms of reference for future forms-design efforts. For the present, however, it is
necessary to make changes consistent with existing laws, regulations, and Coast Guard
direction.) This report summarizes the initial redesign efforts. As noted above, the latest
version of the present BAR form is given in Appendix A and our recommended revision
in Appendix B. Removing these and placing them side-by-side will enable the reader to
see the differences. The main body of this report explains why these changes were made.
Possible benefits of a “user friendly” form
One intended benefit of an easy-to-read and understandable form is that more
accidents will be reported. Boaters have a variety of reasons for failing to fill out forms
including fears of self-incrimination, absence of perceived benefits, and lack of
knowledge that reporting is
mandatory
for
certain
Included among
accidents. 8
these reasons is the complexity
and time required to complete
the present BAR form. A userfriendly form is likely to reduce
the non-response rate. Forms
should be easy to read, easy to
understand, and easy to
complete. 9
Another
potential benefit is that a userfriendly form is likely to
increase the accuracy of
responses. Several industries
have discovered this and make
a clear “business case” for use
of plain English. 10 Several US Government agencies (e.g., the Securities and Exchange
Commission) require that forms and other documents be written in plain English. 11 The
Office of Management and Budget (OMB) Standards and Guidelines for Statistical
8

In a letter from Carl W. Vogt, then Chairman of the National Transportation Safety Board to Admiral
J. William Kime (then Commandant of the Coast Guard) dated 25 May 1993, reference is made to
“deliberate nonreporting, ignorance by the boating public of the reporting requirements, reluctance by
boaters to provide all pertinent information, and the lack of an effective mechanism to enforce the reporting
requirements.” (See http://www.ntsb.gov/recs/letters/1993/M93_10_14.pdf.)
9
See “The plain English guide to forms” available electronically at
http://www.plainenglish.co.uk/formsguide.pdf.
10
See, e.g., “The business case for plain English” available electronically at
http://www.wordcentre.co.uk/page57.htm.
11
See e.g., “SEC adopts plain English in a ‘sweeping revision’ of rules governing prospectus
disclosure” available electronically at http://www.friedfrank.com/cmemos/0197556.htm.

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surveys 12 notes that “agencies should clearly and correctly present all information
products in plain language geared to their intended audiences.” Indeed, under 5 CFR
§1320.9 (Agency certifications for proposed collections of information) the Senior
Official of an agency is required to certify that the form “is written using plain, coherent,
and unambiguous terminology and is understandable to those who are to respond.” 13
Thus, use of plain English and intelligent forms design are not only good practice, but
also required by regulation.
Who submits the BAR form?
Under present regulations (33 CFR §173.55 (a) and (c)) the operator of the vessel
(owner if the operator cannot complete the form) is required to submit the BAR form. Of
course, the operator/owner might consult with authorities or other knowledgeable persons
in filling out the form. 14 And state or federal investigators sometimes complete these
forms, particularly (though not exclusively) in cases where the owner/operator is
deceased or missing. (State authorities may also complete a separate, more detailed form
from which the federally-required data can be extracted.) However, per Coast Guard
direction we developed the form on the assumption that the operator/owner must fill out
the form without professional assistance. Many State personnel believe that trained
accident investigators should complete the BAR form. This is because they believe that
the accuracy of the data now collected from these forms is poor and that the only sources
of reliable accident data are accident reports completed by trained accident investigators.
This question is left for another day.
Why care who fills out the form? First, it determines the target reading level of
the form. As noted by plain-language advocate William H. DuBay: 15
“We should remember that the reading level of the average adult in our
country is the 7th grade. Because most people read comfortably two or
more grades below their ability, experts recommend writing documents
intended for the public at the 5th-grade level. The most popular novelists
write at the 6th and 7th grade levels.”

12

See http://www.whitehouse.gov/omb/inforeg/statpolicy/standards_stat_surveys.pdf. Note also that
the OMB Guidance on Agency Survey and Statistical Information Collections lists several questions under
the rubric of increasing response rates. These include “Is the questionnaire well-designed with userfriendly formatting? Is it as brief as possible? Are the questions, instructions, and definitions easy to
understand?
Is the content of the survey relevant to the respondent?
See
http://www.whitehouse.gov/omb/inforeg/pmc_survey_guidance_2006.pdf.
13
See http://www.givemeliberty.org/RTP2/PRA/PRA-CFR/5_C_F_R_1320_9.pdf.
14
In comments on an earlier draft of this report (August 30, 2007) Design Research Engineering
personnel assert that this report is naïve in downplaying the prominent role that law enforcement officials
play in completing the BAR form. They believe that it is appropriate to acknowledge that in many cases
state reporting officials complete the form. We lack data on the percentage of BAR forms completed by
operators/owners versus those actually completed by state officials. However, it follows that if the form is
sufficiently straightforward to be completed with reasonable accuracy by boaters, it should also be useful to
investigators.
15
See, William H. DuBay “The plain-language crisis” in Plain Language at Work, Newsletter 22
March 2003, available at http://www.impact-information.com.

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(For your reference, this report is written at approximately the 12th-grade level!)
Second, the fact that the operator/owner submits 16 the form also means that we
need to avoid unfamiliar jargon. The person filling out the form must be able to
understand and be able to answer the question(s) in order to provide accurate answers.
According to some state officials, the accuracy of some elements of prior data are
questionable; this belief is one of the reasons why some state personnel wish to have the
form completed by trained investigators—or at least personnel more familiar with the
form.
Even if the system is changed in the future so that only trained investigators
complete and submit the BAR form, it is still important to ensure that the form is readily
understood and in “plain English.”
What information is required to be on the BAR form?
In the longer term, this is an important question. For example:
•

It might be efficient to have only a very short BAR form, limiting the questions to
who, what, where, and when, assuming that state or other investigators will
follow-up and complete
a
more
thorough
analysis on this or a
statistically
chosen
sample of accidents
with
similar
17
characteristics.
Use
of two separate forms
for accident reporting
has been suggested by
NASBLA and others.
Several states now have
two different BAR
forms, one to be used
by the operator/owner
and another to be used
by the accident investigator. (However, this differs from a complete two-tier
system because the State uses data from the investigator’s form to provide data on
reportable accidents.)

16

In comments on an earlier draft of this report Design, Research, Engineering (30 August 2007
memorandum) noted that “We read the regulation as requiring that the operator or owner submit the form,
not necessarily fill out, or complete, the form.” This may be so, but the fact that a more knowledgeable or
experienced person might fill out the form in no way relieves the Coast Guard of the obligation of making
the form understandable to the operator/owner. In short, this is a distinction without difference.
17
Those who object to a radically simpler form note that valuable information would be lost.
However, if the form were used to trigger a follow-up investigation of all (or a statistical sample) accident
reports the overall accuracy of the data might be increased. It is self-evident that no follow-up
investigation can take place if it is not known that one occurred.

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•

Design Research Engineering (2007) suggested deletion of potentially
incriminating questions from the BAR form, such as those relating to use of
alcohol or drugs. Such questions might well be a deterrent to completion of the
form by operators/owners. Moreover, the accuracy of these answers is open to
question as there appear to be incentives for deception. However, 33 CFR §
173.57 (v) requires “the opinion of the person making the report as to the cause of
the casualty including whether or not alcohol, or drugs, or both was a cause or
contributed to causing the casualty.” Whether or not this or related questions
should be required to be answered by the operator is an appropriate topic for
discussion in terms of possible future modifications to the form, but it is not
addressed in this effort.

For purposes of this interim redesign effort, however, we assumed that all
information presently specified in 33 CFR §173.57 (a) through (z) must be collected.
These 26 required data elements are identified in Table 1. (All tables are included at the
end of this section.)
Some of these elements of information specified in 33 CFR §173.57 (a) through
(z) are very detailed. For example, item (w) requires data on “the make, model, type
(open, cabin, house, or other), beam width at widest point, length, depth from transom to
keel, horsepower, propulsion (outboard, inboard, inboard outdrive, sail, or other), fuel
(gas, diesel, or other), construction (wood, steel, aluminum, plastic, fiberglass, or other),
and year built (model year), of the reporting operator’s vessel.” For fields with detailed
specifications we retained this detail adding explanatory material as necessary to
facilitate accurate answers.
But, other information requirements in the CFR are much less specific. For
example, item (l) requires “the cause of each death.” This question does not specify the
level of detail of the possible answers—and may not be able to be answered accurately by
a layman. The BAR form formerly used listed only three possible causes of death;
drowning, disappearance, 18 and other. The present BAR form presents the following
choices; drowning, trauma, carbon monoxide poisoning, heart attack, hypothermia,
electrocution, and other (specify). For this and other less specific questions, we carefully
considered the recommendations of those who commented on the form. Regarding cause
of death, NASBLA 19 offered the following suggestions:
“This report form is intended to be completed and turned in by the
public—a boat owner or operator—following an accident, and the public
is generally not qualified to make a cause of death determination. If
18

It is arguable whether disappearance can be termed a cause of death. The standard reference on
causes of death is based on the International Classification of Diseases (ICD)-10th Edition (see
http://www.who.int/classifications/icd/en/). ICD-10 is high detailed. Of those causes related to transport
accidents, code V92 comes closest. This category includes those who are thrown overboard by motion of
ship of ship or washed overboard. “Disappearance” is not specifically mentioned. As noted in the main
text the recommended form uses the category “disappeared and not yet recovered.”
19
See letter from John Johnson, Executive Director, NASBLA to “whom it may concern,” dated
January 19, 2007.

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anyone other than a qualified medical professional enters cause of death
on this form, it impeaches the quality of the data collected (even EMTs are
not permitted to determine cause of death). If this information is
important to collect, this form isn’t the appropriate way to do it. In the old
form there were only three choices for cause of death; drowning,
disappearance, and other. Those choices were sufficient for lay persons.
If the cause of death field is retained, the term ‘heart attack’ is
inappropriate and should at least be changed to the term cardiac arrest.
Some cardiac arrests are the result of a heart attack (a lay term that means
inadequate cardiac tissue perfusion) but not all ‘heart attacks’ result in
cardiac arrest.
If this field is retained, remove the term hypothermia. Technically, one
does not die from immersion hypothermia. Hypothermia eventually leads
to unconsciousness and drowning and/or cardiac arrest, and those are
already listed. Secondly, even if hypothermia is suspect, a lay person will
not be able to determine it was the cause and even a medical professional
would be unable to unless a body’s core temperature was recorded right at
the time of death. Without a life jacket, most people drown in cold water
long before they become hypothermic, and those that don’t drown die of
cardiac arrest.”
This is wise advice. We changed the cause of death question to read “Nature of
death/disappearance” with answers “Death by drowning,” “Death—other likely cause,”
with an option to provide more detail and finally, “Disappeared and not yet recovered.”
If more detailed and accurate answers are required, then it is necessary to have
medically qualified personnel provide these answers.
More broadly, in cases where the wording of the requirements in the CFR
permitted latitude in interpretation, we tried to frame questions that were easy (or at least
easier) to understand and answer. For example, 33 CFR §175.57 (m) asks for
information on “weather forecasts available to, and weather reports used by the operator
before and during the use of the vessel.” In the present version of the BAR form this is
reduced to:
“Weather forecasts/reports available to and used by the operator before
and during use of the vessel,” to which the person completing the form has
two choices “yes” and “no.”
This particular question on the present form was criticized by one reviewer (Design
Research Engineering [2007]) as “This is a classic ‘double barreled’ question.” We
agree. However, our terms of reference did not permit us to delete this required item of
information. Instead, we believe it reasonable to assume that weather forecasts are

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available for all areas where recreational boating accidents occur, 20 and substituted the
question: “Weather reports consulted prior to accident?” and added possible responses
“Yes” and “No.” 21
In comments on the present form, the Tennessee Wildlife Resources Agency22
identified several extra data fields (shown in Table 2) on the present BAR form that are
not now required by the CFR. We commend their diligence in comparing data fields and
the CFR requirements and have deleted some of these fields.
We did modify the form to add the question regarding the “number and type of
fire extinguishers on board” because this is required by the federal regulations yet not
listed on the present BAR form, an omission noted by the Tennessee Wildlife Resources
Agency in their thoughtful comments. 23
Finally, we changed some wording in the federal regulations in the interests of
clarity and readability. For example, we changed “personal flotation device” to “life
jacket” as this term is more widely understood. Likewise, with one exception (“Vessel
safety check” a term of art) the word “boat” was substituted for “vessel” wherever it
appeared in the present BAR form.
Language
The BAR form is written in English. We did not translate this form into other
languages. However, in the future we think that the benefits of providing the form in
various foreign languages to assist the non-native English speaker should be evaluated.
There is ample precedent for providing accident reporting forms in other
languages used in the United States. For example, the Federal Motor Carrier Safety
Administration (FMCSA) provides many forms in both English and Spanish. 24 There are
commercial forms producers who provide motor vehicle accident forms in Spanish. 25
According to Census data for the year 2000, 17.9% of US residents (though an unknown
proportion of boaters) spoke a language other than English at home and 8.1% spoke
English less than “very well.” 26 Many forms used by social service agencies throughout
20

Weather information (current and forecast) is widely available from newspapers, radio (general and
specialized), television, the Internet, weather fax, and from various mobile phone services. The hearing and
visually impaired can also receive these warnings by connecting a specially designed NWR to attentiongetting devices like strobe lights, personal computers, and text printers. Many pager companies now offer
alerting pagers that provide the latest weather information. And the National Weather Service is responsive
to any claims of gaps in coverage (see e.g.,
http://www.nws.noaa.gov/com/nwsfocus/print/printfs112502.htm for one story).
21
We recognize that this is still a leading question and that boaters may not provide an accurate
answer. However, this question was retained because it is required by the CFR.
22
See comments of this agency dated January 19, 2007.
23
We did not include a question on the amount of each fire extinguisher used because we believed that
there was no practical way for the boater to determine the amount of each fire extinguisher used.
24
See e.g., http://www.fmcsa.dot.gov/forms/print/accident.htm.
25
See e.g., http://www.tibf.com/images/large/frm_Auto_1_lrg.gif.
26
Data are available from the Census Bureau “Language Use and English-Speaking Ability” available
electronically at http://www.census.gov/prod/2003pubs/c2kbr-29.pdf.

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the US are now provided in other languages (e.g., Spanish, Chinese, French, German 27 )
and this should be considered by the Coast Guard for the BAR form. California provides
recreational boating information in Spanish. 28
Of course, if (in the future) the regulations are revised so that BAR forms are to
be completed and submitted by state personnel, this suggestion may be overtaken by
events.

Computerized forms
The use of computerized forms, such as through the Internet, has several benefits
in terms of availability and ease of access and use. So-called “smart forms” can typically
be shorter because these can be structured to “hide” questions and explanatory material
that are not applicable or needed based on earlier responses. For example, in the case of
a property damage only incident, it is unnecessary to ask questions regarding injuries or
the causes of deaths. Pick lists or drop down lists can be incorporated to simplify filling
in the form. A computerized form can also provide (with embedded hyperlinks)
definitions, directions, and other explanatory material, which would increase
comprehension and accuracy.
27

These are listed in decreasing frequency of languages spoken at home in the United States. The
relative frequency of language use might differ among those who engage in recreational boating activity.
28
See e.g., http://www.dbw.ca.gov/Espanol/index.htm.

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As a point of interest, many states now provide either downloadable copies of
their forms on the Internet or enable a boater to fill in the form on-line.29 To our
knowledge there are no States that presently use “smart forms” for accident reporting.
For purposes of this initial project a “paper form” is assumed.
We believe that a smart form is a potentially useful idea for the future. This idea
is applicable whether or not the form is to be filled by the operator/owner or an accident
investigator. Online forms are inherently different than paper forms and should be
developed according to a separate set of design guidelines and usability tested prior to
implementation.
Design principles used
We applied proven form design principles to develop the recommended BAR
form. 30 As shown in Fig. 1, these include use of consistent and simple terminology, easy
to understand instructions, and good layout (and fonts). As noted above, we have used
the CFR requirements as the essential elements of information (EEIs) for this project.

29

Several states, e.g., Alaska (http://www.dnr.state.ak.us/parks/boating/pdf/accident.pdf), California
(http://www.dbw.ca.gov/PDF/AccidentForms/BAR.pdf), Colorado
(http://parks.state.co.us/NR/rdonlyres/843CD616-2341-4CA0-8FFF-7BBF77A3FCC7/0/Public_BAR.pdf),
Connecticut (http://www.ct.gov/dep/lib/dep/Boating/Boating_forms/accidentreport.pdf), Indiana
(http://www.in.gov/dnr/lawenfor/pdf/42528.pdf), Florida
(myfwc.com/law/generalorders/LawForms/forms/FWCDLE_146IV.doc), Massachusetts
(http://www.mass.gov/dfwele/dle/MEP_BoatAccidentRpt.pdf), Maine
(http://www.maine.gov/ifw/atv_snowmobile_watercraft/pdfs/accidentreportformboat.pdf), Nevada
(http://www.ndow.org/boat/safety/boataccidentreport03.pdf), New Mexico
(http://www.emnrd.state.nm.us/PRD/BOATINGWeb/documents/EXHIBITA.2.g.6.NewMexicoboatacciden
treport2004.pdf), Ohio (http://www.dnr.state.oh.us/Portals/4/pdfs/forms/oobar.pdf), Oregon
(http://www.boatoregon.com/PDF-Forms/BoatingAcc.pdf), Rhode Island
(http://www.dem.ri.gov/programs/bnatres/enforce/pdfs/boatacc.pdf), Tennessee
(http://tennessee.gov/twra/pdfs/boataccidentform.pdf), Wisconsin
(http://www.dnr.state.wi.us/org/es/enforcement/DOCS/4100020.pdf), Utah
(http://stateparks.utah.gov/docs/boat-incident-accident.pdf), Virginia
(http://www.dgif.state.va.us/boating/boating_accident_form.pdf), and Washington (http://www.boated.com/wa/wa_specific_images/pdfs/wa_acc_rep_2006.pdf), already have accident reporting forms
available on the Internet. Not all of these forms can be completed electronically, however. And several
states do not provide electronic copies of the forms.
30
There are several standard works on principles of forms design. One very useful reference is from
the Australian Government available electronically at
http://www.anao.gov.au/uploads/documents/User_Friendly_Forms.pdf.

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Figure 1. Principles for improved forms design.

-Consistent and simple terminology
To minimize confusion, we modified the form to use consistent terminology
throughout. For example, as noted by Design Research Engineering (2007) the terms
“USCG approved life jacket,” “life jacket,” and “personal flotation device” are used on
the present form, inviting the person completing the form to speculate about possible
differences in these terms. In the recommended form these are replaced by the single
term “life jacket.” The information requirements given in the federal regulations do not
specify use of the term “USCG approved” and the person completing the form may not
know whether or not these are USCG approved and/or have a motive for claiming that
the lifejacket(s) used were USCG approved.
Terms used in the BAR form should be able to be readily understood by the
owner/operator. 31 Some terminology in the present form (e.g., VSC, 32 tertiary,
whitewater boating, off-throttle steering, runaway boat, water toys) might be unclear to
31

William H. DuBay “The plain-language crisis” in Plain Language at Work, Newsletter 22 March
2003, http://www.impact-information.com/impactinfo/newsletter/plwork01.htm. See also
http://www.socra.org/pdf/200402_Principles_Forms_Design.pdf.
32
Acronyms might not be understood by the respondent and most reference works indicate that these
should be avoided (or defined), see e.g.,
http://www.anao.gov.au/uploads/documents/User_Friendly_Forms.pdf. In this specific example, we define
VSC in the recommended form as “vessel safety check (VSC).”

-12-

persons who fill in the form. In other places the language is overly complex (e.g.,
“Operator of this Vessel [Vessel A]), rather than “operator” within a group of entry fields
labeled “Your Boat.” We redesigned the form to minimize use of acronyms and
abbreviations, substituted simple lay terms (e.g., boat rather than vessel, person rather
than occupant or victim) where possible, and used plain English.
Where available, we relied on Coast Guard experience relative to questions or
answers that seemed confusing to respondents and made modifications. For example,
one of the choices under boat type was “jet boat.” Experience shows that this answer was
widely misunderstood and confused with “personal watercraft.” The answer “jet boat”
was deleted as a choice. Boaters who owned craft that could accurately be termed jet
boats have the option on the recommended form of choosing “open motorboat” under
boat type and “water jet” under type of power.
We used simpler and more familiar terms in the recommended form, even in cases
where arguably more correct terms existed. For example, under “accident details-events”
we included “collision with fixed object” as a choice. “Allision” is arguably the correct
term, 33 but one that is not generally known by the boating public.
Simpler word choices were not available in every instance. We learned from the
usability test (see below) that certain terms, including vessel documentation number and
hull identification number (HIN) were not known to all respondents. We kept these
terms in the recommended form; further simplification would require a change in the
CFR. However, we did include instructions that respondents should simply leave entry
fields blank, rather than guess, if the answers were not known.
-Easy to understand instructions
We did not provide a separate list of instructions or definitions of terms. There is
ample evidence that separate instructions are not read by persons (at least the general
public) completing forms. However, where appropriate we added explanatory material in
the questions or data fields (such as possible answers) to try to reduce possible confusion
and increase the accuracy of responses. We made it easier to read by using bullet points,
short phrases, and additional white space rather than exclusive use of prose.
As noted below, we evaluated the recommended form with a usability test on a
sample of boaters. Questions/data fields on the form that were reportedly difficult to
understand were revised based on this feedback.
-Improved layout
Proper layout is essential for user-friendly forms. As noted by the Australian
Government Department of Education, Science, and Teaching: “The best written plain
English document won’t be effective—or perhaps won’t even be read—if it is badly

33

An allision is the “act of striking or collision of a moving vessel against a stationary object.” See
http://www.answers.com/topic/allision.

-13-

designed.” 34 We have made many layout changes in the recommended form. Here are a
few examples:
•

•

The present BAR form uses all capital letters. Research shows that reading speed
and comprehension are increased if mixed case text is used. 35 (Interestingly,
some people profess to prefer all caps. In fact, one respondent in the usability test
(see below) preferred the current BAR form use of all caps. It’s important to
realize that preference and performance are different measures, which often are
not highly correlated. In most cases performance is the more important measure.)
The layout of the recommended form has been modified to group related items
together, which also increases comprehension and accuracy.
Guidelines
36
suggested in the literature include:
o
o
o
o

o

o
o
o
o
o
o

Avoid using all uppercase for large text areas.
Avoid using italics for large text areas.
Avoid using bolded text for large text areas.
Be careful when using colored text. Use dark text on light
backgrounds to provide the most contrast, which in turn optimizes
legibility.
Mixed-case, black and un-bolded type (on a white or at least very
light background) is easier to read for large text areas. Use color
and bold only to call attention to important items.
Use Serif fonts (e.g., Times New Roman) for close-set blocks of text. 37
Use Sans-serif fonts (e.g., Arial) for large headlines.
Use Sans-serif or serif fonts for airy (i.e., not close-set) sections of text.
Break up the page by using a variety of font sizes, font weights, and
capitalization for different readability focus-points on the page.
Use fonts with clearly-identifiable letter shapes, e.g., ‘a’ rather than ‘a’, ‘g’
rather than ‘g.’
Use ‘fancy’ fonts very sparingly and only for occasional quirky effect.
There is no reason for use of these fonts in the BAR form.

34

See “Design tips” available electronically at
http://www.dest.gov.au/sectors/training_skills/publications_resources/plain_english_at_work/design_tips.htm.
35
According to Karen Schriver in her book Dynamics in Document Design, “When the text is set in all
capital letters, reading speed is slowed by about 13 to 20 percent. Reading speed is optimal when both
uppercase and lower case letters are used.” (see
http://www.adobe.com/devnet/livecycle/articles/graph_effective_form_design_02.html or
http://www.mcneese.edu/colleges/ed/deptpsy/ajpr/vol1/ajpr11.pdf).
36
See, for example, http://www.grc.nasa.gov/WWW/usability/textfontcss.html or
http://hgrebdes.com/typefaces/fontresearch.php.
37
See
http://www.dest.gov.au/sectors/training_skills/publications_resources/plain_english_at_work/design_tips.htm.

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•

Short, “busy” forms are appropriate for knowledgeable high frequency users—
such as a professional accident investigator in this case. But longer, better
organized forms are
more user friendly for
casual
users
(see
comments on brevity
below). 38 We made
several layout changes
to the present BAR
form
to
improve
clarity—even though
some of these changes
increased the length of
the form.

•

The present form has
dark grid lines and
very
little
white
39
This creates
space.
a busy look that is
hard to scan and does
not help lead the eye
in the appropriate
order through the various fields. 40 We changed the layout to use very light
gridlines (“watermark”) and added white space to separate field groups to provide
a cleaner look that is easier to scan and comprehend.

•

Entry fields in the present BAR form are not always grouped logically. Logical
grouping facilitates the respondent’s accurate recall and reporting of key
information 41 such as in this form,
o Report Submission
o Accident Summary
o Your Boat
o Accident Details—External Conditions
o Accident Details—Your Boat
o Accident Details―Activities and Operations on your boat
o Accident Details—Events on your boat
o Accident Details—Contributing Factors on your boat

38

Mayhew, Deborah J., (1992). Principles and Guidelines in Software User Interface Design,
Prentice-Hall, pp120-130, p 185, and pp 146-148.
39
Appropriate use of white space is an important aspect of form design (see
http://www.jasonsantamaria.com/archive/2006/01/05/under_the_loupe_1_white_space.php).
40
See e.g., Mayhew, Deborah J., (1992. Principles and Guidelines in Software User Interface Design,
Prentice-Hall, pp 186-187.
41
See Mayhew, Deborah J., (1992). Principles and Guidelines in Software User Interface Design,
Prentice-Hall, pp 127-128 and 150-152.

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o Accident Details—Your Boat—injured people receiving or in need of
treatment beyond first aid
o Accident Details―Your boat—Deaths/disappearances
o Accident Details―Your boat operator
o Accident Details—Other key people
o Names and addresses
This grouping is more logical, reduces redundancy, and is easier to understand.
•

The layout of the sections in the present form is inconsistent, making getting
oriented in each new section difficult. 42 The recommended form uses a common
set of layout standards across all sections of the form.

As one example of how the layout of the recommended form has been improved and the
instructions have been simplified, consider the following instruction in the header of the
present BAR form:
“THE OPERATOR OF A VESSEL IS REQUIRED TO SUBMIT A REPORT IN
WRITING TO THE STATE REPORTING AUTHORITY WHEN AS A RESULT OF
AN OCCURRENCE THAT INVOLVES THE VESSEL OR ITS EQUIPMENT:
(1) A PERSON DIES; OR (2) A PERSON IS INJURED AND REQUIRES
MEDICAL TREATMENT BEYOND FIRST AID; OR (3) DAMAGE TO THE
VESSEL AND OTHER PROPERTY TOTALS $2,000 OR MORE OR THERE IS
A COMPLETE LOSS OF THE VESSEL; OR (4) A PERSONS DISAPPEARS
FROM THE VESSEL UNDER CIRCUMSTANCES THAT INDICATE DEATH OR
INJURY.
REPORTING AUTHORITIES MAY REQUIRE REPORTS OF
PROPERTY DAMAGE LESS THAN $2,000.
THIS REPORT MUST BE
SUBMITTED WITHIN 48 HOURS OF THE OCCURRENCE IF A PERSON DIES,
IS INJURED, OR DISAPPEARS FROM THE VESSEL. THE REPORT MUST BE
SUBMITTED WITHIN 10 DAYS OF THE OCCURRENCE IF THERE IS ONLY
DAMAGE TO THE VESSEL AND OTHER PROPERTY.
THE OWNER OF THE VESSEL SHALL SUBMIT THIS REPORT TO THE
STATE REPORTING AUTHORITY IF THE OPERATOR CANNOT.”
The above five sentences in the present form are hard on the eyes (use of capital
letters throughout), difficult (there are 160 words), and not very readable (e.g., use of
sans serif font). The use of bold is generally not recommended under the heading of
“Don’t shout” at the audience.43 And, most authorities agree that you should “never set a
whole sentence or paragraph in CAPITAL LETTERS. 44

42

Mayhew, Deborah J., (1992). Principles and Guidelines in Software User Interface Design,
Prentice-Hall, pp 141-143.
43
See
http://www.dest.gov.au/sectors/training_skills/publications_resources/plain_english_at_work/design_tips.htm.
44
This is a direct quote from
http://www.dest.gov.au/sectors/training_skills/publications_resources/plain_english_at_work/design_tips.htm.

-16-

Consider the recommended alternative shown below:
Report required because in this accident (select all that apply)
At least one person died
If so, how many?
At least one person involved in the accident
required or was in need of treatment beyond first aid
If so, how many? _______
At least one person involved in this accident
disappeared and has not yet been recovered
If so, how many? _______
All boat or other property damage (e.g., fishing hunting gear)
caused by this accident totaled(or likely totaled) $2,000 or more:
Approximate value of damage to your boat
$_______
Approximate value of damage to your other property $_______
Your or another boat in this accident was (or likely was) a total loss

To be submitted within:
48 hours (disappearance
or death)
10 days (property damage
only)

Report submitted by (select all that apply):
Boat Operator (required if possible)
Boat owner (if operator unable or same as operator)
Other (describe): ________________________

The recommended alternative is much simpler and easier to read and understand, and also
incorporates instructional information into the data fields themselves, ensuring that
respondents will see and read the instructions.
-Brevity
Other things being equal, shorter forms are better than longer forms. However,
brevity is not the sole design criterion. The recommended BAR form is (in terms of the
number of pages) longer than the present BAR form—six pages compared to four pages.
But, all the information collected is used for the purpose of the form, no questions are
asked that are readily available to the States or the Coast Guard, and much of the
additional length is due to improved layout. (In future design efforts the length may be
able to be reduced by, for example, use of a computerized form or reducing the
information requirements now contained in the CFR.) To lend perspective, the
recommended BAR form—though longer than the latest version—is actually no longer
than those used as late as 2005 and no longer than the form currently in use by some
states (e.g., Colorado, New Mexico, and Washington).
Related to the brevity objective, we redesigned the form so that, if the person
reporting were to fill in only the first page, useful data could be captured to enable
investigators to follow-up.
Comments of key partners
Several key partners, such as members of NASBLA, 45 the National Boating
Safety Advisory Council (NBSAC), and the United States Power Squadrons (USPS®)
read this report in draft. For the most part reaction to the recommended form was very
45

More specifically, members of the Boating Accident Investigation, Reporting & Analysis (BAIRAC)
Committee of NASBLA.

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favorable. This said, many constructively-critical comments were received and we made
revisions to the recommended form based on these comments. For example:
•

•

Four respondents (Major Felix Hensley, Boating Law Administrator, Indiana
Department of Natural Resources, Sergeant Eric Lundin, Connecticut
Environmental Conservation Police, Tamara L. Terry, Ohio Department of
Natural Resources, and Mr. Dick Snyder, Mercury Marine) suggested that
“engine make” (not on the present BAR form, but included in previous forms) be
added. The Office of Boating Safety, however, did not agree that the “engine
serial number” should also be added because of concerns that the
reliability/accuracy of this information has proven questionable.
Several respondents felt that the recommended BAR form was not sufficiently
clear in terms of the definition of “other key people” on page 4 of the
recommended form. We also observed some confusion on this definition on the
usability test. This portion of the form has been revised to make clear that other
key people include all who were other boat operators/owners, owners of damaged
property, passenger on your boat, and any witnesses.

These are just two examples of the many revisions made in response to the comments of
key partners.
However, not all suggestions made by our key partners were adopted. In
particular, suggestions that were inconsistent with the terms of reference were not
adopted, even if we thought they were reasonable. Thus, for example, Tamara L. Terry,
Ohio Department of Natural Resources wrote in a preamble to detailed comments on the
recommended form:
“Before launching into various adjustments to the revised form as
presented, let me reiterate that many of the items on this form (both in its
old form and in its revised form) continue to be outside the scope of what
the Operator or Owner can reasonably be expected to fill out accurately
and consistently. As examples, Operators/Owners are generally not
qualified to determine a cause of death (unless, by chance, they happen to
be a coroner), and most persons filling out this form would be hesitant to
honestly indicate whether alcohol had been involved in, or might have
been a cause of, the accident. These facts have been discussed at length at
previous BAIRAC meetings, so I won’t go into more detail here, but
suffice to say that an in-depth look and potential (probable) revision to the
CFR to eliminate and/or restructure information on the form continues to
be needed…I was pleased to see that there was some thought given (as
indicated in for form revision process document) to making this a two-part
form in the future. This would definitely assist us here in Ohio where our
officers complete many of the investigatory items included in BARD-web
through our own Watercraft Accident Report form…”

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Although we did not make the recommended revision because it would be inconsistent
with CFR requirements (as stated elsewhere in this report) we do believe that it is a useful
suggestion and have included an analysis of the two-tier strategy as part of our
recommended way forward.
Mr. Dick Snyder of Mercury Marine asked: “Why does the BAR on page one in
INFORMATION ASSOCIATED WITH THE VESSEL continue to ask for ‘Depth from
Transom (stern) to Keel (bottommost point) of Vessel?’ Who would ever use or care
about such an odd dimension. Who would ever try to measure it?” [Emphasis in
original.] We did not change this—even though we believe that the comment has
merit—because of the language in the CFR.
Another commenter (Design Research Engineering) also argued 46 strenuously
that the form should be designed for the investigator, not the boat operator/owner. In
reading through an earlier draft of this report they commented:
“Design Principles [a reference to this report in draft] does hold out
promise that this issue [who fills out the form] will be addressed…The
operable words here are ‘are being considered’ and ‘may’ and ‘if
sufficient justification exists’ [references to language in the draft report].
Our reasonable, lay interpretation is that it is not going to happen any time
soon.
This is an ill-advised course of action. Basically there is a means, a
demand, and a need for change to the reporting system: flexibility in the
regulations, widespread use of an ill-suited boat owner/operator form by
law enforcement officials, and the critical need for high quality
information on boating accidents. The quality of the design process and
data collection is compromised by not designing both forms concurrently
(for the boat operator/owner and law enforcement).”
This report contains recommendations and does not present Coast Guard views or
intentions. As noted above, we believe that some two-form system is a reasonable
suggestion. It cannot be developed within the time frame necessitated by this effort
because changes in the CFR are necessary to make this feasible. Whether or not this will
be completed “any time soon” is not under our control. This said, USCG has received
copies of all comments on this report and earlier comments on the present BAR form.
They are also fully aware of views of NASBLA and are committed to continuous
improvement in the system.
Design Research Engineering (August 2007) also commented on this report in
draft as follows:
“We strongly recommend the development of a clear reverse path between
the data elements that are required to meet the anticipated reporting and
46

Memorandum to Bruce Schmidt, USCG and L. Daniel Maxim, dated August 30, 2007.

-19-

analysis needs, and the data collected from the draft BAR form. These
analytical and reporting needs can be drawn from, for example, the
content of the USCG’s annual “Boating Statistics” report or boating safety
initiatives that require periodic evaluation.”
We agree that such a procedure would be useful to define the essential elements of
information. As noted above, we based the design of this form on the elements of
information contained in the CFRs. Time and scope constraints precluded a more
comprehensive approach. Nonetheless, there is merit to a “blank sheet” approach to
forms design in which the need to each element of information would be justified based
on the anticipated uses of the data derived from these forms.
This and other potentially useful suggestions are being retained for future work.
Usability test
We conducted a limited (seven subjects, all boaters and some fisherman as well47 )
usability test as part of this work and made revisions to the recommended form based on
the results of the usability test. The intent of the usability test was to identify any
“serious” flaws in the design, rather than to draw statistical inferences. The majority of
the individuals sampled were male (6 of 7), college educated (7 of 7), roughly half (3)
were 41 – 55 years of age, the other half were older, all were experienced boaters, most
with around 50 years of experience.
The usability test provided information on respondents views of the present and
recommended forms. More important, it identified questions/fields that were ambiguous
or difficult to understand, and permitted us to make appropriate revisions.
Despite the limited sample size, the results of the usability test were interesting.
For example we found that:
•

Nearly half (3 of 7) of the respondents did not know that it was necessary for the
operator/owner to complete a BAR form and most (5 of 7) did not know under
what circumstances the form is required (i.e., the definition of a reportable
accident). Most (6 of 7) did not know where to get blank forms when needed or
where to submit them. This certainly highlights the need to educate recreational
boaters on the requirements for submitting the form.

47

Design Research Engineering (30 August 2007 memorandum) was pleased that a usability test was
conducted. However, they stated “The draft form should be pre-tested with law enforcement officials, who
frequently complete the form, especially for boating accidents involving serious injury or fatality. Since it
is likely that law enforcement will find the draft form ill-suited to their needs and knowledge-level, an
optimal course of action is to begin designing a form specifically for the law enforcement community. We
respectfully disagree with the Design Principles assertion that the regulations do not allow this.” We do not
purport to provide legal analysis of the CFR. Our brief was to develop a form that could be completed by
the operator/owner of the boat. We do agree that the development of any subsequent forms should be fieldtested with the population who will be filling out the form. If a two-tier system is implemented, then it will
be appropriate to field test the form with the target populations.

-20-

•

•

•

•

•

The recommended form was consistently preferred to the present form in several
respects. For example, respondents reported that it was easier to determine if a
report was required, to whom to send the report, more likely to be completed,
easier to understand and complete accurately, had an improved layout (including
adequate space for responses), and the font and reduced capitalization were
preferred. It is interesting to note that some respondents actually believed that the
recommended BAR form was shorter than the present form—a subjective
assessment.
Respondents were unsure about the meaning of certain terms (e.g., medical
treatment beyond first aid, vessel documentation number, hull identification
number, dam/lock, failure to vent, external navigational aid, and gunwale). We
made some changes based on this result, but retained certain terms, such as vessel
documentation number and hull identification number even though one or more
respondents did not know the meaning of these terms.
Respondents felt answers to some questions were unclear or subjective. For
example, possible answers relative to wind and water conditions were questioned
by respondents. Regarding water conditions the use of the descriptors “Calm,”
“Choppy,” “Rough,” and “Very rough” were subjective—even though we defined
each of these terms (e.g., the calm water condition was defined as up to 6 in.
waves). We agree that the descriptive terms, by themselves, admitted to various
interpretations—what is choppy relative to the operator of a 60-ft sailing vessel
might differ if an 8-ft rowboat were being used. As a compromise, we placed the
quantitative description first, followed by a qualitative characterization in
parentheses, for example, “Up to 6 in. waves (calm).
Respondents were irritated by certain questions. For example, they were irritated
that “age” and “date of birth” were both included as fields. Thus, we eliminated
“date of birth” and retained “age.” As a second example, respondents queried the
necessity of including “inches” as well as “feet” in characterizing the length and
beam of their boats; we changed the fields to feet only and changed the header to
read “Size estimates.” In these and other cases we made changes to the form to
address their concerns, unless doing so would compromise compliance with the
CFR requirements.
The recommended form still requires time and effort to complete. We made
several revisions to the recommended form based on the usability test, but some
difficulties remain. In our opinion these remaining difficulties can only be
resolved by eliminating some of the essential elements of information EEIs now
required by the CFR or relaxing the present requirement that the form be
completed by the operator/owner.

Sensitive to the negative impression a longer form might make on
operators/owners, we limited the length of the initial draft of the recommended form to
six pages - two pages more than the current form, but in fact still fewer pages than many
state forms.

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We revised the initial draft of the recommended form to produce a final draft
based on the comments and results of the usability test. However, we held the length of
the final draft of the recommended BAR form to six pages while still improving the
layout, readability, and impression of the form. In so doing we made several
compromises. For example:
•

•

Both internal reviewers and some usability test respondents indicated a desire for
more room in the accident description entry area on page 1 of our initial draft of
the recommended form. However, this (as well as other legitimate suggestions)
would have required adding pages to the recommended form, so we chose not to
take this suggestion at this time. Instead in this case, we added an instruction line
indicating that respondents could attach additional pages on which to continue
their accident description if necessary.
This seemed like a reasonable
compromise in the timeframe we had to complete the revision of the form.
It is worth noting however, that during the usability test, some respondents clearly
indicated they would prefer a longer form that was better organized, better laid
out and easier to understand, to a shorter form that achieved brevity by
sacrificing these things. Some indicated it really did not matter at all how long
the form was if it was truly and optimally 'user friendly". In addition, some test
respondents actually thought the recommended form (six pages) they filled out
was shorter than the current form (four pages), and in addition they thought it
took less time to fill out in spite of the fact that it actually took slightly longer.

We recommend that in any next revision of the form, consideration be given to
the possibility of lengthening the form in order to incorporate more potentially useful
redesign ideas learned during this current revision process. If this is done, it would be
important to run another usability study on the lengthened and redesigned form to
validate the hypothesis that these changes in fact resulted in positive benefits.
Summary
A new BAR form has been developed. This form captures the requirements now
contained in the CFR, incorporates many of the suggestions offered by NASBLA and
other key partners, uses proven design principles to increase form readability and userfriendliness, and reflects lessons learned in the usability test. The new form is slightly
longer (largely because of increased white space and a more organized and consistent
layout), but significantly easier to read and understand. This recommended form (after
Coast Guard review and possible revision) will be submitted for public comment.
There is a French proverb to the effect that “the good is the enemy of the
excellent,” meaning that an “adequate solution” may blind us to the possibility of a much
better solution. The Russian version of the same proverb is “the excellent is the enemy of
the good,” meaning that the quest for perfection may prevent us from implementing an
acceptable solution. In a sense, both versions of this proverb are correct. We believe
that, given constraints on time and scope, the recommended BAR form is a significant
improvement over the present form. We also believe that the recommended form is not
the ultimate solution and that there are promising opportunities for further improvements.

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As part of the BAR form redesign effort, we made several suggestions for further work.
We believe that the design and evaluation of improved forms should continue
expeditiously.
The Way Forward
The next step is for the Coast Guard to decide whether to go forward with the
recommended BAR form to replace the current form. Assuming that the Coast Guard
favors the recommended form, it will be submitted (after possible changes) for public
review and comment. The Coast Guard will consider these comments and decide on the
final version of the form for the coming year.
Beyond this immediate action the BAR form will be periodically revised. As
noted above, one of the assumptions of this preliminary redesign effort is that the new
form would comply with all the information requirements of the present CFR. In the
short term it was not possible to modify these requirements. However, in the longer term
these can be changed. This is a topic for further review. One particular assumption made
in this effort is that the BAR form should be completed by operator/owner of the boat.
As noted above, many believe it is desirable to institute a two-tier reporting requirement
in which the operator/owner fills out a much simplified form and the cognizant agency
fills in a more comprehensive form on all reportable boating accidents. In principle, such
a two-tier scheme might be very attractive because the operator notification form could
be radically simplified, which should increase the response rate. As well, the operator
form could be modified to eliminate possible self-incriminating questions; investigating
authorities could provide these answers. Based on conversations with many NASBLA
personnel and others, this is a potentially attractive option. (Nonetheless, it needs to be
evaluated carefully. It is possible that many more accidents would be reported if a much
simpler form were used by operators 48 , which would have workload implications for the
States. Moreover, the present reporting deadlines must also be considered. Would each
state be prepared to submit the BAR within the present submission deadlines?)
Many states already have two BAR forms at present—one that is filled in by the
operator/owner and the other that is filled in by an accident investigator. The latter form
is used for those accidents that qualify as “reportable.” One reason for having such a
system is that some data now provided by operators/owners are not believed reliable.
Use of the recommended BAR form should make it easier to understand—it remains to
be seen whether the responses from this form will be sufficiently accurate to use directly
or whether a follow-up investigation is required in any event. If so, a radically simplified
operator report form could be designed. The principal purpose of the simplified form
would be to alert investigators to the fact that an accident occurred. Additionally, the
simplified operator form could provide very basic information that might be used for
statistical purposes in the event that the State did not follow-up on the accident. There is
48

Indeed, one goal of a radically simplified form is that non-response rates for otherwise “reportable”
accidents would decrease substantially. This would be highly desirable in terms of correctly estimating the
social costs of recreational boating accidents. However, this could result in substantial increases in
workload if each accident were investigated by competent personnel. This is not meant to suggest that a
two-tier system is not appropriate. Rather it means that systematic analysis is required.

-23-

no reason for undue delay in analyzing options or in developing a revised form (or set of
forms). The Coast Guard and partners could easily begin such a project in parallel with
the approval process for the recommended form.
We believe that it is appropriate to carefully review carefully the essential
elements of information (EEIs) on the form. This should be done in parallel with any
redesign effort.
Several other suggestions are noted above and/or have been made by others. For
example, the use of smart forms and making these forms available in other languages are
ideas with possible merit.
There is probably more to do on the selection of typeface, font size, and use (if
any) of color. We chose the font size in part to avoid making the form “too long.” But
there is evidence that (particularly for older readers) larger font sizes are easier to
read 49 —and color can make a difference.
While forms should be designed to increase readability and clarity, this is only
one of several possible initiatives that might be considered to increase response rates.
Efforts to increase boater awareness of legal requirements might have merit. Here are
some other ideas:
•

•

•

Expand coverage of the requirements to report accidents in public education
offerings of States and such organizations as the United States Coast Guard
Auxiliary and the United States Power Squadrons.
Produce additional
flyers/posters that publicize accident reporting requirements. 50 One such poster is
reproduced at the end of this section.
Publicize the fact that the BAR form cannot be used in any subsequent litigation
in certain states. Under current law (46 USC Section 6102) “If a State marine
casualty reporting system provides that information derived from casualty reports
(except statistical information) may not be publicly disclosed, or otherwise
prohibits use by the State or any person in any action or proceeding against a
person, the Secretary may use the information provided by the State only in the
same way that the State may use the information.” Many States now require that
this information be treated as confidential.
Explain what is done with the data and why this benefits all boaters to help
answer the question “why should I fill in this form?” One answer is that it is
legally required. A more compelling reason is that it can help improve boating
safety. Present texts used in public education classes generally mention that
completing this form is required by law and may provide information on how to

49

See, e.g., http://hgrebdes.com/typefaces/fontresearch.php and also
http://www.psych.ucalgary.ca/PACE/VA-Lab/gkconnol/Thesis.html.
50
Such products are already available, see http://www.art4use.com/barposter/pdfs/involved11.pdf.

-24-

•
•
•

get this form. Little (if any) space is devoted to an explanation of why completing
this form benefits boating safety. 51
Have insurance companies require a copy of the completed BAR form as a
condition for reimbursement—this is a common requirement for motor vehicle
accidents.
Increase the severity of penalties for and/or the likelihood of detection of noncompliance.
Continue to develop statistical techniques to correct for non-response.

These are illustrative ideas only.
recommendations.

These should be evaluated before making

Thus, the work described in this report should be seen as one of many future
efforts aimed at continuous improvement in the overall reporting and analysis
methodology for recreational boating accidents. And the Coast Guard is well advised to
be mindful of the comment 52 that “quality data begins with quality data-collection
forms.”
Acknowledgements
We appreciate the help and guidance furnished by Jeff Hoedt, Jeff Ludwig, and
Bruce Schmidt of the Office of Boating Safety and Arthur A. Requina of the USCG
Office of Information Management in the BAR form redesign effort. We also appreciate
the many useful suggestions of all who commented on the present BAR form and on this
report in draft. Their rapid turnaround of the review draft was particularly noteworthy—
this final report is materially better because of their contributions. The views and
recommendations contained in this report are those of the authors and do not necessarily
represent the positions or policies of the United States Coast Guard or the Coast Guard
Auxiliary Association.

51

One useful web site posting provides a justification for completing the form: “The need to fill out an
accident report is to be able to develop safety regulations as well develop manufacturing standards to
provide better boats and, boating standards. The information contained in such reports is also helpful in
educating people on boating safety…Without these reports the possibility exist that boating accidents are
overlooked with more injuries and even fatalities as a result.”
See http://www.boating102.com/tag/boating-accident/.
52
Design Research Engineering 30 August memorandum, Op. Cit.

-25-

Table 1. Required contents of report as specified in 33 CFR Ch. 1, Part 173 Subpart C –
Casualty and Accident Reporting, §173.57 Contents of report. This defines the minimum
reporting requirements.
(a) The numbers and names of each vessel
involved.

(n) The name and address of each owner of
property involved.

(b) The name and address of each owner of
each vessel involved.

(o) The availability and use of personal
flotation devices.

(c) The name of the nearest city or town, the
county, the State, and the body of water.

(p) The type and amount of each fire
extinguisher used.

(d) The time and date the casualty or accident
occurred.

(q) The nature and extent of each injury.

(e) The location on the water.

(r) A description of all property damage and
vessel damage with an estimate of the cost
of all repairs.

(f) The visibility, weather, and water
conditions.

(s) A description of each equipment failure
that caused or contributed to the cause of
the casualty.

(g) The estimated air and water temperatures.

(t) A description of the vessel casualty or
accident.

(h) The name, address, age, or date of birth,
telephone number, vessel operating
experience, and boating safety training of
the operator making the report.

(u) The type of vessel operation (cruising,
drifting, fishing, hunting, skiing, racing, or
other), and the type of accident (capsizing,
sinking, fire, or explosion or other).

(i) The name and address of each operator of
each vessel involved.

(v) The opinion of the person making the
report as to the cause of the casualty,
including whether or not alcohol or drugs,
or both, was a cause or contributed to
causing the casualty.

(j) The number of persons on board or towed
on skis by each vessel.

(w) The make, model, type (open, cabin, house,
or other), beam width at widest point,
length, depth from transom to keel,
horsepower, propulsion (outboard,
inboard, inboard outdrive, sail, or other),
fuel (gas, diesel, or other), construction
(wood, steel, aluminum, plastic, fiberglass,
or other), and year built (model year), of
the reporting operator’s vessel.

(k) The name, address, and date of birth of
each person injured or killed.

(x) The name, address, and telephone number
of each witness.

(l) The cause of each death.

(y) The manufacturer’s hull identification
number, if any, of the reporting operator’s
vessel.

(m) Weather forecasts available to, and
weather reports used by, the operator
before and during the use of the vessel.

(z) The name, address, and telephone number
of the person submitting the report.

-26-

Table 2. Information requested on Form CG-3865 (Rev. 12-06) that does not appear to be
prescribed by 33 CFR §173.57.
   1.  Page 1 – The operator’s gender, male or female. 
   2.  Page 1 – Operator wearing a safety lanyard at the time of the accident. 
   3.  Page 1 – Rented vessel (yes or no). 
   4.  Page 1 – Current vessel safety check (VSC) (yes or no). 
   5.  Page 1 – Operator arrested due to boating under the influence (BUI) for this accident 
only. 
   6.  Page 1 – Operator blood alcohol concentration (BAC) level. 
   7.  Page 2 – Engine(s) used to propel the vessel, (number of engines). 
   8.  Page 2 – Did the accident result in a “Hit and Run”? 
   9.  Page 2 – Vessel speed at the time of the accident, (not moving, etc....) 
10.  Page 3 – (Injured victim information) Age of victim. 
11.  Page 3 – (Injured victim information) Was injured victim admitted to the hospital? 
12.  Page 3 – (Injured victim information) Was a life jacket worn by the victim inflatable? 
13.  Page 3 – (Injured victim information) Type of life jacket worn (Type I, etc...) 
14.  Page 3 – (Injured victim information) Injury caused by (Check all that apply) 
15.  Page 3 – (Injured victim information) Alcohol use apparent by the injured victim 
16.  Page 3 – (Injured victim information) Blood alcohol concentration (BAC) 
17.  Page 3 – (Injured victim information) Drug use apparent by the injured victim 
18.  Page 3 – (Injured victim information) Specify the type(s) of drugs being used: 
19.  Page 3 – (Injured victim information) Victim status at the time of the accident 
20.  Page 3 – (Injured victim information) Victim activity at the time of the accident 
21.  Page 3 – (Deceased victim information) Was victim struck by the propeller? 
22.  Page 3 – (Deceased victim information) Was victim struck by the vessel? 
23.  Page 3 – (Deceased victim information) Was the life jacket worn by the victim 
inflatable? 
24.  Page 3 – (Deceased victim information) Type of life jacket worn 
25.  Page 3 – (Deceased victim information) Victim status at the time of the accident 
26.  Page 3 – (Deceased victim information) Victim activity at the time of the activity 
27.  Page 3 – (Deceased victim information) Alcohol use apparent by the victim 
28.  Page 3 – (Deceased victim information) Blood alcohol concentration (BAC) level: 
29.  Page 3 – (Deceased victim information) Drug used apparent by the victim 
30.  Page 3 – (Deceased victim information) Type(s) of drugs being used: 
31.  Page 4 – (Witness information) Telephone number 
32.  Page 4 – (Owners of property information) Telephone number 
33.  Page 4 – (Operator or owner of other vessel(s) information) Telephone number 

Source: Tennessee Wildlife Resources Agency

-27-

-28-

Collision with non-commercial boat?

Collision with fixed object?

Person left boat voluntarily?

-29-

Appendix A
The Present BAR Form
This appendix provides a copy of the present BAR form that was revised
(based on the contents of the main report) to produce the recommended form.

Appendix B
The Recommended BAR Form
This appendix provides a copy of the recommended BAR form developed as part of this
project.

U.S. Dept. of Homeland Security

Recreational Boating Accident Report

U.S. Coast Guard CG-3865 (Rev. 08-07)

OMB No: 1625-0003
Expires: dd/yy/yyyy

NOTE: each boat operator/owner involved in an accident should submit a separate report.
Estimated report form completion time: 30 min
For each question below, please provide answers IF APPLICABLE AND IF KNOWN, otherwise leave blank.
REPORT SUBMISSION
Report required because (select all that apply):
… At least one person in this accident died :
If so, how many?

To be submitted within:
48 hours (if injury, disappearance or death)
10 days (if boat/property damage only )

… At least one injured person in this accident required or was in need of
treatment beyond first aid:
If so, how many?
… At least one person in this accident disappeared and has not
yet been recovered:
If so, how many?

To be submitted to:
(Local State Reporting Authority)

… All boat and other property damage (e.g., fishing/hunting gear) caused
by this accident totaled (or likely totaled) $2,000 or more:
Approximate value of damage to your boat:
$
Approximate value of damage to your other property:
$
… Your or another boat in this accident was (or likely was) a total loss

Town
ST 12345
Phone: 111-222-3333
An agency may not conduct or sponsor and a person is not required to
respond to an information collection, unless it displays a currently valid
OMB Control number.

Report submitted by (select all that apply):
… Boat Operator (required if possible)
… Boat Owner (if operator unable, or same as operator)
… Other (describe):
First name:

For State Agency Use Only
First name:
Last name:
Phone:

Last name:
Primary cause of accident:

Phone:

-

-

ACCIDENT SUMMARY
WHEN
Date:
Time:

mm/dd/yy
:

ACCIDENT DESCRIPTION
Briefly describe this accident (attach extra pages if necessary):

| am | pm (select one)

WHERE
Body of water name:
Location (on water)
description:

DAMAGE TO YOUR BOAT
Briefly summarize any damage to your boat:

Nearest city/town:
County:
State:
YOUR BOAT - PEOPLE
# people on board (including operator):
# people being towed (e.g., on tubes, skis):
# people wearing lifejackets (on board or towed):

DAMAGE TO YOUR OTHER PROPERTY (NOT BOAT)
Briefly summarize any damage to your other property (not boat):

OTHER BOATS INVOLVED IN ACCIDENT
# of other boats involved?
U.S. Dept. of Homeland Security

U.S. Coast Guard CG-3865 (Rev 08-07)

Page 1 of 6

For each question below, please provide answers IF APPLICABLE AND IF KNOWN, otherwise leave blank.
YOUR BOAT
BOAT IDENTIFICATION
Your boat name:

Manufacturer:

Model name:

Model year:

Registration #:

Documentation #:

Hull Identification # (HIN):
SIZE ESTIMATES
Length:
ft.

Rented:

Depth from transom (stern) to
keel (bottommost point):

HULL MATERIAL
Type of hull material (select one):
| Fiberglass
| Wood
| Aluminum
| Steel
BOAT TYPE
Boat type (select one):
| Cabin motorboat
| Open motorboat
| Auxiliary sail
| Pontoon boat
ENGINE
# engines:
Manufacturer:

| Inflatable
| Houseboat
| Sail (only)
| Kayak

| Yes

| No

Beam width at widest point:
ft.

ft.

in.

| Rubber/vinyl/canvas
| Plastic

| Other (describe):

Available propulsion (select all that apply):
… Propeller
… Air thrust
| Canoe
| Personal watercraft (PWC)
… Other (describe):
… Sail
| Rowboat
(e.g., Wave Runner™,
… Manual
| Air boat
Jet Ski™, Sea-Doo™)
… Water jet
| Other (describe):

Engine type and horsepower (select one):
| Outboard | Sterndrive (I/O)
Total horsepower:

| Inboard

| None

hp

Fuel type (select all that apply):
… Gasoline … Electric
… Diesel

SAFETY MEASURES
Organizations that have conducted a vessel safety check (VSC) on board your boat within the past year (including carriage of
safety equipment, e.g., lifejackets, anchor and line, fire extinguishers): … Federal Agency (Name):
… US Coast Guard Auxiliary: VSC Decal? | Yes

… State Agency (Name):

… US Power Squadrons:

… Other Agency (Name):

# Life jackets on board:

| No
VSC Decal? | Yes | No
# Fire extinguishers on board:

Type of fire extinguishers (e.g., ABC):

ACCIDENT DETAILS - EXTERNAL CONDITIONS
WEATHER
Overall weather was (select one):
| Clear
| Raining
| Cloudy
| Snowing
| Foggy
| Hazy
| Other (describe):

It was
Visibility was
(select one):
(select one):
| Day
| Good
| Night
| Fair
| Poor
Approximate air temperature:

WATER
Overall water conditions (select one):
| Up to 6 in. waves (calm)
| Over 6 in., up to 2 ft. waves (choppy)
| Over 2 ft., up to 6 ft waves (rough)
| Over 6 ft. waves (very rough)
U.S. Dept. of Homeland Security

Wind was (select one):
| 0 mph (none)
| Over 0, up to 12 mph (light)
| Over 12, up to 25 mph (moderate )
| Over 25, up to 55 mph (strong)
| Over 55 mph (stormy)
o

F

Other water conditions:
o
Approximate water temperature:
F
Strong current?
Hazardous waters?(e.g., rapid tidal flow, currents)
Congested waters?
U.S. Coast Guard CG-3865 (Rev 08-07)

| Yes
| Yes
| Yes

| No
| No
| No

Page 2 of 6

For each question below, please provide answers IF APPLICABLE AND IF KNOWN, otherwise leave blank.
ACCIDENT DETAILS - YOUR BOAT
MACHINERY/EQUIPMENT FAILURE
Failure of the following machinery/equipment on your boat contributed to this accident (select all that apply):
… Engine
… Sail/mast
… Steering
… Radio
… Fire extinguisher
… Electrical system
… Onboard lights … Throttle
… Auxiliary equipment … Ventilation
… Fuel system
… Seats
… Shift
… Sound equipment (e.g., horn, whistle)
… Onboard navigation aids (e.g., GPS, Loran)

… Other (list):

ACCIDENT DETAILS - ACTIVITIES AND OPERATIONS ON YOUR BOAT
OPERATOR/PASSENGER ACTIVITIES
Operator/passenger activities on your boat at time of accident :
Activities were (select one):
Operator/passenger activities (select all that apply):
… Fishing
… Tubing
… Starting engine
| Commercial

… Making repairs
| Recreational
Hunting
Water Skiing
… White water activity (e.g., rafting)
… Relaxing
BOAT OPERATIONS
Your boat operations at time of accident (select all that apply):
… Sailing
… Racing
… Changing direction
… Cruising (underway under power)
… At anchor
… Changing speed
… Drifting
… Being towed
… Tied to dock/mooring
… Rowing/paddling
… Other (list):

… Other (list):

… Towing another vessel
… Launching
… Docking/undocking

ACCIDENT DETAILS - EVENTS ON YOUR BOAT
ACCIDENT EVENTS
Types of events occurring to/on your boat during accident (select all that apply):
… Collision with recreational boat
… Flooding/swamping
… Person fell overboard
… Collision with commercial boat (e.g., tug, barge)
… Fire/explosion - fuel
… Person fell on/within boat
… Collision with fixed object (e.g., dock, bridge)
… Fire/explosion - non-fuel
… Sudden medical condition
… Collision with submerged object (e.g., stump, cable) … Carbon monoxide exposure … Person struck by boat
… Collision with floating object (e.g., log, buoy)
… Mishap of skier, tuber,
… Person struck by
… Capsizing
wakeboarder, etc.
propeller or propulsion unit
… Grounding
… Person left boat voluntarily … Person electrocuted
… Sinking
… Person ejected from boat (caused by collision or manuever)
… Other (describe):

ACCIDENT DETAILS - CONTRIBUTING FACTORS ON YOUR BOAT
CONTRIBUTING FACTORS
Indicate factors on your boat which may have contributed to this accident (select all that apply):
… Alcohol use
… Operator inattention
… Hazardous waters
… Restricted vision (e.g., fog)
… Drug use
… Operator inexperience
… Heavy weather
… Missing/inadequate
… Excessive speed
… Language barrier
… Hull failure
aids to navigation (e.g., buoy,
… Improper anchoring
… Navigation rules violation … Ignition of fuel or vapor
daymarker)
… Improper loading
… Failure to vent
… Starting in gear
… Inadequate on-board
… Overloading
… Dam/lock
… Sharp turn
navigation lights
… Improper lookout
… Force of wake/wave
… People on gunwale, bow
… Other (describe):
or transom
U.S. Dept. of Homeland Security

U.S. Coast Guard CG-3865 (Rev 08-07)

Page 3 of 6

For each question below, please provide answers IF APPLICABLE AND IF KNOWN, otherwise leave blank.
ACCIDENT DETAILS - YOUR BOAT INJURED PEOPLE RECEIVING OR IN NEED OF TREATMENT BEYOND FIRST AID
Report only injured people on or struck by your boat , receiving or in need of treatment beyond first aid.
Do not report injured people on or being pulled by another boat or no boat (e.g., swimmers, scuba divers, people on a dock).
If more than one injured person to report, attach additional copies of this page. If none , SKIP INJURED PEOPLE section.
INJURED PERSON
First:

MI:

Last:

Street:

City:
Phone:

State:
-

-

-

Age:

INJURY DETAILS
Injury caused when person (select all that apply):
… Struck the:
(e.g., boat, water)
… Was struck by a:
(e.g., boat, propeller)
… Was exposed to carbon monoxide poisoning
… Received an electric shock
… Other (describe):
Person was wearing lifejacket?
Person received treatment beyond first aid?
Person was admitted to a hospital?

Zip:

| Yes
| Yes
| Yes

| No
| No
| No

Nature of most serious injury (select one):

| Scrape/bruise
| Cut
| Sprain/strain
| Concussion/brain injury
| Spinal cord injury
| Broken/fractured bone

| Dislocation
| Internal organ injury
| Amputation
| Burn
| Other (describe):

Body part of most serious injury (e.g., head, hip, knee):

ACCIDENT DETAILS - YOUR BOAT - DEATHS/DISAPPEARANCES
Only report deaths/disappearances of people on your boat , or struck by your boat.
If more than one death/disappearance to report, attach additional copies of this page.
If none , SKIP DEATHS/DISAPPEARANCES section.
PERSON WHO DIED/DISAPPEARED
First:

MI:

Last:

Street:

City:
Phone:

State:
-

-

Zip:

Age:

DETAILS OF DEATH/DISAPPEARANCE
Injury caused when person (select all that apply):
… Struck the:
(e.g., boat, water)
… Was struck by a:
(e.g., boat, propeller)
… Was exposed to carbon monoxide poisoning
… Received an electric shock
… Other (describe):

Nature of death/disappearance (select one):
| Death - by drowning
| Death - other likely cause (describe):

| Disappeared and not yet recovered
Person was wearing lifejacket?

U.S. Dept. of Homeland Security

-

U.S. Coast Guard CG-3865 (Rev 08-07)

| Yes

| No

Page 4 of 6

For each question below, please provide answers IF APPLICABLE AND IF KNOWN, otherwise leave blank.
ACCIDENT DETAILS - YOUR BOAT OPERATOR
OPERATOR INSTRUCTION
Boating safety instruction completed (select all that apply):
… None
… State course
… USCG Auxiliary course
… US Power Squadrons course
… Internet (name of sponsoring organization):

OPERATOR SAFETY MEASURES
On board, prior to accident, was operator wearing:
A lifejacket?
| Yes
| No
An engine cut-off switch (Lanyard) if equipped?
| Yes
| No
On board, prior to accident, was operator using:
Alcohol?

| Yes

… Other (describe):

| No

Drugs?

| Yes
OPERATOR EXPERIENCE
Experience operating this type of boat (select one):

| 0 to 10 hours
| Over 10, up to 100 hours

| No

Operator arrested for Boating Under the Influence?

| Yes

| Over 100, up to 500 hours
| Over 500 hours

| No

Weather reports consulted prior to accident?

| Yes

| No

ACCIDENT DETAILS - OTHER KEY PEOPLE
Only report other key people not already documented as injured, died, disappeared or operator/owner of your boat.
If more than two other key people to report, attach additional copies of this page.
NAME/ADDRESS
This other key person was a(n) (select all that apply):
… Other boat operator … Other boat owner

… Owner of other damaged property

First:

MI:

… Passenger on your boat

… Witness

Last:

Street:

City:

State:

Other boat name (if any):
Other boat registration # (if any):

Zip:
Phone:

-

-

NAME/ADDRESS
This other key person was a(n) (select all that apply):
… Other boat operator … Other boat owner
First:

… Owner of other damaged property
MI:

… Passenger on your boat

… Witness

Last:

Street:

City:
Other boat name (if any):
Other boat registration # (if any):
U.S. Dept. of Homeland Security

State:

Zip:
Phone:

U.S. Coast Guard CG-3865 (Rev 08-07)

-

-

Page 5 of 6

For each question below, please provide answers IF APPLICABLE AND IF KNOWN, otherwise leave blank.
YOUR BOAT OPERATOR
NAME/ADDRESS
First:

MI:

Last:

Street:

City:

State:

Zip:

-

AGE/GENDER/PHONE
Age:

Gender:

| Male | Female

Phone:

-

-

YOUR BOAT OWNER
If same as your boat operator SKIP rest of YOUR BOAT OWNER section.
NAME/ADDRESS/PHONE
First:

MI:

Last:

Street:

City:
Phone:

State:
-

Zip:

-

-

PERSON SUBMITTING THIS REPORT
If same as your boat operator OR owner , SKIP rest of PERSON SUBMITTING THIS REPORT section.
NAME/ADDRESS/PHONE/ROLE
First:

MI:

Last:

Street:

City:
Phone:

State:
-

Zip:

-

-

I was a(n) (select one):
| Other person on board this boat
| Accident witness not on board this boat
| Other (describe):

SIGNATURE OF PERSON SUBMITTING THIS REPORT
Your signature:

Date:

mm/dd/yy

Submit any comments on this report form to:
Office of Management and Budget, Paperwork Reduction Project (1625-0003), Washington DC 20593.

U.S. Dept. of Homeland Security

U.S. Coast Guard CG-3865 (Rev 08-07)

Page 6 of 6

Appendix C
Illustrative State BAR Forms
This appendix contains examples of state BAR forms, including those from the States of
Alaska, California, Colorado, Connecticut, Massachusetts, Nevada, New Mexico, Ohio, Rhode
Island, Utah, and Washington.

PLEASE TYPE OR PRINT - FILL OUT COMPLETELY
STATE OF ALASKA

BOATING ACCIDENT REPORT

(Rev. 3/03)

CASE NO.

The operator of a boat used for non-commercial purposes is required to file a report in writing whenever a boating accident results in loss of life or
disappearance from a vessel, an injury which requires medical treatment beyond first aid, property damage in excess of $500, or complete loss of
the vessel. Federal law requires reports in death and injury cases must be submitted within 48 hours, and reports in other cases must be submitted
within 10 days. Reports may be submitted either to any office of the State of Alaska, Dept. of Public Safety or by mail to: State of Alaska, Office
of Boating Safety, 550 W. 7th Ave., Suite 1370, Anchorage, AK 99501. This form is provided to assist the operator in filing the required written report.
COMPLETE ALL BLOCKS. (INDICATE THOSE NOT APPLICABLE BY "NA")
ACCIDENT DATA
AM NAME OF BODY OF WATER
PM
NEAREST CITY OR TOWN

DATE OF ACCIDENT

TIME

NUMBER OF VESSELS
INVOLVED
WEATHER

LOCATION (Give Location Precisely)
STATE

ZIP CODE

NAME OF OPERATOR

WATER CONDITIONS
TEMPERATURE
WIND
Calm (Waves less than 6")
(Estimate)
None
Choppy (Waves 6" to 2 feet)
Air
F
Light (0-6 mph)
Rough (Waves 2 feet to 6 feet)
Moderate (7-14 mph)
Very Rough (Greater than 6 feet)
Water
F
Strong (15-25 mph)
Storm (Over 25 mph)
Strong Current
DRIVER'S LICENSE NO.
OPERATOR ADDRESS

OPERATOR TELEPHONE NUMBER
(
)

DATE OF BIRTH
Mo
Day
Year

Clear
Cloudy
Fog

Male
NAME OF OWNER

Rain
Snow
Hazy

OPERATOR'S EXPERIENCE
None
Under 100 Hours
Over 100 Hours
OWNER ADDRESS

Female

OWNER TELEPHONE NUMBER
(
)

NUMBER OF PEOPLE
ON BOARD

VISIBILITY
DAY
NIGHT
Good
Fair
Poor

INSTRUCTION IN BOATING SAFETY
State Course
U.S. Power Squadron
USCG Auxiliary
American Red Cross
None
Other (Specify)

NUMBER OF PEOPLE
BEING TOWED

RENTED BOAT?
Yes

No

BOAT NO. 1 (This Vessel)
BOAT REGISTRATION OR DOCUMENTATION NUMBER

STATE

HULL IDENTIFICATION NUMBER

BOAT NAME

BOAT MANUFACTURER

LENGTH

MODEL

YEAR BUILT

TYPE OF BOAT
Open Motorboat
Cabin Motorboat
Auxiliary Sail
Sail (only)
Rowboat
Canoe / Kayak (circle)
Personal Watercraft
Pontoon Boat
Houseboat
Other (specify)

HULL MATERIAL
Wood
Aluminum
Steel
Fiberglass
Rubber/Vinyl/Canvas
Rigid Hull Inflatable
Other (specify)

OPERATION AT TIME OF ACCIDENT
(Check all Applicable)
Cruising
Changing Direction
Changing Speed
Drifting
Towing
Being Towed
Rowing/Paddling
Sailing
Launching
Docking/Undocking
At Anchor
Tied to Dock/Moored
Other (Specify)

ENGINE
PROPULSION
Outboard
Propeller
Inboard
Water Jet
Inboard-Sterndrive
Air Thrust
(I/O)
Manual
Airboat
Sail
FUEL
NUMBER OF
ENGINES
Gasoline
Diesel
TOTAL
Electric
HORSEPOWER

ACTIVITY AT TIME OF ACCIDENT
Fishing
Tournament
Hunting
Swimming/Diving
Making Repairs
Waterskiing/Tubing/Etc.
Racing
Whitewater Sports
Fueling
Starting Engine
Non-Recreational
Other (Specify)

TYPE OF ACCIDENT
Grounding
Capsizing
Flooding/Swamping
Sinking
Fire or Explosion (Fuel)
Fire or Explosion (Other)
Skier Mishap
Collision with Vessel
Collision with Fixed Object
Collision with Floating Object
Falls Overboard
Falls in Boat
Struck By Boat
Struck by Motor/Propeller
Struck Submerged Object
Other (Specify)

ESTIMATED SPEED
10 - 20 MPH

None
21 - 40 MPH

Under 10 MPH
Over 40 MPH

Hit and Run

(COMPLETE OTHER SIDE)

PERSONAL FLOTATION DEVICES
(PFDs): Was Boat Adequately equipped
with Coast Guard Approved PFDs?
Yes
No
Were PFDs Accessible?
Yes
No
FIRE EXTINGUISHERS
ON BOARD?
USED?

Yes
Yes

No
No

WHAT CONTRIBUTED TO ACCIDENT
(Check all Applicable)
Weather
Excessive Speed
Improper Lookout
Restricted Vision
Overloading
Improper Loading
Hazardous Waters
Alcohol Use
drug Use
Hull Failure
Machinery Failure
Equipment Failure
Operator Inexperience
Operator Inattention
Congested Waters
Passenger/Skier Behavior
Dam/Lock
Other (Specify)

DECEASED (If More Than 2 Fatalities, Attach Additional Forms)
ADDRESS OF VICTIM

NAME OF VICTIM
DATE OF BIRTH

Male

Female

DEATH CAUSED BY?

NAME OF VICTIM
DATE OF BIRTH

Drowning

Male

Female

DEATH CAUSED BY?

Drowning

INJURED (If More Than 2 Injuries, Attach Additional Forms)
ADDRESS OF VICTIM

DATE OF BIRTH

MEDICAL TREATMENT BEYOND FIRST AID?

Yes

No

WAS PFD WORN?

ADMITTED TO HOSPITAL?
Yes
No
PRIOR TO ACCIDENT?

Yes
Yes

No
No

DATE OF BIRTH
WAS PFD WORN?
WAS IT INFLATABLE?
NAME
DATE OF BIRTH

No

Other

WAS PFD WORN?
Yes
Disappearance

ADDRESS OF VICTIM

NAME OF VICTIM

WAS IT INFLATABLE?
NAME OF VICTIM

No

Other

WAS PFD WORN?
Yes
Disappearance

Yes

DESCRIBE INJURY
AS A RESULT OF ACCIDENT?

Yes

No

Yes

No

No
ADDRESS OF VICTIM

MEDICAL TREATMENT BEYOND FIRST AID?

Yes

No

ADMITTED TO HOSPITAL?

Yes

No

DESCRIBE INJURY

Yes
No
PRIOR TO ACCIDENT?
Yes
No
AS A RESULT OF ACCIDENT?
Yes
No
OTHER PEOPLE ABOARD THIS BOAT (If More Than 2 People, Attached Additional Forms)
ADDRESS
WAS PFD WORN?

Yes

No

AS A RESULT OF ACCIDENT?

Yes

No
ADDRESS

DATE OF BIRTH

WAS PFD WORN?

Yes

No

NAME OF OPERATOR

AS A RESULT OF ACCIDENT?
Yes
No
WAS IT INFLATABLE?
BOAT NO. 2 (If More Than 2 People, Attach Additional Forms)
OPERATOR ADDRESS

NAME

OPERATOR TELEPHONE NUMBER
(
)
NAME OF OWNER

PRIOR TO ACCIDENT?

Yes

No

WAS IT INFLATABLE?

Yes

No

PRIOR TO ACCIDENT?

Yes

No

Yes

No

BOAT REGISTRATION OR DOCUMENTATION NUMBER

STATE

OWNER ADDRESS

OWNER TELEPHONE NUMBER
(
)
ESTIMATED AMOUNT:

THIS BOAT AND CONTENTS

PROPERTY DAMAGE
OTHER BOAT(S) AND CONTENTS:

OTHER PROPERTY:

$
$
$
ACCIDENT DESCRIPTION: Please describe the sequence of events, using additional sheets as necessary. Include any information regarding the the use of
PFDs, the failure of equipment, and the involvement of alcohol and / or drugs in causing or contributing to the accident. Attach any diagrams.

NAME

WITNESSES NOT ON THIS VESSEL
ADDRESS

NAME

ADDRESS

NAME

PERSON COMPLETING REPORT
ADDRESS

SIGNATURE

QUALIFICATION

OPERATOR

NAME OF REVIEWING OFFICE
PRIMARY CAUSE

This Report
DATE RECEIVED

Investigation

TELEPHONE NUMBER
OWNER

INVESTIGATOR
FOR AGENCY USE ONLY
CAUSES BASED ON (Check One):

TELEPHONE NUMBER
(
)
TELEPHONE NUMBER
(
)

(
)
DATE SUBMITTED

OTHER

Investigation and This Report
RECREATIONAL

SECONDARY CAUSE

COMMERCIAL

Other
NON-REPORTABLE

CALIFORNIA BOATING ACCIDENT REPORT
The operator of
results in death,
submitted within
of the accident.
(916) 263-8189.

CALIFORNIA DEPARTMENT OF BOATING AND WATERWAYS

every recreational vessel is required by Section 656 of the Harbors and Navigation Code to file a written report whenever a boating accident occurs which
disappearance, injury that requires medical attention beyond first aid, total property damage in excess of $500, or complete loss of a vessel. Reports must be
48 hours in case of death occurring within 24 hours of an accident, disappearance, or injury beyond first aid. All other reports must be submitted within 10 days
Reports are to be submitted to the California Department of Boating and Waterways at 2000 Evergreen Street, Suite 100, Sacramento, California 95815-3888,
Failure to submit this report as required is a misdemeanor and is punishable by a fine not to exceed $1000 or imprisonment not to exceed 6 months or both.

DATE OF ACCIDENT (M/D/Y)

TIME OF ACCIDENT

COUNTY

BODY OF WATER

LOCATION ON WATER

AM
PM
# INJURED

# DEAD

TOTAL $$

LAW ENFORCEMENT ON ACCIDENT SCENE?

YES
WATER CONDITIONS

WEATHER (CHECK ALL THAT APPLY):

CLEAR

FOG

SNOW

WATER

LIGHT (0-6 mph)

ROUGH (waves 2'-6')

HAZY

TEMPERATURE

NONE

CHOPPY (waves 6"-2')
CLOUDY

NO

WIND CONDITIONS

CALM (waves less than 6")

RAIN

AGENCY NAME

VERY ROUGH (waves >6')

AIR

VISIBILITY

STRONG CURRENT

MODERATE (7-14 mph)

GOOD

STRONG (15-25 mph)

FAIR

STORM (over 25 mph)

POOR

YES

NO

CAUSE OF ACCIDENT (CHECK ALL THAT APPLY):

TYPE OF ACCIDENT (CHECK ALL THAT APPLY):

CAPSIZING

FIRE / EXPLOSION (fuel)

IMPROPER LOOKOUT / INATTENTION

HAZARDOUS WEATHER / WATER

COLLISION WITH VESSEL

FIRE / EXPLOSION (other than fuel)

OPERATOR INEXPERIENCE

RESTRICTED VISION

COLLISION WITH FIXED OBJECT

FLOODING / SWAMPING

EXCESSIVE SPEED

IGNITION OF SPILLED FUEL / VAPOR

COLLISION WITH FLOATING OBJECT

SINKING

MACHINERY FAILURE

IMPROPER ANCHORING

FALL OVERBOARD

STRUCK BY BOAT / PROPELLER

EQUIPMENT FAILURE

ALCOHOL USE

FALL IN BOAT

SKIER MISHAP

IMPROPER LOADING

FAILURE TO VENT

OVERLOADING

OTHER

OTHER

D E S C R I B E W H AT H A P P E N E D A N D W H AT YO U C O U L D H AV E D O N E TO P R E V E N T T H I S AC C I D E N T
(Expl ai n th e c a u s e o f d e a t h o r in ju r y, me d ic a l t re a t me n t , e tc. U se sketch if helpful. If needed, continue description on addi t ional paper.)

V I C T I M O R W I T N E S S I N F O R M AT I O N
VICTIM / WITNESS
NAME & ADDRESS

DBW FORM BAR-1 (1/00)

VICTIM / WITNESS
STATUS

RIDING IN
VESSEL #

AGE

INJURY DESCRIPTION

CAUSE OF DEATH

COULD
VICTIM SWIM?

LIFE JACKET
WORN?

INJURED

DROWNING

YES

YES

DEAD
WITNESS ONLY

TRAUMA
OTHER

NO

NO

INJURED

DROWNING

YES

YES

DEAD
WITNESS ONLY

TRAUMA
OTHER

NO

NO

INJURED

DROWNING

YES

YES

DEAD
WITNESS ONLY

TRAUMA
OTHER

NO

NO

INJURED

DROWNING

DEAD
WITNESS ONLY

TRAUMA
OTHER

YES

YES

NO

NO

THIS CONFIDENTIAL REPORT IS USED IN RESEARCH FOR THE PREVENTION OF ACCIDENTS AND A COPY IS FORWARDED TO THE UNITED STATES COAST GUARD

CALIFORNIA BOATING ACCIDENT REPORT

CALIFORNIA DEPARTMENT OF BOATING AND WATERWAYS

IN F OR MATION : OP E R ATOR #1
IS OWNER DIFFERENT THAN OPERATOR?

OPERATOR NAME AND ADDRESS

YES

OPERATOR EXPERIENCE

NO

OWNER NAME AND ADDRESS

OPERATOR EDUCATION
AMERICAN RED CROSS
USCG AUXILIARY
US POWER SQUADRON
STATE COURSE
INFORMAL
NONE

UNDER 10 HOURS
10 TO 100 HOURS
OVER 100 HOURS

AGE

IN F O R MATION : V E S S E L #1
THIS
VESSEL
ONLY

# INJURED

# DEAD

ESTIMATED DAMAGE

BOAT NUMBER (CF OR DOC #)

RENTED BOAT
YES

BOAT NAME

BOAT MODEL

YEAR BUILT

ACTIVITY

FIRE EXTINGUISHER ON BOARD

RECREATIONAL

COMMERCIAL

TYPE OF BOAT

OTHER

YES

HULL MATERIAL

# OF PERSONS TOWED

NO

MFR. HULL ID #

BOAT MANUFACTURER

(YOU R V E S S E L)
# OF PERSONS ON BOARD

LENGTH

TYPE OF FUEL

LIFE JACKETS ON BOARD

FIRE EXTINGUISHER USED

NO

YES

PROPULSION

HORSEPOWER

# OF ENGINES

NO

YES

LIFE JACKETS ACCESSIBLE

NO

YES

LIFE JACKETS WORN

NO

YES

OPERATION AT TIME OF ACCIDENT

OPEN MOTORBOAT

WOOD

OUTBOARD

CRUISING

CABIN MOTORBOAT

ALUMINUM

INBOARD

CHANGING DIRECTION

FIBERGLASS

INBOARD / OUTBOARD

CHANGING SPEED

TIED TO DOCK

PERSONAL WATERCRAFT

NO

DRIFTING

✔ AT ANCHOR

HOUSEBOAT
PLASTIC

JET

TOWING SKIER / TUBER

LAUNCHING

SAILBOAT (sail only)

RUBBER / VINYL

SAIL ONLY

TOWING SKIER- SKIER DOWN

DOCKING / LEAVING DOCK

CANOE / KAYAK

OTHER (specify)

PADDLE / OARS

TOWING ANOTHER VESSEL

SAILING

OTHER (specify)

BEING TOWED BY ANOTHER VESSEL

OTHER (specify)

SAILBOAT (aux. engine)

RAFT
ROWBOAT

SPEED

OTHER (specify)

MPH

IN F OR MATION : OP E R ATOR #2
OPERATOR NAME AND ADDRESS

IS OWNER DIFFERENT THAN OPERATOR?

YES

OPERATOR EXPERIENCE

NO

OWNER NAME AND ADDRESS

OPERATOR EDUCATION
AMERICAN RED CROSS
USCG AUXILIARY
US POWER SQUADRON
STATE COURSE
INFORMAL
NONE

UNDER 10 HOURS
10 TO 100 HOURS
OVER 100 HOURS

AGE

IN F O R MATION : V E S S E L #2
THIS
VESSEL
ONLY

# INJURED

# DEAD

ESTIMATED DAMAGE $$

BOAT NUMBER (CF OR DOC #)

BOAT NAME

YEAR BUILT

FIRE EXTINGUISHER ON BOARD
COMMERCIAL

TYPE OF BOAT

OTHER

HULL MATERIAL

# OF PERSONS TOWED

✔ NO

BOAT MODEL

ACTIVITY

(OTH ER V E S S E L IN VOLV E D )
# OF PERSONS ON BOARD

MFR. HULL ID#

BOAT MANUFACTURER

RECREATIONAL

RENTED BOAT
✔ YES

YES

LENGTH

TYPE OF FUEL

FIRE EXTINGUISHER USED

NO

PROPULSION

YES

HORSEPOWER

# OF ENGINES

LIFE JACKETS ON BOARD

NO

YES

LIFE JACKETS ACCESSIBLE

NO

YES

LIFE JACKETS WORN

NO

YES

NO

OPERATION AT TIME OF ACCIDENT

OPEN MOTORBOAT

WOOD

OUTBOARD

CRUISING

DRIFTING

CABIN MOTORBOAT

ALUMINUM

INBOARD

CHANGING DIRECTION

AT ANCHOR

FIBERGLASS

INBOARD / OUTBOARD

CHANGING SPEED

TIED TO DOCK

PLASTIC

JET

TOWING SKIER / TUBER

LAUNCHING

RUBBER / VINYL

SAIL ONLY

TOWING SKIER- SKIER DOWN

DOCKING / LEAVING DOCK

OTHER (specify)

PADDLE / OARS

TOWING ANOTHER VESSEL

SAILING

OTHER (specify)

BEING TOWED BY ANOTHER VESSEL

OTHER (specify)

PERSONAL WATERCRAFT
HOUSEBOAT
SAILBOAT (aux. engine)
SAILBOAT (sail only)
CANOE / KAYAK
RAFT
ROWBOAT

SPEED

OTHER (specify)

MPH

QUALIFICATION OF PERSON COMPLETING REPORT
NAME OF PERSON COMPLETING THE REPORT

OPERATOR

OWNER

OTHER (specify)

SIGNATURE OF PERSON COMPLETING THE REPORT
DBW FORM BAR-1 (1/00)

THIS CONFIDENTIAL REPORT IS USED IN RESEARCH FOR THE PREVENTION OF ACCIDENTS AND A COPY IS FORWARDED TO THE UNITED STATES COAST GUARD

REPORTING AGENCY

CASE NUMBER

STATE OF COLORADO DIVISION OF PARKS

CONNECTING CASE #

BOATING ACCIDENT REPORT FORM

THE OPERATOR OF EVERY VESSEL IS REQUIRED TO FILE A REPORT IN WRITING WHENEVER A BOATING ACCIDENT RESULTS
IN: LOSS OF LIFE OR DISAPPEARANCE FROM A VESSEL; AN INJURY WHICH REQUIRED MEDICAL TREATMENT BEYOND FIRST
AID; OR PROPERTY DAMAGE IN EXCESS OF $500 OR COMPLETE LOSS OF THE VESSEL. REPORTS MUST BE SUBMITTED
WITHIN 5 DAYS. ALL REPORTS MUST BE SUBMITTED TO THE DIVISION OF PARKS AND OUTDOOR RECREATION, 13787 S.
HWY. 85, LITTLETON, COLORADO 80125. ANY PERSON FAILING TO FILE THIS REPORT WHEN REQUIRED IS GUILTY OF A
MISDEMEANOR AND, UPON CONVICTION THEREOF, SHALL BE PUNISHED AS PROVIDED FOR BY LAW. (C.R.S. AS AMENDED)
COMPLETE ALL BLOCKS (INDICATE THOSE NOT APPLICABLE BY “NA”)

ACCIDENT DATA
NUMBER OF PERSONS DECEASED

NUMBER INJURED BEYOND FIRST AID

NUMBER DISAPPEARED

NUMBER OF VESSELS INVOLVED

TOTAL PROPERTY DAMAGE AMOUNT $

WAS VESSEL A TOTAL LOSS

DATE OF ACCIDENT

TIME

LOCATION NAME

STATE

NAME OF BODY OF WATER

NEAREST CITY OR TOWN

DATE REPORTED

TIME REPORTED

REPORT STATUS

❑ STATE REPORTABLE

❑ AM

❑ PM

COUNTY

LATITUDE

ALCOHOL INVOLVED ❑ YES
❑ PM

❑ RECREATIONAL

❑ NO

COUNTY CODE

❑ COMMERCIAL

❑ USCG NON-REPORTABLE
VISIBILITY

WEATHER

WATER CONDITIONS

WIND

TEMPERATURE

(CHECK ALL APPLICABLE)

❑ CALM (WAVES < 6”)

❑ NONE

AIR

(

) °F

DAY

❑ CLEAR

❑ RAIN

❑ CHOPPY (WAVES 6” - 2’)

❑ LIGHT (0 - 12 MPH)

WATER (

) °F

❑

GOOD

❑ CLOUDY

❑ SNOW

❑ ROUGH (WAVES 2’ - 6’)

❑ MODERATE (13 - 24 MPH)

❑

FAIR

❑

❑ FOG

❑ HAZY

❑ VERY ROUGH (> 6’)

❑ STRONG (25 - 54 MPH)

❑

POOR

❑

❑ STRONG / SWIFT CURRENT

❑ STORM (55 MPH AND OVER)

❑ UNKNOWN

❑ NO

LONGITUDE

❑ AM

❑ USCG REPORTABLE

❑ YES

NIGHT
❑

PERSON COMPLETING REPORT
LAST NAME

FIRST

PHONE NO. (

)

STREET ADDRESS

CITY

STATE

ZIP

STATUS OF PERSON COMPLETING REPORT

❑ OPERATOR

❑ OWNER

❑ INVESTIGATOR

❑ OTHER (SPECIFY)
SIGNATURE

DATE SUBMITTED

FOR AGENCY USE ONLY
CAUSES BASED ON (CHECK ONE)

❑ THIS REPORT

❑ INVESTIGATION ❑ INVESTIGATION AND THIS REPORT

❑ OTHER (SPECIFY)
NAME OF REVIEWING STATE REPORTING AUTHORITY

DATE RECEIVED

SIGNATURE OF REVIEWING OFFICIAL

DATE REVIEWED

INVESTIGATOR’S LAST NAME

FIRST

PHONE NO. (

PRIMARY CAUSE

SECONDARY CAUSE

TERTIARY CAUSE

REVISED 4/06

)

1

OPERATOR / OWNER INFORMATION 1 (IF MORE THAN 3, ATTACH ADDITIONAL FORMS)
OPERATOR 1 LAST NAME

FIRST

MIDDLE INITIAL

STREET ADDRESS

STATE

CITY

ZIP

PHONE NO. (

)

DATE OF BIRTH

OPERATOR EXPERIENCE WITH THIS VESSEL
❑ MALE
❑ FEMALE

❑ < 10 HOURS

❑ > 500 HOURS

❑ 10 - 100 HOURS

❑ OTHER

AGE IN YEARS

OPERATOR INSTRUCTION IN BOATING SAFETY
❑ STATE COURSE
❑ USCG AUXILIARY
❑ US POWER
SQUADRONS

❑ 100 - 500 HOURS

OWNER 1 LAST NAME

❑ RED CROSS
❑ INTERNET COURSE
(SPECIFY)

FIRST

❑ NONE
❑ OTHER
(SPECIFY)
MIDDLE INITIAL

STREET ADDRESS

CITY

STATE

ZIP

OPERATOR 2 LAST NAME

FIRST

PHONE NO. (

)

OPERATOR / OWNER INFORMATION 2
MIDDLE INITIAL

STREET ADDRESS

STATE

CITY

ZIP

PHONE NO. (

)

DATE OF BIRTH

OPERATOR EXPERIENCE WITH THIS VESSEL
❑ MALE
❑ FEMALE

❑ < 10 HOURS

❑ > 500 HOURS

❑ 10 - 100 HOURS

❑ OTHER

AGE IN YEARS

OPERATOR INSTRUCTION IN BOATING SAFETY
❑ STATE COURSE
❑ USCG AUXILIARY
❑ US POWER
SQUADRONS

❑ 100 - 500 HOURS

OWNER 2 LAST NAME

❑ RED CROSS
❑ INTERNET COURSE
(SPECIFY)

FIRST

❑ NONE
❑ OTHER
(SPECIFY)
MIDDLE INITIAL

STREET ADDRESS

CITY

STATE

ZIP

PHONE NO. (

)

OPERATOR / OWNER INFORMATION 3
OPERATOR 3 LAST NAME

FIRST

MIDDLE INITIAL

STREET ADDRESS

STATE

CITY

ZIP

PHONE NO. (

)

DATE OF BIRTH

OPERATOR EXPERIENCE WITH THIS VESSEL
❑ MALE
❑ FEMALE

❑ < 10 HOURS

❑ > 500 HOURS

❑ 10 - 100 HOURS

❑ OTHER

❑ 100 - 500 HOURS

OWNER 3 LAST NAME

OPERATOR INSTRUCTION IN BOATING SAFETY
❑ STATE COURSE
❑ USCG AUXILIARY
❑ US POWER
SQUADRONS

❑ RED CROSS
❑ INTERNET COURSE
(SPECIFY)

FIRST

REVISED 4/06

❑ NONE
❑ OTHER
(SPECIFY)
MIDDLE INITIAL

STREET ADDRESS

STATE

AGE IN YEARS

CITY

ZIP

PHONE NO. (

)

2

ACCIDENT DESCRIPTION
DESCRIBE WHAT HAPPENED (SEQUENCE OF EVENTS) AND CONTRIBUTING FACTORS. INCLUDE FAILURE OF MACHINERY OR EQUIPMENT. INCLUDE A
DIAGRAM AND 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 PERSONAL FLOATATION
DEVICES (PFDS).
PLEASE DO NOT LIST ANY PERSONAL IDENTIFIERS IN THIS SECTION -- SUCH AS NAMES OF INDIVIDUALS, TELEPHONE NUMBERS, STREET ADDRESSES,
ETC. REFER TO INDIVIDUALS AS OPERATOR 1, OPERATOR 2, VICTIM 1, VICTIM 2, ETC. AND TO THE VESSEL(S) INVOLVED AS VESSEL 1, VESSEL 2, ETC.
FOR EXAMPLE: OPERATOR OF VESSEL 1 DID NOT HAVE A PROPER LOOKOUT AND RAN INTO VESSEL 2 INJURING VICTIMS 1 AND 2 ON VESSEL 2.

REVISED 4/06

3

VESSEL INFORMATION (COMPLETE ONE FORM FOR EACH VESSEL) VESSEL# ❑ 1 ❑ 2 ❑ 3 (CHECK ONE)
NUMBER DECEASED FOR THIS VESSEL

OPERATOR DECEASED ❑ YES

NUMBER INJURED BEYOND FIRST AID FOR THIS VESSEL

❑ NO

AMOUNT OF DAMAGE FOR THIS VESSEL

$

DESCRIBE VESSEL DAMAGE

AMOUNT OF DAMAGE TO OTHER PROPERTY

$

DESCRIBE OTHER PROPERTY DAMAGE

VESSEL REGISTRATION NUMBER

STATE

VESSEL MAKE

HULL IDENTIFICATION NUMBER (HIN)

VESSEL MODEL

NAME OF VESSEL MANUFACTURER
RENTED VESSEL
❑ YES
❑ NO

YEAR BUILT

OPERATOR LIVED AT VESSEL OWNER’S RESIDENCE
VESSEL OWNER WAS

❑ OCCUPANT

❑ YES

❑ OPERATOR

VESSEL LENGTH IN FEET AND INCHES
BUI ARREST

❑ NO
❑ NOT PRESENT

❑ NO

COAST GUARD (USCG) APPROVED PERSONAL FLOTATION DEVICES (PFDS)

OPERATOR WEARING USCG PFD

REQUIRED NUMBER OF USCG APPROVED PFDS ON BOARD?

❑ YES

❑ NO

❑ YES

USCG APPROVED PFDS ACCESSIBLE

❑ YES

❑ NO

________________
FIRE EXTINGUISHERS
ON BOARD
❑ YES ❑ NO

❑ NO

FIRE EXTINGUISHERS
USED
❑ YES ❑ NO

SAFETY LANYARD USED APPROPRIATELY
❑ YES

OPERATOR BAC

❑ YES

❑ NO

TYPE OF VESSEL

VESSEL HULL MATERIAL

ENGINE

❑ AIR BOAT

❑ FIBERGLASS

❑ OUTBOARD

❑ JET

❑ PROPELLER

❑ AUXILIARY SAIL

❑ ALUMINUM

❑ STERNDRIVE -

❑ SAIL

❑ WATER JET

❑ CABIN MOTORBOAT

❑ RUBBER/VINYL/CANVAS

❑ MANUAL

❑ MANUAL

❑ CANOE

❑ RIGID HULL INFLATABLE

❑ INBOARD

❑ OTHER

❑ SAIL

❑ HOUSEBOAT

❑ KEVLAR

❑ NONE

❑ INFLATABLE

❑ PLASTIC

❑ KAYAK

PROPULSION

INBOARD (I/O)

❑ AIR THRUST

(ROYALEX, POLYETHYLENE)
NUMBER OF ENGINES _______________

❑ JET BOAT

❑ WOOD

❑ OPEN MOTORBOAT

❑ STEEL

❑ PERSONAL WATERCRAFT (PWC)

❑ OTHER (SPECIFY)

❑ PONTOON BOAT

ENGINE MAKE _____________________________________________
FUEL

❑ ROWBOAT
❑ SAIL (ONLY)

❑ GASOLINE

❑ DIESEL

❑ ELECTRIC

TOTAL HORSEPOWER FOR PRIMARY ENGINE (S) ______________

❑ OTHER (SPECIFY)

ENGINE SERIAL NUMBER (S) __________________________________

ACCIDENT EVENTS AND CONTRIBUTING FACTORS
OPERATION AT TIME OF ACCIDENT

ACTIVITY AT TIME OF ACCIDENT

TYPE OF ACCIDENT (NUMBER BY ORDER OF OCCURRENCE)

❑ AT ANCHOR

❑ COMMERCIAL ACTIVITY

_____ CAPSIZING

_____ FIRE/EXPLOSION (FUEL)

❑ BEING TOWED

❑ FISHING

_____ CARBON MONOXIDE

_____ FLOODING/SWAMPING

❑ CHANGING DIRECTION

❑ FUELING

❑ CHANGING SPEED

❑ HUNTING

❑ CRUISING

❑ MAKING REPAIRS

❑ DOCKING/UNDOCKING

❑ RACING

❑ DRIFTING

❑ STARTING ENGINE

❑ LAUNCHING

❑ SWIMMING

_____ COLLISION WITH VESSEL

_____ SKIER MISHAP

❑ ROWING/PADDLING

❑ SCUBA DIVING / SNORKELING

_____ ELECTROCUTION

_____ STRUCK BY VESSEL

❑ SAILING

❑ FISHING TOURNAMENT

_____ FALL WITHIN A VESSEL

_____ STRUCK BY PROPELLER

❑ TIED TO DOCK/MOORING

❑ TUBING

_____ FALL ON A VESSEL

OR PROPULSION UNIT

❑ TOWING ANOTHER VESSEL

❑ WATER SKIING

_____ FALL OVERBOARD

_____ STRUCK SUBMERGED

❑ TOWING WATER DEVICE OR SKIER

❑ WHITEWATER BOATING

_____ FIRE OR EXPLOSION

❑ OTHER (SPECIFY)

❑ OTHER (SPECIFY)

BOATING CITATIONS ISSUED

❑ YES

EXPOSURE
_____ COLLISION WITH FIXED
OBJECT
_____ COLLISION WITH FLOATING
OBJECT

(OTHER)

_____ GROUNDING
_____ PERSON LEAVES A VESSEL
_____ PERSON EJECTED FROM
A VESSEL
_____ SINKING

OBJECT
_____ OTHER (SPECIFY)

❑ NO

DESCRIPTION OF VIOLATION

REVISED 4/06

4

VESSEL INFORMATION CONTINUED (COMPLETE ONE FORM FOR EACH VESSEL) VESSEL# ❑ 1 ❑ 2 ❑ 3 (CHECK ONE)
DID THE ACCIDENT RESULT IN A HIT AND RUN?
❑ YES

NUMBER OF PEOPLE ON BOARD

NUMBER OF PEOPLE BEING TOWED

❑ NO

ESTIMATED SPEED AT TIME OF ACCIDENT
❑ IDLING

❑ PLOWING

❑ NOT MOVING

❑ UNDER 10 MPH

❑ ACCELERATING

❑ 10-20 MPH

❑ PLANING (ON PLANE)

CONTRIBUTING FACTORS (CHECK ALL THAT APPLY)

❑ 21-40 MPH

❑ OVER 40 MPH

❑ DECELERATING
SPECIFY “EQUIPMENT FAILURE”

❑ ALCOHOL USE

❑ OPERATOR INEXPERIENCE

❑ AUXILIARY EQUIPMENT FAILUIRE

❑ CARELESS/RECKLESS OPERATION

❑ OVERLOADING

❑ COMMUNICATION EQUIPMENT FAILURE

❑ CONGESTED WATERS

❑ PASSENGER / SKIER BEHAVIOR

❑ FIRE EXTINGUISHER NOT SERVICEABLE

❑ DAM / LOCK

❑ RESTRICTED VISION

❑ SAIL DISMASTING

❑ DRUG USE

❑ RULES OF THE ROAD VIOLATION

❑ SEAT BROKE LOOSE

❑ EQUIPMENT FAILURE

❑ SHARP TURN

❑ SOUND PRODUCING EQUIPMENT FAILURE

❑ EXCESSIVE SPEED

❑ STANDING / SITTING ON

❑ VISUAL DISTRESS SIGNALS FAILED

❑ FAILURE TO VENT

GUNWHALE, BOWS, OR TRANSOM

❑ HAZARDOUS WATERS

❑ STARTING IN GEAR

❑ VESSEL HULL FAILURE

❑ WAKE

❑ IGNITION OF SPILLED FUEL

❑ WEATHER (HEAVY)

OR VAPOR

SPECIFY “MACHINERY FAILURE”
❑ ELECTRIC SYSTEM FAILURE
❑ ENGINE FAILURE
❑ FUEL SYSTEM FAILURE

❑ NO PROPER LOOKOUT

❑ SHIFT FAILURE

❑ MACHINERY FAILURE

❑ OFF-THROTTLE STEERING

❑ OPERATOR INATTENTION

❑ NAVIGATION AID MISSING

❑ IMPROPER ANCHORING

❑ NAVIGATION AID NOT PERFORMING PROPERLY

❑ IMPROPER LOADING

❑ OTHER (SPECIFY)

❑ STEERING SYSTEM FAILURE
❑ THROTTLE FAILURE
❑ VENTILATION SYSTEM FAILURE

❑ LACK OF / IMPROPER BOAT LIGHTS

ACCIDENT DESCRIPTORS
❑ BOAT FOUND CAPSIZED

❑ BOAT STRUCK BY LIGHTNING

❑ COLLISION WITH

❑ VICTIM STRUCK BY BOOM

COMMERCIAL VESSEL

❑ BOAT FOUND UPRIGHT, DRIFTING,
OCCUPANTS DISAPPEARED

❑ RUNAWAY BOAT

❑ VICTIM ENTANGLED IN LINES

❑ PARASAILING ACCIDENT
ESTIMATED NUMBER OF DAYS VESSEL USED THIS YEAR

TYPICAL NUMBER OF HOURS VESSEL USED EACH DAY THIS YEAR

TYPICAL NUMBER OF PERSONS (INCLUDING YOURSELF) ON BOARD VESSEL EACH DAY THIS YEAR

OTHER PEOPLE ON BOARD THIS VESSEL (IF MORE THAN 2 PEOPLE, ATTACH ADDITIONAL FORMS)
LAST NAME

FIRST

STREET ADDRESS

CITY

DATE OF BIRTH

❑ MALE

WAS PFD WORN

PFD WORN PRIOR TO ACCIDENT

❑ YES

❑ YES

❑ NO

❑ FEMALE

❑ NO

STATE

LAST NAME

FIRST

STREET ADDRESS

CITY
❑ MALE

WAS PFD WORN

PFD WORN PRIOR TO ACCIDENT

❑ YES

❑ YES

❑ NO

❑ FEMALE

❑ NO

ZIP

PFD WORN AS A RESULT
OF ACCIDENT
❑ YES

DATE OF BIRTH

MIDDLE INITIAL

WAS PFD WORN INFLATABLE
❑ YES

❑ NO

❑ NO
MIDDLE INITIAL

STATE

ZIP

PFD WORN AS A RESULT
OF ACCIDENT
❑ YES

WAS PFD WORN INFLATABLE
❑ YES

❑ NO

❑ NO

WITNESSES NOT ON THIS VESSEL (IF MORE THAN 2 WITNESSES, LIST ON SEPARATE SHEET)
WITNESS 1 LAST NAME

FIRST

STREET ADDRESS

CITY

WITNESS 2 LAST NAME

FIRST

STREET ADDRESS

CITY

REVISED 4/06

PHONE NO. (
STATE

ZIP
PHONE NO. (

STATE

)

)
ZIP

5

INJURED VICTIMS (IF MORE THAN 2 INJURIES, ATTACH ADDITIONAL FORMS)
VICTIM 1 LAST NAME

FIRST

MIDDLE INITIAL

CITY

STATE

ZIP

WITH WHICH VESSEL IS THIS VICTIM ASSOCIATED?

AGE OF VICTIM

VICTIM 1 STREET ADDRESS

MEDICAL TREATMENT BEYOND FIRST AID? ❑ YES
ADMITTED TO HOSPITAL?

❑ YES

TYPE OF PFD WORN

❑ YES

❑ TYPE I

PRIOR TO ACCIDENT?

❑ TYPE II

❑ YES

❑ TYPE III

❑ NO
❑ NO

AS A RESULT OF ACCIDENT?

❑ TYPE V

❑ NO

PFD WORN WAS
USCG PFD APPROVAL NUMBER

❑ INHERENTLY BUOYANT
❑ INFLATABLE

160._________________________
ALCOHOL USE APPARENT
❑ YES

❑ NO

TYPE OF INJURY (CHECK ALL THAT APPLY)

❑ NO

❑ NO

WAS PFD WORN?

❑ YES

DATE OF BIRTH

BAC__________
INJURY CAUSED BY (CHECK ALL THAT APPLY)

PRIMARY

SECONDARY

AMPUTATION

❑

❑

BACK INJURY

❑

❑

BROKEN BONE(S)

❑

❑

BURNS

❑

❑

CARBON MONOXIDE POISONING

❑

❑

CONTUSION

❑

❑

DISLOCATION

❑

❑

ELECTROCUTION

❑

❑

HEAD INJURY

❑

❑

HYPOTHERMIA

❑

❑

INTERNAL INJURIES

❑

❑

LACERATION

❑

❑

IMPACT WITH VESSEL

❑ YES

❑ NO

IMPACT WITH WATER

❑ YES

❑ NO

IMPACT WITH FIXED /
FLOATING OBJECT

NECK INJURY

❑

❑

❑ YES

❑ NO

SHOCK

❑

❑

STRUCK BY VESSEL

❑ YES

❑ NO

❑

❑

STRUCK BY PROPULSION SYSTEM

SPINAL INJURY

❑ YES

❑ NO

EXPOSURE TO ELEMENTS

❑ YES

❑ NO

SPRAIN / STRAIN

❑

❑

TEETH

❑

❑

INJURED STATUS
❑ OPERATOR

❑ PASSENGER

❑ SWIMMER

❑ WATER SKIER

VICTIM 2 LAST NAME

FIRST

MIDDLE INITIAL

CITY

STATE

ZIP

WITH WHICH VESSEL IS THIS VICTIM ASSOCIATED?

AGE OF VICTIM

VICTIM 2 STREET ADDRESS

MEDICAL TREATMENT BEYOND FIRST AID? ❑ YES
ADMITTED TO HOSPITAL?

❑ YES

TYPE OF PFD WORN

❑ YES

❑ TYPE I

PRIOR TO ACCIDENT?

❑ TYPE II

❑ YES

❑ TYPE III

❑ NO

❑ TYPE V

AS A RESULT OF ACCIDENT?
❑ YES

❑ NO
USCG PFD APPROVAL NUMBER

PFD WORN WAS
❑ INHERENTLY BUOYANT

160._________________

❑ INFLATABLE
ALCOHOL USE APPARENT
❑ YES

❑ NO

TYPE OF INJURY (CHECK ALL THAT APPLY)

❑ NO

❑ NO

WAS PFD WORN?
❑ NO

DATE OF BIRTH

BAC__________
INJURY CAUSED BY (CHECK ALL THAT APPLY)

PRIMARY

SECONDARY

AMPUTATION

❑

❑

BACK INJURY

❑

❑

BROKEN BONE(S)

❑

❑

BURNS

❑

❑

CARBON MONOXIDE POISONING

❑

❑

CONTUSION

❑

❑

DISLOCATION

❑

❑

ELECTROCUTION

❑

❑

HEAD INJURY

❑

❑

HYPOTHERMIA

❑

❑

INTERNAL INJURIES

❑

❑

LACERATION

❑

❑

NECK INJURY

❑

❑

IMPACT WITH VESSEL

❑ YES

❑ NO

IMPACT WITH WATER

❑ YES

❑ NO

IMPACT WITH FIXED /
FLOATING OBJECT

❑ YES

❑ NO

SHOCK

❑

❑

STRUCK BY VESSEL

❑ YES

❑ NO

SPINAL INJURY

❑

❑

STRUCK BY PROPULSION SYSTEM

❑ YES

❑ NO

EXPOSURE TO ELEMENTS

❑ YES

❑ NO

SPRAIN / STRAIN

❑

❑

TEETH

❑

❑

INJURED STATUS
❑ OPERATOR

REVISED 4/06

❑ PASSENGER

❑ SWIMMER

❑ WATER SKIER

6

DECEASED VICTIMS (IF MORE THAN 2 FATALITIES, ATTACH ADDITIONAL FORMS)
VICTIM 1 LAST NAME

FIRST

MIDDLE INITIAL

CITY

STATE

ZIP

WITH WHICH VESSEL IS THIS VICTIM ASSOCIATED?

AGE OF VICTIM

ALCOHOL USE APPARENT

DRUG USE APPARENT

VICTIM 1 STREET ADDRESS

❑ YES

❑ NO

BAC__________

❑ YES

❑ NO

DATE OF BIRTH

TYPE__________

VICTIM ACTIVITY

PFD WORN

TYPE OF PFD WORN

❑ FISHING

❑ YES

❑ TYPE I

❑ HUNTING

PFD WORN WAS

❑ TRAUMA

❑ SCUBA DIVING / SNORKELING

❑ INHERENTLY BUOYANT

❑ ELECTROCUTION

❑ SWIMMING

❑ INFLATABLE

❑ TUBING

PFD USED – BUT NOT WORN

❑ WATER SKIING

❑ YES

CAUSE OF DEATH
❑ CARBON MONOXIDE POISONING
❑ DROWNING
❑ HYPOTHERMIA

❑ OTHER (SPECIFY)

VICTIM STRUCK
BY VESSEL

VICTIM STRUCK BY
PROPULSION UNIT

❑ YES ❑ NO

❑ YES ❑ NO

❑ OTHER (SPECIFY)

❑ NO

❑ TYPE II
❑ TYPE III
❑ TYPE V
PFD PERFORMANCE
❑ SUCCESSFUL

TYPE _______________

❑ FAILED

❑ NO

❑ IMPROPER WEAR / USE

PFD WAS NOT WORN AND NOT USED
❑ YES

❑ NO

COMMENTS

❑ UNKNOWN
DISAPPEARANCE
❑ YES ❑ NO

USCG PFD APPROVAL NUMBER

DECEASED STATUS

PHYSICAL CONDITION

❑ OPERATOR

❑ UNKNOWN

❑ PASSENGER

❑ UNDER INFLUENCE OF ALCOHOL / DRUGS

❑ SWIMMER

❑ OTHER (SPECIFY)

❑ NORMAL

160._________________________________
VICTIM SWIMMING ABILITY

❑ ILL

❑ HANDICAPPED

❑ YES
❑ NO
❑ UNKNOWN

❑ WATER SKIER
❑ OTHER (SPECIFY)

VICTIM 2 LAST NAME

FIRST

MIDDLE INITIAL

CITY

STATE

ZIP

WITH WHICH VESSEL IS THIS VICTIM ASSOCIATED?

AGE OF VICTIM

ALCOHOL USE APPARENT

DRUG USE APPARENT

VICTIM 2 STREET ADDRESS

❑ YES

❑ NO

BAC__________

❑ YES

❑ NO

DATE OF BIRTH

TYPE__________

VICTIM ACTIVITY

PFD WORN

TYPE OF PFD WORN

❑ FISHING

❑ YES

❑ TYPE I

❑ HUNTING

PFD WORN WAS

❑ TRAUMA

❑ SCUBA DIVING / SNORKELING

❑ INHERENTLY BUOYANT

❑ ELECTROCUTION

❑ SWIMMING

❑ INFLATABLE

❑ TUBING

PFD USED – BUT NOT WORN

❑ WATER SKIING

❑ YES

CAUSE OF DEATH
❑ CARBON MONOXIDE POISONING
❑ DROWNING
❑ HYPOTHERMIA

❑ OTHER (SPECIFY)

VICTIM STRUCK
BY VESSEL

VICTIM STRUCK BY
PROPULSION UNIT

❑ YES ❑ NO

❑ YES ❑ NO

❑ OTHER (SPECIFY)

❑ NO

❑ TYPE II
❑ TYPE III
❑ TYPE V
PFD PERFORMANCE
❑ SUCCESSFUL

TYPE _______________

❑ FAILED

❑ NO

❑ IMPROPER WEAR / USE

PFD WAS NOT WORN AND NOT USED
❑ YES

❑ NO

COMMENTS

❑ UNKNOWN
DISAPPEARANCE
❑ YES ❑ NO

USCG PFD APPROVAL NUMBER
PHYSICAL CONDITION

❑ OPERATOR

❑ UNKNOWN

❑ PASSENGER

❑ UNDER INFLUENCE OF ALCOHOL / DRUGS

❑ SWIMMER

❑ OTHER (SPECIFY)

❑ WATER SKIER

❑ NORMAL

160._________________________________
VICTIM SWIMMING ABILITY

DECEASED STATUS

❑ ILL

❑ HANDICAPPED

❑ YES
❑ NO
❑ UNKNOWN

❑ OTHER (SPECIFY)

REVISED 4/06

7

Massachusetts Environmental Police
Boating & R.V. Safety Bureau
1 Trowbridge Road
Bourne, MA 02532
Phone: (508) 759-0002 Fax: (508) 759-3357

BOATING ACCIDENT REPORT
The operator/owner of a vessel used for recreational purposes is required to file a report in writing whenever an accident results in: loss of life or disappearance from a
vessel; an injury which requires medical treatment beyond first aid; or property damage in excess of $500 or complete loss of the vessel. Reports in death and injury cases
must be submitted within 48 hours. Reports in other cases must be submitted within 5 days. Reports must be submitted to the above address. This form is provided to
assist the operator in filing the required written report.

COMPLETE ALL BLOCKS (indicate those not applicable by “NA”)
NAME AND ADDRESS OF OPERATOR

AGE OF OPERATOR

OPERATOR’S EXPERIENCE

DATE OF BIRTH

OPERATOR TELEPHONE NUMBER

OWNER TELEPHONE NO.

NAME AND ADDRESS OF OWNER

RENTED BOAT?
[ ] YES
[ ] NO

NUMBER OF
PERSONS ON
BOARD
_____________

Other Boat Operating Exp.
This type of boat
[ ] Under 20 hours
[ ] Under 20 hours
[ ] 20 to 100 hours
[ ] 20 to 100 hours
[ ] 100 to 500 hours
[ ] 100 to 500 hours
[ ] Over 500 hours
[ ] Over 500 hours
FORMAL INSTRUCTION BOATING SAFETY
[ ] NONE
[ ] USCG AUXILIARY
[ ] STATE
[ ] U.S. POWER SQUADRONS
[ ] AMERICAN RED CROSS
[ ] OTHER (Specify)______________________________

BOAT REGISTRATION NO.

BOAT NAME

VESSEL NO. 1 (this vessel)
BOAT MAKE
BOAT MODEL

TYPE OF BOAT
[ ] Open Motorboat
[ ] Cabin Motorboat
[ ] Auxiliary Sail
[ ] Sail (only)
[ ] Rowboat
[ ] Canoe
[ ] Other (Specify)
__________________________

HULL MATERIAL
[ ] Wood
[ ] Aluminum
[ ] Steel
[ ] Fiberglass
[ ] Rubber/Vinyl
[ ] Other (Specify)

ENGINE
[ ] Outboard
[ ] Inboard gasoline
[ ] Inboard diesel
[ ] Inboard outdrive
[ ] Jet
[ ] Other (Specify)

_________________

_________________

DATE OF ACCIDENT

TIME

AM
PM

PROPULSION
No. of engines ___________
Horsepower (total) _______
Type of Fuel ____________

MFR HULL IDENTIFICATION NO

CONSTRUCTION
Length ____________
Year built (boat) ___________

Has boat had a Safety Examination? [ ] YES
[ ] NO
For current year? [ ] YES
[ ] NO
Indicate whether [ ] USCG AUX. Courtesy Marine Exam
[ ] State/Local
[ ] Other

ACCIDENT DATA
NAME OF BODY OF WATER

LOCATION (Give location precisely)

Lat: ______________
Long: _____________

STATE

NEAREST CITY OR TOWN

COUNTY

VISIBILITY
WIND
TEMPERATURE
WATER CONDITIONS
Day
Night
[ ] None
(Estimate)
[ ] Calm (waves less than 6”)
[ ]
Good
[ ]
[ ] Light (0-6mph)
Air ___________ F
[ ] Choppy (waves 6” to 2’)
[ ]
Fair
[ ]
[ ] Moderate (7-14 mph)
[ ] Rough (waves 2’ to 6’)
[ ]
Poor
[ ]
Water _________ F [ ] Strong (15-25 mph)
[ ] Very Rough (greater than 6’)
[ ] Storm (Over 25 mph)
[ ] Strong Current
OPERATION AT TIME OF ACCIDENT
TYPE OF ACCIDENT
WHAT IN YOUR OPINION CONTRIBUTED TO
(Check all that apply)
THE ACCIDENT (check all that apply)
[ ] Alcohol Use
[ ] Weather
[ ] Collision with Fixed
[ ] Grounding
[ ] Drifting
[ ] Commercial Activity
[ ] Drug Use
[ ] Excessive Speed
Object
[ ] Capsizing
[ ] At Anchor
[ ] Cruising
[ ] Fault of Hull
[ ] No Proper Lookout
[ ] Collision with Floating
[ ] Flooding
[ ] Tied to Dock
[ ] Maneuvering
[ ] Fault of Machinery
[ ] Restricted Vision
Object
[ ] Sinking
[ ] Fueling
[ ] Approaching Dock
[ ] Fault of Equipment
[ ] Overloading
[ ] Falls Overboard
[ ] Fire or Explosion (Fuel)
[ ] Fishing
[ ] Leaving Dock
[ ] Operator
[ ] Improper Loading
[ ] Falls in Boat
[ ] Fire or Explosion (Other
[ ] Hunting
[ ] Water Skiing
Inexperience
[ ] Hazardous Waters
[ ] Hit by Boat or Propeller
than Fuel)
[ ] Skin
[ ] Racing
[ ] Operator Inattention
[ ] Other (Specify)
[ ] Other (Specify)
[ ] Fallen Skier
Diving/Swimming
[ ] Towing
[ ] Collision with Vessel
[ ] Being Towed
[ ] Other (Specify)
______________________
____________________
PERSONAL FLOTATION DEVICES (PFD’S)
PROPERTY DAMAGE
FIRE EXTINGUISHERS
WEATHER
[ ] Clear
[ ] Cloudy
[ ] Fog

[ ] Rain
[ ] Snow
[ ] Hazy

Was the boat adequately equipped with
C.G. Approved Flotation Devices? [ ] YES [ ] NO
Were they accessible? [ ] YES [ ] NO
Were they serviceable? [ ] YES [ ] NO
Were they used by survivors? [ ] YES [ ] NO
What Type? [ ] I, [ ] II, [ ] III, [ ] IV, [ ] V
Were PFD’s properly Used? [ ] YES [ ] NO
Adjusted? [ ] YES [ ] NO
Sized? [ ] YES [ ] NO

Was the vessel carrying NON approved
flotation devices? [ ] YES [ ] NO
Were they accessible? [ ] YES [ ] NO
Were they used? [ ] YES [ ] NO
If Yes, indicate kind
(specify)__________________________
Include any comments on PFD’s under
Accident Description on other side of form

Were they used? (If yes, list
Est. Amount
Types and number used)
This Boat $
[ ] Yes [ ] No [ ] NA
Other Boat $
Types: _____________
Other Property $
DESCRIBE PROPERTY DAMAGE
NAME AND ADDRESS OF OWNER OF DAMAGED
PROPERTY

If more than 3 fatalities and/or injuries, attach additional forms
NAME

DECEASED
DATE OF BIRTH

ADDRESS

WAS VICTIM?
[ ] Swimmer
[ ] Non Swimmer

DEATH CAUSED BY
[ ] Drowing
[ ] Other
[ ] DISAPPEARANCE

WAS PFD WORN?
[ ] YES [ ] NO
What Type?

NAME

ADDRESS

DATE OF BIRTH

WAS VICTIM?
[ ] Swimmer
[ ] Non Swimmer

DEATH CAUSED BY
[ ] Drowing
[ ] Other
[ ] DISAPPEARANCE

WAS PFD WORN?
[ ] YES [ ] NO

NAME

ADDRESS

DATE OF BIRTH

WAS VICTIM?
[ ] Swimmer
[ ] Non Swimmer

DEATH CAUSED BY
[ ] Drowing
[ ] Other
[ ] DISAPPEARANCE

WAS PFD WORN?
[ ] YES [ ] NO

What Type?

What Type?

NAME

ADDRESS

INJURED
DATE OF BIRTH

NATURE OF INJURY

MEDICAL TREATMENT
[ ] YES [ ] NO

NAME

ADDRESS

DATE OF BIRTH

NATURE OF INJURY

MEDICAL TREATMENT
[ ] YES [ ] NO

NAME

ADDRESS

DATE OF BIRTH

NATURE OF INJURY

MEDICAL TREATMENT
[ ] YES [ ] NO

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)

NAME OF OPERATOR

VESSEL NO. 2 (if more than 2 vessels, attach additional forms)
OPERATOR ADDRESS

TELEPHONE NUMBER

BOAT NUMBER
BOAT NAME

NAME OF OWNER

OWNER ADDRESS

NAME

ADDRESS

TELEPHONE NUMBER

NAME

ADDRESS

TELEPHONE NUMBER

NAME

ADDRESS

TELEPHONE NUMBER

WITNESSES

SIGNATURE

PERSON COMPLETING REPORT
ADDRESS

TELEPHONE NUMBER

QUALIFICATION (Check one)
DATE SUBMITTED
[ ] Operator [ ] Owner [ ] Investigator [ ] Other
(Do Not Use) – FOR REPORTING AUTHORITY REVIEW (Use Agency date stamp)
CAUSES BASED ON (check one)
NAME OF REVIEWING OFFICE
DATE RECEIVED
[ ] This report
[ ] Investigation and this report
[ ] Investigation
[ ] Could not be determined
PRIMARY CAUSE OF ACCIDENT

SECONDARY CAUSE OF ACCIDENT

REVIEWED BY

New Mexico Boating Accident Report

Agency Case Number

Commercial

More than $2000 damage

Government

Injured beyond First Aid #____

Recreational

Alcohol involved

Estimate of total damages

Disappearance #____

Fatality

$

Type:

Total Vessels Involved ________

Total Injured ________

Total Fatalities ________

General and Geographic Information
Date of Accident

Time of Accident

Nearest City

Date/Time Officer Arrived

No. of Vessels Involved

Body of Water

Exact Location

County
Nearest River Mile or Point Marker

Latitude: Deg

Min

Sec

Longitude Deg

Accident Site

Restricted Area

Min

Sec

Temperature

Strong Current

Lake/Reservoir

Creek

No Wake

Water

deg. F.

River Current

River

Marina/Harbor

Swimming Area

Air

deg. F.

Dam Generated

Below Dam

Boat Ramp

Other

Agency Lake

Other

Boats “Keep Out”
Special Event (Permitted)

Weather

Visibility

Light

Wind

Water Conditions

Clear

Cloudy

Dawn

Fair

Light (0-6 mph)

Calm (waves less than 6”)

Rain

Hazy

Day

Good

Moderate (7-14 mph)

Choppy (6” to 2’)

Foggy

Snow

Dusk

Poor

Strong (15-25 mph)

Rough (2’ to 6’)

Storm (over 25 mph)

Very Rough (more than 6’)

Thunder storm

Night

White Water (River)

Accident Events and Contributing Factors
Accident Type
(You may enter a primary, secondary, and tertiary accident type for each vessel by placing a 1, 2, or 3 in the appropriate area.)
VA VB VC

VA VB VC

VA VB VC

VA VB VC

Capsizing

Falls overboard

Grounding

Struck by boat (person)

Collision with fixed
object

Fall on PWC

Sinking

Fire/Explosion (fuel)

Skier hit object

Struck by skeg/prop
(person)

Collision with floating
object or person

Fire/Explosion
(non-fuel)

Skier mishap/fall

Struck underwater object
Vessel wake damage

Collision with vessel

Starting engine

Flooding (swamping)

Other

Fall in boat

Contributing Factors (You may enter up to three contributing causes for each vessel.)
VA VB VC Vessel/Injured
Alcohol use

VA VB VC Vessel/Injured

VA VB VC Vessel/Injured

VA VB VC Vessel/Injured

Failure to vent
fumes

Machinery failure

Sharp turn

Careless/Reckless

No proper look-out

Congested waters

Hazardous waters

Operator inattention

Skier or occ.
behavior

Dam or lock

Hull failure

Operator inexperience

Viol. of Nav. Rule

Drug use

Ignition of fuel vapor

Overloading

Vision obstructed

Equipment failure

Improper anchoring

Other

Excessive speed

Improper loading

Standing/sitting of gunwhale, bow, or transom

Off throttle steering
jet

Lack of proper lights

Machinery Failure

Equipment Failure

(Enter every system that failed for each vessel.)

(Indicate the equipment that failed.)

VA VB VC Vessel

VA VB VC Vessel

VA VB VC Vessel

Weather

VA VB VC Vessel

Unknown

Shift failure

Unknown

PFDs

Electrical system

Steering system

Auxiliary equipment

Sail demasting

Engine failure

Throttle failure

Communications

Seat broke loose

Fuel system

Ventilation system

Fire extinguisher

Sound producing

Starting eng. in gear

Visual distress

Vessel and Operational Information
Type of Boat

# of Engines

Propulsion

Safety Equipment

VA VB VC Vessel

Pontoon Boat

Vessel A

VA VB VC Vessel

VA VB VC Vessel

Airboat

Mini Jet Boat

Vessel B

Cabin Motorboat

Rowboat (Jon)

Vessel C

Canoe/Kayak

Total H. P.

Houseboat

Sail (Aux.
power)

Open Motorboat

Sail (only)

Personal
watercraft

Seaplane

VA VB VC Vessel

Vessel A
Vessel B

Req. PFDs on board

Manual

PFDs accessible

Propeller

Fire ext. on board

Sail

Fire ext. used

Water Jet

Nav. lights operational
Nav. lights turned on

Vessel C

Other

Hull Material
VA VB VC Vessel

Air Thrust

VA VB VC Vessel

Current Safety Exam

Fuel

Engine

Vessel was-

VA VB VC Vessel

VA VB VC Vessel

VA VB VC Vessel

Aluminum

Rigid hull infl.

Diesel

Airboat

Rented

Fiberglass

Steel

Electric

Inboard

Plastic

Wood

Gasoline

Outboard

Borrowed (not
in household)

Rubber/Vinyl

Other

I/O

Operation at Time of Accident

Activity at Time of Accident

VA VB VC Vessel

VA VB VC Vessel/Injured

VA VB VC Vessel

VA VB VC Vessel/Injured

At anchor

Docking/Undocking

Commercial purpose

Scuba diving

Being towed

Drifting

Fishing (recreational)

Skiing (surfing, etc.)

Towing a boat

Launching/Loading

Fueling

Starting engine

Changing direction

Rowing/Paddling

Hunting

Swimming/snorkeling

Changing speed

Sailing

Making repairs

Tournament (fishing)

Cruising

Wake/Surf jumping

Racing

Boat pulling tube

Docked (moored)

Other

Racing (unpermitted)

White water sports

Recreational cruising

Other

Vessel A
Reg. or Doc. No.

HIN No.

Length

Make

No. of POB

No. Injured

Estimated Speed:

Documented Name

Model
No. Fatalities

Not Moving

Federal Definition of Vessel:

Engine Serial #

Under 10 mph
Recreational

Year

No. of Skiers Towed

10-20 mph
Commercial

21-40 mph

Hit and Run

41-60 mph

Government

61-80 mph

Over 80 mph

Est. damage this boat $

Operator Information
Driver’s License #

Ht.

Exp. date

Last Name
Street

City

Age

DOB (mm/dd/yy)

State

Zip

Work Ph.

Operator Experience
10-100 hours

Restr .

Eye

M.I.

Home Ph.

Under 10 hours

Wt.

First

Operator Education
USCG
Aux.

Over 100 hours

USPS

BUI Info

Status of Op.

Other Operator Info

Red Cross

Refused

Uninjured

None

Been drinking

Injured

Other

BUI arrest

Missing

PFD used

Drugs

Fatality

Person can swim

State

Male
Female

Person was ejected

BAC

No. of Other Boating Citations

Gender

Lanyard used

Owner/Passenger Information

First Listed is Also Owner
DOB

Psgr. #
Last

First

Str.1

Str 2

2 Last

First

Str.1

Str.2

3 Last

First

Str.1

Str.2

1

Last

First

Str.1

Str.2

4

City

MI

Phone

ST

ZIP

MI

Phone

City

ST

ZIP

MI

Phone

City

ST

ZIP

MI

Phone

City

ST

ZIP

M/F

Ejected?

PFD

Swim

Vessel B
Reg. or Doc. No.

HIN No.

Length
No. of POB
Estimated Speed:

Engine Serial #

Make
No. Injured
Not Moving

Federal Definition of Vessel:

Documented Name

Model
No. Fatalities

Under 10 mph
Recreational

Year

No. of Skiers Towed

10-20 mph
Commercial

21-40 mph

Hit and Run

41-60 mph

Government

61-80 mph

Over 80 mph

Est. damage this boat $

Operator Information
Driver’s License #

Ht.

Exp. date

Last Name

Wt.

First

Street

Restr.

Eye

M.I.
City

Age

DOB (mm/dd/yy)

State

Home Ph.

Zip

Work Ph.

Operator Experience

Operator Education

Under 10 hours

USCG Aux.

Red Cross

10-100 hours

USPS

None

Over 100 hours

State

Other

BUI Info

Status of Op.

R e f u s e d
Been drinking
BUI arrest
D r u g s

No. of Other Boating Citations

B A C

Other Operator Info
Gender

Uninjured

Male

Injured

Female

Missing

PFD used

Fatality

Person can swim
Person was ejected
Lanyard used

Owner/Passenger Information

First Listed is Also Owner
DOB

Psgr. #

1

First

Last

Str.1

Str 2

2 Last

First

Str.1

Str.2

3 Last

First

Str.1

Str.2

City

Last

First

Str.1

Str.2

Reg. or Doc. No.

HIN No.

4

MI

Phone

ST

ZIP

MI

Phone

City

ST

ZIP

MI

Phone

City

ST

ZIP

MI

Phone

City

ST

ZIP

M/F

Ejected?

PFD

Swim

PFD

Swim

Vessel C
Length

Make

No. of POB

No. Injured

Estimated Speed:

Not Moving

Federal Definition of Vessel:

Engine Serial #

Documented Name

Model
No. Fatalities

Under 10 mph
Recreational

10-20 mph
Commercial

Year

No. of Skiers Towed
21-40 mph

Hit and Run

41-60 mph

Government

61-80 mph

Over 80 mph

Est. damage this boat $

Operator Information
Driver’s License #

Ht.

Exp. date

Last Name

First

Street

Restr.

Age

DOB (mm/dd/yy)

State

Zip

Work Ph.

Operator Experience
10-100 hours

Eye

M.I.
City

Home Ph.

Under 10 hours

Wt.

Operator Education
USCG
Aux.

Over 100 hours

USPS

BUI Info
Refused

Red Cross

Been drinking

None

BUI arrest

Other

Drugs

State

BAC

No. of Other Boating Citations

Status of Op.
Uninjured

Other Operator Info
Gender

Injured

Male
Female

Missing

PFD used

Fatality

Person can swim
Person was ejected
Lanyard used

Owner/Passenger Information

First Listed is Also Owner
DOB

Psgr. #

1

Last

First

Str.1

Str 2

2 Last

First

Str.1

Str.2

3 Last

First

Str.1

Str.2

Last

First

Str.1

Str.2

4

City

MI

Phone

ST

ZIP

MI

Phone

City

ST

ZIP

MI

Phone

City

ST

ZIP

MI

Phone

City

ST

ZIP

M/F

Ejected?

Injury Information
Vessel

Treatment

Status

Injured

Victim Information

Fatality

Missing (body not found)

Operator

Swimmer

Admitted to hospital

Passenger

Skier

First

M.I.

Street

City

Home Ph.

Injury Classification

Impact with boat

State

Type I

Amputation

Type II

Impact with fixed
object

Back Injury

Type III

Broken bones

Type IV

Impact with floating
object

Burns

Type V

Struck by boat

Contusions

Inflatable

Propeller or skeg

Dislocations

Other

Head Injury

USCG Approved
USCG Approval #

Hypothermia

PFD Worn

Internal Injuries

Fishing

Buoyant

Laceration

Hunting

Not Worn not used

Shock

Snorkeling

PFD Worn as
result of accident

Spinal Injury

Swimming

Sprain/Strain

Water skiing

PFD Worn prior to
accident

Teeth/Jaw

Other

Victim Physical Condition
Unknown
Normal

Not Worn but used

Neck Injury

Scuba diving

Ill

Fatal Synopsis

Under influence
of alcohol/drugs
Other

Handicapped

Victim Cause of Death and Recovery Info

Drug :

Drowning

BAC :

Hypothermia

Apparent

Trauma

Vessel

Treatment
Injured

Victim Information

Fatality

Missing (body not found)

Operator

Swimmer

Treated

Other

Admitted to hospital

Passenger

Skier

First

M.I.

Street

City

Home Ph.
Impact with boat

Type II

Impact with fixed
object

Back Injury

Type III

Broken bones

Type IV

Impact with floating
object

Burns

Type V

Struck by boat

Contusions

Inflatable

Propeller or skeg

Dislocations

Other

Head Injury

Buoyant
Not Worn but used

Neck Injury

Not Worn not used

Shock

PFD Worn as
result of accident

Spinal Injury
Sprain/Strain

Water skiing

PFD Worn prior to
accident

Teeth/Jaw

Other

Victim Physical Condition
Unknown
Handicapped

PFD Worn

Laceration

Swimming

Normal

USCG Approved

Internal Injuries

Snorkeling

Ill

Under influence
of alcohol/drugs
Other

Zip

USCG Approval #

Hypothermia

Scuba diving

Age:

Type I

Amputation

Hunting

Female

PFD

Pri. Sec.

Fishing

Male

DOB (mm/dd/yy)

Location of Injury

Impact with water

Victim Activity

Refused treatment

State

Work Ph.

Injury Classification

Alcohol found

Location Body ________________ Water Depth ______

Hospital Name:

On shore/dock

Last Name

Cause of Injury

Age:
Zip

Location of Injury

Pri. Sec.

Victim Activity

Female

PFD

Impact with water

Status

Male

DOB (mm/dd/yy)

Work Ph.

Cause of Injury

Refused treatment

Hospital Name:

On shore/dock

Last Name

Treated

Fatal Synopsis

Victim Cause of Death and Recovery Info

Drug :

Drowning

Other

BAC :

Hypothermia

Alcohol found

Apparent

Trauma

Location Body ________________ Water Depth ______

Diagram of Accident

For the Boat Accident Diagram: Indicate the location of all damaged areas on the boat configuration in the diagram. Indicate if damage
was only
Below Waterline,
Lower Unit,
Windshield,
Sunk, or
Injured no Damage. Indicate Vessel A, B, or C in the
diagram. On the vessel configuration, indicate the location of persons involved using “O” for Operator and “P” for Passenger (use the
number of the passenger from the Vessel A, B, or C sections).

Synopsis of Accident

Non-Vessel Property Damage
Was there damage to property excluding the vessels and their contents?

Yes

No

Estimated Amount $

Describe Property Damage

Non Vessel Property Owner Information
Last Name

First

Street

M.I.

City

Ph. #

State

Zip

Violations
Vessel Priority

Vessel #

Vessel #

Stand On

Violator’s Name
(Just check box if operator)

Vessel #

Statute or
Regulation

Give Way

Hit and Run Vessel #
Common
Name of the
Violation

Violation

Operator
Operator
Operator
Operator
Operator
Operator
Operator

Status

Citation

No Action

Warning

Pending

Citation

No Action

Warning

Pending

Citation

No Action

Warning

Pending

Citation

No Action

Warning

Pending

Citation

No Action

Warning

Pending

Citation

No Action

Warning

Pending

Citation

No Action

Warning

Pending

Citation
Case #

Officer Completing Report
Officer Signature

Supervisor Signature

Investigation Status

Print Officer Name, Badge #, and Radio #
Last

First

Badge #

Radio #

Complete

Pending

Not Required

Preliminary

M.I.

Causes Based On
Investigation
Operator Report

Address 1

Reviewer Interpretation

Address 2
City

State

Zip

Ph #

Print Supervisor Name and Radio #
Last

First

M.I.

Radio #

Investigative Time (Include total hours for reports, search & rescue, and investigation)
Officer Hours

Supervisor Hours

Investigator Hours

Admin. Hours

Total Hours

Date Investigation Completed (MM/DD/YY)

Date Report Received (MM/DD/YY)

Do Not Complete Below This Line – State Safety Review Only
Date Investigation Completed (MM/DD/YY)
Federal Accident Classification (For Statistical Use)
Recreational
Primary Type

Commercial
Secondary Type

Tertiary Type

Government
Primary Cause

Secondary Cause

Non-Reportable
Tertiary Cause

Reviewed by:

ID #

Notes:

Additional Witnesses
Name (Last, First, MI)

Address (Street, City, State, ZIP)

Phone #’s Home/Bus

OHIO OPERATOR BOATING ACCIDENT REPORT
Ohio Department of Natural Resources
Division of Watercraft
2045 Morse Road, Building A
Columbus, Ohio 43229-6693
Phone: (614) 265-6480
NOTE: SECTION 1547.59 of the Ohio Revised Code requires operators of all vessels to file the attached report in case of collision,
accident, or other casualty involving a vessel.
THE OPERATOR OF A VESSEL USED FOR RECREATIONAL PURPOSES IS REQUIRED TO FILE A REPORT IN WRITING
WHENEVER AN ACCIDENT RESULTS IN: LOSS OF LIFE OR DISAPPEARANCE FROM A VESSEL; AN INJURY WHICH
REQUIRES TREATMENT BEYOND FIRST AID; OR COMBINED PROPERTY DAMAGE IN EXCESS OF $500, OR COMPLETE
LOSS OF VESSEL. REPORTS IN DEATH AND INJURY CASES MUST BE SUBMITTED WITHIN 48 HOURS. REPORTS IN
OTHER CASES MUST BE SUBMITTED WITHIN 10 DAYS. The report filed shall be used for statistical purposes only,

as required by federal regulations, and shall not be admissable for any purpose in any civil, criminal, or
administrative action at law.
SEND COMPLETED REPORT TO: Ohio Department of Natural Resources, Division of Watercraft , LE/SAR Section, Bldg. A-2,
2045 Morse Road, Columbus, Ohio 43229-6693.

INSTRUCTIONS: Complete pages 2, 3 and 4. Listed below are explanations for some of the questions on this form.
Water Conditions:
Calm (waves <6˝) = Water smooth with little wave action.
Choppy (6˝ - 2´) = White caps are becoming visible.
Rough (2´ - 6´)
= White caps are prevalent with strong wave action.
Very Rough (6´) = Very large and active wave action.
Strong Current
= Water movement in a certain direction.

Wind Conditions:
Light (0-6 mph)
Moderate (7-14 mph)
Strong (15-25 mph)
Storm (over 25 mph)

No wind to rustle leaves.
Enough wind to move small branches.
Enough wind to move large branches.
Difficult to walk against the wind.

Operator Experience: Estimate the total hours experience you have operating a boat.
Manufacturer’s Hull ID Number: The hull identification number is usually found on the starboard (right) outside of the transom (back of
the boat) and is at least a 12-digit number (if 1972 or newer). An example would be ABC456781272.
Boat Number: This refers to the boat registration number or, in the case of a federally documented vessel, the document number. An
example of an Ohio boat number is OH-1234-BD.
Expiration Date: This is the date the boat registration (the decal) expires, found on the registration or the decal.
Type of Boat:

Auxiliary Sail
Sail (only)
Rowboat
Personal Watercraft

Construction:

LENGTH

A sailboat equipped with an inboard engine.
Any vessel equipped with mast and sails, dependant on the wind to propel it.
Any vessel designed to be rowed and is propelled by human muscular effort.
“Personal watercraft” means a vessel, less than 16 feet in length, propelled by machinery, and is
designed to be operated by a person sitting or kneeling on the vessel rather than by the individual
sitting or standing inside the vessel.
TRANSOM DEPTH

WIDTH

The Ohio D.N.R., Division of Watercraft thanks you for completing and mailing this form.

Be sure to sign the last page of this form.
DNR 8255

OHIO OPERATOR BOATING ACCIDENT REPORT

ODNR Number

(Offical Use Only)
USCG Number

(Official Use Only)

Page 2
ACCIDENT INFORMATION

Number of Boats in Accident?___________
Complete Loss of Vessel?

❐ Yes

❐ Yes

Injuries Requiring Medical Treatment Beyond First Aid?

❐ No

Death Related to Accident?
❐ Yes

Disappearance of Person Indicating Injury or Death?

❐ No

❐ Yes

❐ No

❐ No

If Yes, Number of Deaths?

______________

Property Damage Estimate? This Boat $_____________________ Other Boat $_____________________ Other Property $_______________________
Describe damage______________________________________________________________________________________________________________
Date of Accident
/
/

Day of Week

Time of
Accident

❐ AM

❐ PM

Name of Body of Water

Location

Nearest City or Town

(If known)

County

State

Latitude__________________

Ohio

Longitude________________

ENVIRONMENTAL CONDITIONS (If not known, estimate)
Weather

Water Conditions (Waves)

Temperatures

Wind (MPH)

❐ Calm (< 6")

❐ Choppy (6" - 2')

Air ______°F

❐ None

❐ Light (0-6)

❐ Cloudy ❐ Snow

❐ Rough (2' - 6')

❐ Very Rough (> 6')

Water _____°F

❐ Mod. (7-14)

❐ Strong (15-25)

❐ Fog

❐ Strong Current

❐ Clear

❐ Rain
❐ Hazy

Visibility

❐ Storm (> 25)

TYPE OF ACCIDENT

Day / Night

Good ______

❐

❐

Fair _______

❐

❐

Poor ______

❐

❐

WHAT CONTRIBUTED TO ACCIDENT

Check all applicable. If more than one, number choices in chronological
order of occurrence.

Check all applicable. If more than one, number choices in chronological
order of occurrence.

___ Capsizing

___ Sinking

___ Alcohol Use

___ Improper Ventilation

___ Collision with Fixed Object

___ Skier Mishap

___ Careless/Reckless Operation

___ Lack of or Improper Lights

___ Collision with Floating Object

___ Struck Submerged Object

___ Congested Waters

___ Machinery Failure

___ Collision with Vessel

___ Other (Specify) ____________

___ Dam/Lock

___ Operator Inattention

___ Fall in Boat

___________________

___ Drug Use

___ Operator Inexperience

___ Fall Overboard

___ Equipment Failure

___ Overloading

___ Fire or Explosion (Fuel)

___ Excessive Speed

___ Passenger/Skier Behavior

___ Fire or Explosion (Other)

___ Hazardous Waters

___ Restricted Vision

___ Flooding/Swamping

___ Hull Failure

___ Rules of the Road Infraction

___ Grounding

___ Ignition of Spilled Fuel/Vapor

___ Starting in Gear

___ Hit and Run

___ Improper Anchoring

___ Sitting/Standing on Gunwales,
Bow, Transom

___ Person Struck by Boat

___ Improper Loading

___ Person Struck by Motor/Propeller

___ Improper Lookout

___ Starting Engine

___ Other (Specify) ____________________________________________

___ Weather

OPERATOR/ OWNER INFORMATION
Operator’s Name

Telephone Number
(

Address

Operator’s Date of Birth SS#

❐ Male

Telephone Number
(

)

Address

City, State, Zip Code

/

Owner’s Name (If different from Operator)

)

/
❐ Female

Age

County

City, State, Zip Code

Operator Experience

Operator Instruction in Boating Safety

❐ Under 10 hours

❐ State Course

❐ 10 - 100 hours

❐ American Red Cross

❐ > 100 hours

County

❐ U.S. Power Squadron
❐ None

❐ USCG Auxiliary

OHIO OPERATOR BOATING ACCIDENT REPORT

Page 3

BOAT INFORMATION
Boat Rented
❐ Yes ❐ No

Number of Persons
Onboard

Number of Persons
Being Towed

Boat Manufacturer

Mfg. Hull ID Number

Boat Number

Expiration Date

Boat Name

Boat Model

Location of Boat After Accident

/

/

Type of Boat

Hull Material

Engine

Propulsion

Personal Floatation Devices (PFD’s)

❐ Open Motorboat

❐ Wood

❐ Outboard

❐ Propeller

❐ Cabin Motorboat

❐ Aluminum

❐ Inboard

❐ Water Jet

Was boat adequately equipped with
Coast Guard Approved Life Jackets?

❐ Auxiliary Sail

❐ Steel

❐ Inboard/Outdrive

❐ Air Thrust

❐ Sail (only)

❐ Fiberglass

❐ None

❐ Rowboat

❐ Infl. Rubber/Canv.

❐ Canoe/Kayak

❐ Rigid Hull Infl.

❐ Personal Watercraft

❐ Other__________

❐ Pontoon

________________

❐ Manual

❐ NO

Were Life Jackets Accessible?

❐ Sail

❐ YES

❐ NO

Were Life Jackets Worn?
❐ YES
Number of Engines

❐ Houseboat
❐ Other _________________

Total Horsepower

Construction (See diagram on Page 1)

❐ YES

Length_______´ _______˝

❐ NO

Fuel

Fire extinguishers on board?

❐ Gasoline

❐ YES

❐ Diesel

Used?

❐ Electric

❐ YES

Width_______´ _______˝

❐ NO
❐ NO

Transom Depth__________˝

Year Built__________

Capacity Plate Information (Boats after 1972)
If applicable:

Total Lbs.___________________

Number of Persons___________________

Operation at Time of Accident (Check all applicable)

HP___________________

Activity at Time of Accident (Check any applicable)

❐ Cruising

❐ Sailing

❐ Fishing

❐ Whitewater Sports

❐ Changing Speed

❐ Launching

❐ Hunting

❐ Fueling

❐ Changing Direction

❐ Docking/Leaving Dock

❐ Tournament

❐ Starting Engine

❐ Drifting

❐ At Anchor

❐ Swimming/Diving

❐ Commercial Activity

❐ Towing Another Boat

❐ Tied to Dock/Moored

❐ Making Repairs

❐ Other (specify)________________

❐ Being Towed

❐ Other (specify) ___________________________

❐ Water Skiing/Tubing

______________________________

❐ Rowing/Paddling

_________________________________________

❐ Racing

Estimated Speed

❐ None

❐ Under 10 MPH

❐ 10-20 MPH

❐ 21-40 MPH

❐ Over 40 MPH

FATALITIES INFORMATION (Attach additional pages if needed)
Victim from:

Victim from:
❐ Other Boat

❐ This Boat

❐ No Boat

Victim from:

❐ This Boat

❐ Other Boat

❐ No Boat

❐ This Boat

❐ Other Boat

❐ No Boat

Name __________________________________

Name __________________________________

Name __________________________________

Address _________________________________

Address _________________________________

Address _________________________________

City, State, Zip ___________________________

City, State, Zip ___________________________

City, State, Zip ___________________________

Telephone # _____________________________

Telephone # _____________________________

Telephone # _____________________________

Date of Birth _____________ Age __________

Date of Birth _____________

Date of Birth _____________ Age __________

❐ Male ❐ Female SS#

❐ Male ❐ Female SS#

Age __________

❐ Male ❐ Female SS#

Death Caused By:

❐ Impact/Trauma

Death Caused By:

❐ Impact/Trauma

Death Caused By:

❐ Impact/Trauma

❐ Drowning

❐ Unknown

❐ Drowning

❐ Unknown

❐ Drowning

❐ Unknown

❐ Hypothermia

❐ Other _____________

❐ Hypothermia

❐ Other _____________

❐ Hypothermia

❐ Other _____________

Was Victim:

❐ Water Skier

Was Victim:

❐ Water Skier

Was Victim:

❐ Water Skier

❐ Operator

Propeller Injury?

❐ Operator

Propeller Injury?

❐ Operator

Propeller Injury?

❐ Passenger

❐ Yes

❐ Passenger

❐ Yes

❐ Passenger

❐ Yes

❐ Swimmer

❐ No

❐ Swimmer

❐ No

❐ Swimmer

❐ No

Victim’s Swimming Ability

Victim’s Swimming Ability
❐ Unknown

❐ Swimmer

❐ Non-Swimmer

PFD Worn? ❐ No ❐ Yes Type ___________

❐ Unknown

❐ Swimmer

Victim’s Swimming Ability
❐ Non-Swimmer

PFD Worn? ❐ No ❐ Yes Type ___________

❐ Unknown

❐ Swimmer

❐ Non-Swimmer

PFD Worn? ❐ No ❐ Yes Type ___________

OHIO OPERATOR BOATING ACCIDENT REPORT

Page 4

INJURED PERSONS (Attach additional pages if needed)
Victim: ❐ This Boat ❐ Other Boat ❐ No Boat

Victim: ❐ This Boat ❐ Other Boat ❐ No Boat

Victim: ❐ This Boat ❐ Other Boat ❐ No Boat

Name __________________________________

Name __________________________________

Name __________________________________

Address _________________________________

Address _________________________________

Address _________________________________

City, State, Zip ___________________________

City, State, Zip ___________________________

City, State, Zip ___________________________

Telephone # _____________________________

Telephone # _____________________________

Telephone # _____________________________

Date of Birth _____________ Age __________

Date of Birth _____________

Date of Birth _____________

❐ Male ❐ Female
Medical Treatment Beyond First Aid
(Treatment by a Physician)
❐ Yes ❐ No
Admitted to Hospital ❐ Yes ❐ No ❐ Unknown

❐ Male ❐ Female
Medical Treatment Beyond First Aid
(Treatment by a Physician)
❐ Yes ❐ No
Admitted to Hospital ❐ Yes ❐ No ❐ Unknown

❐ Male ❐ Female
Medical Treatment Beyond First Aid
(Treatment by a Physician)
❐ Yes ❐ No
Admitted to Hospital ❐ Yes ❐ No ❐ Unknown

Was Victim:
❐ Operator
Propeller Injury?
❐ Passenger
❐ Yes
❐ Swimmer
❐ No
❐ Water Skier
PFD Worn? ❐ No ❐ Yes Type ___________
Injury (If more than one, number choices in order
of severity)
___ Amputation
___ Internal Injuries
___ Back Injury
___ Laceration (Cuts)
___ Broken Bone(s)
___ Neck Injury
___ Burns
___ Shock
___ Contusion (Bruises)
___ Spinal Injury
___ Dislocation
___ Sprain/Strain
___ Head Injury
___ Teeth
___ Hypothermia

Was Victim:
❐ Operator
Propeller Injury?
❐ Passenger
❐ Yes
❐ Swimmer
❐ No
❐ Water Skier
PFD Worn? ❐ No ❐ Yes Type ___________
Injury (If more than one, number choices in order
of severity)
___ Amputation
___ Internal Injuries
___ Back Injury
___ Laceration (Cuts)
___ Broken Bone(s)
___ Neck Injury
___ Burns
___ Shock
___ Contusion (Bruises)
___ Spinal Injury
___ Dislocation
___ Sprain/Strain
___ Head Injury
___ Teeth
___ Hypothermia

Was Victim:
❐ Operator
Propeller Injury?
❐ Passenger
❐ Yes
❐ Swimmer
❐ No
❐ Water Skier
PFD Worn? ❐ No ❐ Yes Type ___________
Injury (If more than one, number choices in order
of severity)
___ Amputation
___ Internal Injuries
___ Back Injury
___ Laceration (Cuts)
___ Broken Bone(s)
___ Neck Injury
___ Burns
___ Shock
___ Contusion (Bruises)
___ Spinal Injury
___ Dislocation
___ Sprain/Strain
___ Head Injury
___ Teeth
___ Hypothermia

Age __________

Age __________

ACCIDENT DESCRIPTION
DESCRIBE WHAT HAPPENED: Sequence of events leading up to the accident (attach additional pages if necessary)

OTHER BOAT(S) INVOLVED
Operator’s Name

Address

Boat Number

Telephone # (

)

Boat Name

WITNESSES
Name

Address

Telephone # (

)

Name

Address

Telephone # (

)

SIGNATURE
❐ Operator ❐ Owner ❐ Investigator
__________________________________________________________________________________________
Print Name
Signature
Date (Month, Day, Year)
❐ Other _______________________
Accident Reported to Law Enforcement Agency
❐ Yes

❐ No

Name of Agency ________________________________________________________________________________________________

FOR REPORTING AUTHORITY REVIEW (Do Not Use)
Name of Reviewing Office

Name of Reviewing Officer Amended Report ❐ Yes ❐ No

Primary Cause

Secondary Cause

PLEASE DOUBLE CHECK YOUR REPORT FOR ACCURACY.

Date

INSTRUCTIONS FOR COMPLETING RHODE ISLAND BOATING ACCIDENT REPORT

Rhode Island boating accident report must be filled out by the owner/operator of any vessel that
is involved in a boating accident on the inland waters and the coastal waters contiguous to this
state that meets the following criteria:
1. Loss of life or disappearance from a vessel.
2. Injury to any person that requires medical treatment beyond ordinary first aid. (if you go
to the emergency room or call a rescue, it is beyond first aid)
3. Property damage in excess of $2000.00 (combined damage to both vessels if more than
one vessel involved)
4. Complete loss of a vessel.
Accidents that involve loss of life or injury must be submitted within 48 hours. All other
accidents must be reported within 10 days of the incident.
Accidents must be reported to the State Authorities where the accident occurred.
If more than one vessel is involved the owner/operator of all vessels must fill out and file a
boating accident report.
When filling out a boating accident report, insure that all of the blocks are filled out completely.
1.
2.
3.
4.

Most information about your boat can be found on the registration card.
Both, the operator and the owner information is required to be completed.
Addresses should be complete including zip codes.
Damage estimates MUST be filled out. (Best guess estimate is acceptable and
changed as information is received).
5. Accident description should be as clear and accurate as possible. Diagrams and
description can be continued on additional sheets if necessary. Include any
information as to the involvement of alcohol or drugs in the cause or contributing to
the accident. Include any descriptive information about the use of lifejackets (PFD’s)
that may have contributed to the survival or assistance to anyone involved.
6. Once the form has been completed it should be sent to:
Department of Environmental Management
Division of Law Enforcement
235 Promenade Street
Providence, RI 02908
Attention: Boating Accident
If you have any difficulty with/or questions regarding the BOATING ACCIDENT FORM, you
may call this office at (401) 222 3070 during normal business hours and your call will be
referred to an Environmental Police Officer for assistance.

BOATING ACCIDENT REPORT
235 Promenade Street
Providence, RI 02908
(401) 222 2284

State of Rhode Island & Providence Plantations
Department of Environmental Management
Division of Law Enforcement
Environmental Police

THE OPERATOR OF A VESSEL USED FOR RECREATIONAL PURPOSES IS REQUIRED TO FILE A REPORT IN WRITING WHENEVER AN ACCIDENT RESULTS IN LOSS
OF LIFE OR DISAPPEARANCE FROM A VESSEL; AN INJURY WHICH REQUIRES MEDICAL TREATMENT BEYOND FIRST AID; OR PROPERTY DAMAGE IN EXCESS OF
$2,000 OR COMPLETE LOSS OF THE VESSEL. REPORTS IN DEATH AND INJURY CASES MUST BE SUBMITTED WITHIN 48 HOURS. REPORTS IN OTHER CASES
MUST BE SUBMITTED WITHIN 10 DAYS. REPORTS MUST BE SUBMITTED TO THE REPORTING AUTHORITY IN THE STATE WHERE THE ACCIDENT OCCURRED. THIS
FORM IS PROVIDED TO ASSIST THE OPERATOR IN FILING THE REQUIRED WRITTEN REPORT. RIGL 46-22-21
COMPLETE ALL BLOCKS (INDICATE THOSE NOT APPLICABLE BY “NA”
ACCIDENT DATA
DATE OF ACCIDENT

TIME

NUMBER OF VESSELS
INVOLVED

NEAREST CITY OR TOWN

COUNTY

WEATHER
(CHECK ALL
CLEAR
CLOUDY
FOG

WATER CONDITIONS
CALM WAVES (LESS THAN 6”)
CHOPPY (WAVES 6” TO 2’)
ROUGH (WAVES 2’ TO 6’)
VERY ROUGH (GREATER THAN 6’)

TEMPERATURE
(ESTIMATE)

APPLICABLE)
RAIN
SNOW
HAZY

AM
PM

NAME OF BODY OF WATER

LOCATION (GIVE LOCATION PRECISELY)
STATE

ZIP CODE

WIND

VISIBILITY
DAY
GOOD
FAIR
POOR

NONE
LIGHT (0-6 MPH)
MODERATE (7-14 MPH)
STRONG (15-25 MPH)
STORM (OVER 25 MPH)

AIR ___________ ˚F
WATER ________˚F

NIGHT

STRONG CURRENT
NAME OF OPERATOR

OPERATOR ADDRESS

OPERATOR TELEPHONE NUMBER
(
)
MALE

DATE OF BIRTH
MO
DAY

OPERATOR EXPERIENCE
NONE
UNDER 100 HOURS
100 HOURS OR MORE
OWNER ADDRESS

YR

FEMALE

NAME OF OWNER
OWNER TELEPHONE NUMBER
(
)

NUMBER OF PEOPLE ON BOARD

BOATING SAFETY
STATE COURSE
USCG AUXILIARY
NONE

NUMBER OF PEOPLE BEING TOWED

BOAT REGISTRATION OR DOCUMENTATION NUMBER

BOAT NO. 1 (THIS VESSEL)
STATE
HULL IDENTIFICATION NUMBER

BOAT MANUFACTURER

LENGTH

TYPE OF BOAT
OPEN MOTORBOAT
CABIN MOTOR BOAT
AUXILIARY SAIL
SAIL (ONLY)
ROWBOAT
CANOE/KAYAK
PERSONAL WATERCRAFT
PONTOON BOAT
HOUSEBOAT
OTHER (SPECIFY)

OPERATION AT TIME OF ACCIDENT
(check all applicable)

HULL MATERIAL
WOOD
ALUMINUM
STEEL
FIBERGLASS
RUBBER/VINYL
RIDGID HULL INFLAT
OTHER (SPECIFY

COMMERCIAL
YES

PROPULSIONB
PROPELLER
WATERJET
AIR THRUST
MANUAL
SAIL

FUEL

NUMBER OF ENGINES
GASOLINE
DIESEL
ELECTRIC
NONE

VESSEL?
NO

FISHING
TOURNAMENT
HUNTING
SWIMMING/DIVING
MAKING REPAIRS
WATERSKIING/TUBING/ETC:
RACING
WHITEWATER SPORTS
FUELING
STARTING ENGINE (S)
NON-RECREATIONAL
COMMERCIAL ACTIVITY
OTHER (SPECIFY)

10-20 MPH
21-40 MPH

OVER 40 MPH

RENTED BOAT?
YES

NO

BOAT NAME
YEAR BUILT

ENGINE
OUTBOARD
INBOARD
INBOARD/STERNDRIVE
AIRBOAT

ACTIVITY AT TIME OF ACCIDENT
(check any if applicable)

CRUISING
CHANGING DIRECTION
CHANGING SPEED
DRIFTING
TOWING
BEING TOWED
ROWING/PADDLING
SAILING
LAUNCHING
DOCKING/UNDOCKING
AT ANCHOR
TIED TO DOCK/MOORING
OTHER (SPECIFY)
COMMERCIAL OPERATION

ESTIMATED SPEED
NONE
UNDER 10 MPH

MODEL

INSTRUCTION
U.S. POWER SQUADRON
AMERICAN RED CROSS
OTHER

TOTAL HORSEPOWER

Type of accident
GROUNDING
CAPSIZING
FLOOD/SWAMPING
SINKING
FIRE OR EXPLOSION (FUEL)
FIRE OR EXPLOSION (OTHER)
SKIER MISHAP
COLLISION WITH VESSEL
COLLISION WITH FIXED OBJECT
COLLISION WITH FLOATING OBJ.
FALLS OVERBOARD
FALLS IN BOAT
STRUCK BY BOAT
STRUCK BY MOTOR/PROPELLER
STRUCK SUBMERGED OBJECT
OTHER (SPECIFY

HIT AND RUN

PERSONAL FLOTATION DEVICES (LIFE JACKETS) WAS
BOAT ADAQUATLEY EQUIPPED WITH CG APPROVED
LIFE JACKETS?
YES
WERE THE LIFE JACKETS USED?

FIRE EXTINGUISHERS
ON BOARD?
USED?

YES
YES

What contributed to accident?
(check all applicable)
WEATHER
EXCESSIVE SPEED
IMPROPER LOOKOUT
RESTRICTED VISION
OVERLOADING
IMPROPER LOADING
HAZARDOUS WATERS
ALCOHOL USE
DRUG USE
HULL FAILURE
MACHINERY FAILURE
OPERATOR INEXPERIENCE
OPERATOR INATTENTION
CONGESTED WATERS
PASSENGER/SKIER BEHAVIOR
DAM/LOCK SAFETY
OTHER (SPECIFY)

NO
NO

DECEASED (IF MORE THAN 2 FATALITIES, ATTACH ADDITIONAL FORMS)
NAME OF VICTIM

ADDRESS OF VICTIM

WAS LIFEJACKET WORN?
YES

DATE OF BIRTH

MALE

DEATH CAUSED BY

FEMALE

NAME OF VICTIM

DROWNING

OTHER

ADDRESS OF VICTIM

NO

DISAPPEARANCE
WAS LIFE JACKET WORN?
YES

NAME OF VICTIM

MALE

FEMALE

DEATH CAUSED BY

DROWNING

OTHER

NO

DISAPEARANCE

INJURED (IF MORE THAN 2 INJURIES, ATTACH ADDITIONAL FORMS)
NAME OF VICTIM
DATE OF BIRTH

ADDRESS OF VICTIM
MEDICAL TREATMENT BEYOND FIRST AID
ADMITTED TO THE HOSPITAL?

WAS PFD WORN?
WAS IT INFLATABLE

YES
YES

NO
NO

PRIOR TO
ACCIDENT?

YES
YES

NO
NO

DESCRIBE INJURIES

YES

NO

AS A RESULT OF THE ACCIDENT

NAME OF VICTIM
DATE OF BIRTH

YES

NO

YES

NO

ADDRESS OF VICTIM
MEDICAL TREATMENT BEYOND FIRST AID?
ADMITTED TO THE HOSPITAL?

WAS PFD WORN?
WAS IT INFLATABLE

YES
YES

NO
NO

PRIOR TO THE
ACCIDENT

YES
YES

NO
NO

DESCRIBE INURIES

YES

NO

AS A RESULT OF THE ACCIDENT

BOAT NO. 2 (IF MORE THAN 2 VESSELS, ATTACH ADDITIONAL IDENTIFYING INFORMATION)
NAME OF OPERATOR

OPERATOR ADDRESS

OPERATOR TELEPHONE NUMBER
(
)
NAME OF OWNER

BOAT REGISTRATION OR DOCUMENTATION NUMBER

STATE

OWNER ADDRESS

OWNER TELEPHONE NUMBER
(
)

PROPERTY DAMAGE
ESTIMATED AMOUNT
(USE BEST GUESS IF FORMAL ESTIMATE NOT
AVAILABLE)

THIS BOAT AND CONTENTS
$

OTHER BOAT AND CONTENTS
$

OTHER PROPERTY
$

DESCRIBE PROPERTY DAMAGE

WITNESS NOT ON THIS VESSEL
NAME

ADDRESS

TELEPHONE NUMBER
(
)

NAME

ADDRESS

TELEPHONE NUMBER
(
)

NAME

ADDRESS

SIGNATURE

QUALIFICATION

PERSON COMPLETING THIS REPORT
TELEPHONE NUMBER
(
)
OPERATOR
INVESTIGATOR

OWNER
OTHER

DATE SUBMITTED

ACCIDENT DESCRIPTION
DESCRIBE WHAT HAPPENED (SEQUENCE OF EVENTS, INCLUDE FAILURE OF EQUIPMENT. INCLUDE A DIAGRAM IF NEEDED. 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 LIFE JACKETS.

FOR AGENCY USE ONLY
CAUSES BASED ON (CHECK ONE)
NAME OF REVIEWING OFFICER
PRIMARY CAUSE

THIS REPORT
DATE RECEIVED

INVESTIGATION

INVESTIGATION AND THIS REPORT
RECREATIONAL
COMMERCIAL
SECONDARY CAUSE

OTHER
NON-REPORTABLE

WASHINGTON STATE PARKS & RECREATION COMMISSION
BOATING PROGRAMS (360) 586-6592

PARKS USE ONLY
V

F

I

D$

WASHINGTON BOAT ACCIDENT
REPORT (BAR)
When you have completed this report mail to sheriff or police department that has jurisdiction where accident occurred,
or mail to Boating Program at :

Washington State Parks and Recreation Commission
PO Box 42654, Olympia WA 98504-2654
OPERATOR/OWNER: Shall submit report to sheriff or police department that has authority where accident occurred.
Reports in death and injury cases must be submitted within 48 hours. Reports in other cases are required within 10 days.
When the operator is incapacitated, the operator/owner or law enforcement agency shall file the boating accident. Report.
The operator of a boat involved in an accident is required by law to file a report in writing when:
• A boating accident results in loss of life.
• Property damage is in excess of $500, or there is a complete loss of
a vessel.
• Injury which required medical treatment
beyond first aid.
• The disappearance of a person from a vessel under circumstances
that indicate death or injury.
This report is confidential and will only be used by governmental agencies for statistical purposes as provided in
RCW 79A.60.210.
PLEASE TYPE OR PRINT – Complete all requested information. Your Accuracy Will Help Make Our Waters Safer!
County, WA, City of

REPORT NUMBER

OPERATOR INFORMATION
OPERATOR NAME (LAST/FIRST MI)

TELEPHONE NUMBER

OPERATOR ADDRESS (STREET, CITY, STATE, ZIP CODE)

AGE

DOB

ACCIDENT NARRATIVE (DESCRIBE ACCIDENT IN YOUR OWN WORDS - DESCRIBE HOW EACH EVENT OCCURRED IN THIS ACCIDENT)

WASHINGTON BOAT ACCIDENT REPORT
P&R A-000 (03/2005)

1

OPERATOR
EXPERIENCE WITH
THIS TYPE OF BOAT

OPERATOR EXPERIENCE
WITH OTHER TYPES OF
BOATS

Under 10 hr
10-100 hrs
Over 100 hrs.
Unknown

FORMAL INSTRUCTION IN BOATING SAFETY

Under 10 hr
10-100 hrs
Over 100 hrs.
Unknown

USCG Auxiliary
US Power Squadron
American Red Cross

Other State or Local Class
No Formal Training
None
Unknown

OWNER NAME (IF DIFFERENT THAN OPERATOR)

TELEPHONE NUMBER

OWNER ADDRESS (STREET, CITY, STATE, ZIP CODE)

ACCIDENT DATA
TIME OF ACCIDENT (2400 HR)

DATE OF ACCIDENT
(MM/DD/YYYY)

COUNTY

BODY OF WATER (BOW)

GPS COORDINATES LATITUTE

PRECISE ACCIDENT LOCATION

GPS COORDINATES LONGITUTE
STATE

NEAREST CITY OR TOWN

WA
Recreational

PLEASE CHECK ALL THAT APPLY:

Y

N

ZONE OF OPERATION

Unzoned
No Wake
No Boats

$500 or More Damage

Y

N

Hit & Run

BODY OF WATER

Restricted MPH
Ski

Speed
Other

Y

N

TRAFFIC

River
Channel

Ocean
Lake

Light
Medium
Heavy

CONDITIONS
WEATHER

WIND

(CHECK ALL THAT
APPLY)

Clear
Cloudy
Fog
Rain
Snow
Hazy
Unknown

WATER CONDITIONS

Calm (waves less than 6")
Choppy (waves 6"-2')
Rough (waves 2'-6')
Very Rough (waves 6'+)
Strong Current
Unknown

None
Light (0-6 mph)
Moderate (7-14 mph)
Strong (15-25 mph)
Storm (over 25 mph)
Unknown

TEMPERATURE
S

VISIBILITY
DAY

°F Air

NIGHT

VISIBILITY

Good

°F

Fair

Water

Poor
Unknown

Unknown

TYPE OF ACCIDENT

Capsizing
Carbon Monoxide Poisoning
Collision with Fixed Object
Collision with Floating Object
Collision with Other Boat
Dam Related

Fall in Boat
Fire/Explosion (Fuel)
Fire/Explosion (Other than Fuel)
Flooding/Swamping
Grounding
Locking Through Dam

Fall Overboard
Struck by Boat
Struck by Propeller
Swimmer
Sinking

Tow Sport: Skier, Tuber,
Kneeboard
Starting/Stopping Engine
Struck Submerged Object
Willful Action
Other:

BOAT # 1
DATA
ESTIMATED BOAT DAMAGE
$
REGISTRATION NUMBER
NUMBER OF ENGINES

1

2

BOAT RENTED

Yes
STATE

HORSEPOWER

#1

MFG

DOCUMENTATION #

NUMBER OF
SKIERS

MODEL

LENGTH

YR. MFG

MFG. HIN

BOAT NAME

#2

BOAT INVOLVED WITH

Fixed Object
Swimmer
Other Boat
Other Object

# OF PERSONS ON BOARD

No

BOAT SAFETY INFORMATION

Person Towed
Other:

No
If boat PWC, did operator have a safety lanyard attached? Yes
This boat has had a USCG Auxiliary, USPS, State, or Local Safety Check. Most
recent year the safety check completed:
This boat has never had a safety check.

WASHINGTON BOAT ACCIDENT REPORT
P&R A-000 (03/2005)

2

BOAT # 1 (continued)
PERSONAL FLOTATION DEVICES (PFD's)

Was there a USCG approved PFD for each person on
board (POB)?
Were PFDs accessible?
Were PFDs in good conditions?
How many POB were wearing PFDs at time of accident?
What type of approved PFDs were on board (check labels)

Yes
Yes
Yes

No
No
No

I

II

Yes
Yes

No
No

III

IV

V

FIRE EXTINGUISHERS

Was there a Fire Extinguisher on board if required?
Was a Fire Extinguisher used?
If Yes, list types and # used:
ALCOHOL INVOLVEMENT

Yes
Yes
Yes
Yes

Was there any liquor or alcoholic beverages on board during the operation of this boat?
Did operator consume any alcohol before or during the operation of this boat?
Did any passengers consume any alcohol before or during the operation of this boat?
If 2 or more boats were involved in this accident, was there any indication that the operator(s) had been
drinking?

No
No
No
No

ESTIMATED USAGE OF BOAT

Estimated number of days vessel used this year:
Typical number of hours vessel used each day this year:
Typical number of persons (Including yourself) on board vessel each day this year:
TYPE OF BOAT

Airboat
Sail Only
Sail with Motor
Pedal Boat

Houseboat
Jet Boat
Pontoon Boat
Canoe

Cabin Motorboat
Open Motorboat
Raft
Rowboat

TYPE OF HULL

Personal Watercraft
(PWC or “Jet Ski”)
Rigid Hull Inflatable
Kayak (type

Sea Kayak

Other

White Water

General Use)

TYPE OF ENGINE

Aluminum
Fiberglass
Plastic
Rigid Hull Inflatable

Rubber/Vinyl/Canvas
Steel
Wood
Other

Electric
Inboard
Jet Pump
Outboard

Inboard Gasoline
Manually Powered
Inboard-Out drive
Inboard Diesel

Other
None

TYPE OF PROPULSION

Air Thrust
Manual

Propeller
Sail

Water Jet
Other

OPERATION AT THE TIME OF ACCIDENT - WHAT WAS BOAT OPERATION AT TIME OF ACCIDENT?

At Anchor/Moorage
Being Towed
Changing Direction
Changing Speed

Cruising
Docking/Undocking
Drifting/floating
Launching/retrieving

Rowing or Padding
Sailing
Tied to Dock/Mooring
Towing another Boat

Towing one or more persons
Start/Stop Engine
Fueling
Emergency Repairs
Other

ACTIVITY AT TIME OF ACCIDENT - WHY WERE BOATERS ON WATER?

Commercial
Diving or
Swimming
Fishing
Hunting
Permitted Racing
Repairs
Site Seeing
Floating or drifting

Tournament/Race
Traveling Between Locations
PWC Play: Jumping Wakes,
Turning Circles, etc.
Maneuvering within Marina or
Moorage
Water Skiing or Other Tow Sport
Whitewater Sports

ESTIMATED SPEED

River Rafting
Flat-water Paddling
Racing
Sailing
Working on Boat
Other

Not Moving
1-10 mph
11-20 mph
21-30 mph
31-40 mph
41-60 mph
61-80 mph
Over 80 mph

WASHINGTON BOAT ACCIDENT REPORT
P&R A-000 (03/2005)

3

CAUSE OF ACCIDENT (Check all that apply)

Alcohol Use
Ignition of Spilled Fuel or Vapor
Passenger/Skier Behavior
Boat, Machinery, or Equipment
Improper Anchoring
Restricted Vision
Improper Loading
Rules of the Road Violation
Exhaust
Congested Waters
Improper Lighting or No Lights
Sharp Turn
Dam/Lock
Machinery Failure
Standing/Sitting on Gunwale, Bow or Transom
Drug Use
Negligent Operation
Starting in Gear
Equipment Failure
No Proper Lookout
Wake
Excessive Speed
Operator error
Weather (Heavy)
Failure of Hull
Operator Inattention
Improper exhaust venting
Failure to Vent
Starting in Gear
Other:
Hazardous Waters
Operation Inexperience
Over Powering
Overloading
If two (2) or more vessels were involved – did the operator of other vessel (s) file a report?
Yes
No
BOAT DAMAGE – CIRCLE DAMAGED AREA(S)

TOP

BOTTOM

RIGHT

LEFT

TRANSOM

BOAT NAME

BOAT # 2
DATA
ESTIMATED BOAT DAMAGE
$
REGISTRATION NUMBER
NUMBER OF ENGINES

1

BOAT RENTED

Yes
STATE

HORSEPOWER

2

#1

MFG

DOCUMENTATION #

NUMBER OF
SKIERS

MODEL

LENGTH

YR. MFG

MFG. HIN

#2

BOAT INVOLVED WITH

Fixed Object
Swimmer
Other Boat
Other Object

# OF PERSONS ON BOARD

No

Person
Towed
Other:

BOAT SAFETY INFORMATION

No
If boat PWC, did operator have a safety lanyard attached? Yes
This boat has had a USCG Auxiliary, USPS, State, or Local Safety Check. Most
recent year the safety check completed:
This boat has never had a safety check.

PERSONAL FLOTATION DEVICES (PFD's)

Yes
Yes
Yes

Was there a USCG approved PFD for each person on board (POB)?
Were PFDs accessible?
Were PFDs in good conditions?

No
No
No

How many POB were wearing PFDs at time of accident?
What type of approved PFDs were on board (check labels)

I

II

III

IV

V

FIRE EXTINGUISHERS

Was a Fire Extinguisher on board if required?
Was a Fire Extinguisher used?
If Yes, list types and # used:

Yes
Yes

No
No

ALCOHOL INVOLVEMENT

Was there any liquor or alcoholic beverages on board during the operation of this boat?
Did operator consume any alcohol before or during the operation of this boat?
Did any passengers consume any alcohol before or during the operation of this boat?
If 2 or more boats were involved in this accident, was there any indication that the operator(s) had been drinking?

Yes
Yes
Yes
Yes

No
No
No
No

ESTIMATED USAGE OF BOAT

Estimated number of days vessel used this year:
Typical number of hours vessel used each day this year:
Typical number of persons (Including yourself) on board vessel each day this year:

WASHINGTON BOAT ACCIDENT REPORT
P&R A-000 (03/2005)

4

BOAT # 2 (continued)
TYPE OF BOAT

Airboat
Sail Only
Sail with Motor
Pedal Boat

Houseboat
Jet Boat
Pontoon Boat
Canoe

Cabin Motorboat
Open Motorboat
Raft
Rowboat

TYPE OF HULL

Personal Watercraft
(PWC or “Jet Ski”)
Rigid Hull Inflatable
Kayak (type)

Other

TYPE OF ENGINE

Aluminum
Fiberglass
Plastic
Rigid Hull Inflatable

Rubber/Vinyl/Canvas
Steel
Wood
Other

Electric
Inboard
Jet Pump
Outboard

Inboard Gasoline
Manually Powered
Inboard-Out drive
Inboard Diesel

Other
None

TYPE OF PROPULSION

Air Thrust
Manual

Propeller
Sail

Water Jet
Other

OPERATION AT THE TIME OF ACCIDENT - WHAT WAS BOAT OPERATION AT TIME OF ACCIDENT?

At Anchor/Moorage
Being Towed
Changing Direction
Changing Speed

Cruising
Docking/Undocking
Drifting/floating
Launching/retrieving

Rowing or Padding
Sailing
Tied to Dock/Mooring
Towing another Boat

Towing one or more persons
Start/Stop Engine
Fueling
Emergency Repairs
Other

ACTIVITY AT TIME OF ACCIDENT - WHY WERE BOATERS ON WATER?

Commercial
Diving or Swimming
Fishing
Hunting
Permitted Racing
Repairs
Site Seeing
Floating or drifting

Tournament/Race
Traveling Between Locations
PWC Play: Jumping Wakes,
Turning Circles, etc.
Maneuvering within Marina or
Moorage
Water Skiing or Other Tow Sport
Whitewater Sports

ESTIMATED SPEED

River Rafting
Flat-water Paddling
Racing
Sailing
Working on Boat
Other

Not Moving
1-10 mph
11-20 mph
21-30 mph
31-40 mph
41-60 mph
61-80 mph
Over 80 mph

CAUSE OF ACCIDENT (Check all that apply)

Alcohol Use
Ignition of Spilled Fuel or Vapor
Passenger/Skier Behavior
Boat, Machinery, or Equipment
Improper Anchoring
Restricted Vision
Improper Loading
Rules of the Road Violation
Exhaust
Congested Waters
Improper Lighting or No Lights
Sharp Turn
Dam/Lock
Machinery Failure
Standing/Sitting on Gunwale, Bow or Transom
Drug Use
Negligent Operation
Starting in Gear
Equipment Failure
No Proper Lookout
Wake
Excessive Speed
Operator error
Weather (Heavy)
Failure of Hull
Operator Inattention
Improper exhaust venting
Failure to Vent
Starting in Gear
Other:
Hazardous Waters
Operation Inexperience
Over Powering
Overloading
If two (2) or more vessels were involved – did the operator of other vessel (s) file a report?
Yes
No
BOAT DAMAGE – CIRCLE DAMAGED AREA(S)

TOP

BOTTOM

RIGHT

LEFT

TRANSOM

WASHINGTON BOAT ACCIDENT REPORT
P&R A-000 (03/2005)

5

INDIVIDUALS INVOLVED
INDIVIDUALS INVOLVED (NAME, ADDRESS, PHONE) - DETAIL FATALITY/INJURY BELOW USING THESE ID NUMBERS *

PDF
YES

DATE OF BIRTH

INVOLVEMENT

BOAT #

NO

1
2
3
4
5
6
7
8
SEATING POSITIONS (USE ABOVE NUMBERS TO INDICATE POSITION OF INDIVIDUALS INVOLVED)

BOW

STERN

RIGHT

LEFT

STERN

BOW

BOAT #1 TOP VIEW

BOAT #1 TRANSOM VIEW
NON-BOAT PROPERTY DAMAGE

BOAT #2 TOP VIEW

LEFT

INVOLMENT

RIGHT

BOAT #2 TRANSOM VIEW

O=
P=
W=
S=

Operator
Passenger
Witness
Tow Sport Rider

PROPERTY DESCRIPTION

PROPERTY DAMAGE ESTMATE
$

PROPERTY OWNER’S NAME

PHONE NUMBER

PROPERTY OWNER’S ADDRESS
DAMAGE TO OTHER PROPERTY
PROPERTY DAMAGE ESTMATE

OTHER PROPERTY DAMAGED

Yes

No

$

DESCRIBE:

INJURY (S)
VICTIM ONE’S INFORMATION
*
FROM BOAT #

AGE

No Boat

#:
VICTIM WAS
Operator

Passenger

Swimmer

Person Towed

Male
Female
PROPELLER INJURY
Yes
No

MEDICAL TREATMENT BEYOND FIRST AID
Yes
No
PFD WORN
Yes
No

TYPE:

INJURY CAUSED BY
Impact with Boat

Impact with Fixed Object

Struck by Boat

Impact with Floating Object

Impact with Water

Other

INJURY TYPE (Check all that apply. If more than one, number choices in order of severity)
Amputation

Hypothermia

Head Injury

Sprain/Strain

Spinal Injury

Broken Bone (s)

Back Injury

Internal Injuries

Teeth
Burns
Laceration (Cuts)
Contusion (Bruises)

VICTIM TWO’S INFORMATION
*
FROM BOAT #
VICTIM WAS
Operator

AGE

No Boat

#:
Passenger

Swimmer

Person Towed

Male
Female
PROPELLER INJURY
Yes
No

Neck Injury

Other

Dislocation
Shock

Carbon Monoxide
MEDICAL TREATMENT BEYOND FIRST AID
Yes
No
PFD WORN
Yes
No

TYPE:

WASHINGTON BOAT ACCIDENT REPORT
P&R A-000 (03/2005)

6

INJURY CAUSED BY
Impact with Boat

Impact with Fixed Object

Struck by Boat

Impact with Floating Object

Impact with Water

Other

INJURY TYPE (Check all that apply. If more than one, number choices in order of severity)
Amputation

Hypothermia

Head Injury

Sprain/Strain

Spinal Injury

Broken Bone (s)

Back Injury

Internal Injuries

Teeth
Burns
Laceration (Cuts)
Contusion (Bruises)

VICTIM THREE’S INFORMATION
*
FROM BOAT #

AGE

No Boat

#:
VICTIM WAS
Operator

Passenger

Swimmer

Person Towed

Male
Female
PROPELLER INJURY
Yes
No

Neck Injury

Other

Dislocation
Shock

Carbon Monoxide
MEDICAL TREATMENT BEYOND FIRST AID
Yes
No
PFD WORN
Yes
No

TYPE:

INJURY CAUSED BY
Impact with Boat

Impact with Fixed Object

Struck by Boat

Impact with Floating Object

Impact with Water

Other

INJURY TYPE (Check all that apply. If more than one, number choices in order of severity)
Amputation

Hypothermia

Head Injury

Sprain/Strain

Spinal Injury

Broken Bone (s)

Back Injury

Internal Injuries

Teeth
Burns
Laceration (Cuts)
Contusion (Bruises)

Neck Injury

Other

Dislocation
Shock

Carbon Monoxide

ADDITIONAL INJURIES – ATTACH LIST
ESTIMATED NUMBER OF DAYS VESSEL USED THIS YEAR

TYPICAL NUMBER OF HOURS VESSEL USED EACH DAY THIS YEAR

TYPICAL NUMBER OF PERSONS (INCLUDING YOURSELF) ON BOARD VESSEL EACH DAY THIS YEAR

AGENCY REPORT DATE

IF TWO (2) OR MORE VESSELS WERE INVOLVED – DID THE OPERATOR OF OTHER VESSEL FILE A REPORT?

YES

NO

SIGNATURE OF PERSON REPORTING

DATE

STATE PARKS USE ONLY
PRIMARY CAUSE OF ACCIDENT

SECONDARY CAUSE OF ACCIDENT

REVIEWED BY

CAUSE BASED ON (CHECK ONE)

BAR

Investigation

BAR & Investigation

Could not be determined, Narrative Report Attached

WASHINGTON BOAT ACCIDENT REPORT
P&R A-000 (03/2005)

7