BRCC Accident/Injury/Incident Report Form

This form is to be used to report accidents or incidents that occur to dragon boats, small vessels, the dock, or neighboring boats resulting in damage and or injuries to paddlers, including health incidents on any of the boats. The Certified Steersperson on board is in charge and is responsible to fill out and submit this form.

In the event of a major spectator loss or fatality, please contact K & K’s 24-hour number at (260) 459-5000.

Report of Incident

Who is submitting the Report?

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Are you a
What is your Team Affiliation

Who was the BRCC Certified Steersperson/Witness/Coach?

(BRCC rules require a BRCC Certified Steersperson to be in charge of any dragon boat that leaves the dock.)

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Incident Details

Type of Incident

Accident/Collision

Fill out this section if there was an accident or a collision resulting in property damage - Dragon Boat, Marina, Small Vessel, or Other Boats.

Do not make any statements regarding the cause of the accident. Give no opinions or conjectures to anyone other than your insurance company representative. DO NOT ADMIT TO LIABILITY. DO NOT INFER OR PROMISE TO PAY. Use, "The accident is under investigation."

Name of Dragon Boat or Vessel involved
Was there property damage?

Personal Injury

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Was the person that suffered a Personal Injury treated? (First Aid, Medical Assistance, Ambulance, Hospital?

Health Incident

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Was the person with the Health Incident treated? (First Aid, Medical Assistance, Ambulance, Hospital?

Personal Conflict in the Marina/Verbal Harassment

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