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RSP Incident Report
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Email
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MM
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DD
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YYYY
Vessel
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Choose
Donald Searle
Rona II
Merrilyn
Lady Shona
Launch
Tender
Skipper
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Your answer
Mate
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Your answer
Nature of Incident
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Accident
Incident
Near Miss
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Who was involved (including witnesses)?
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Your answer
Place
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Be as specific as possible, e.g. which port, where at sea, where on boat
Your answer
Type of Incident
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Choose
Navigation
Safety
Fire
Trips Slips & Falls
Safeguarding/Welfare
Personnel
Contact with another vessel
Grounding
Man Over Board
Mechanical/engine
Description of Incident
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What evolution was taking place?
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Your answer
Describe the outcome (etc damage, injury etc)
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Your answer
Possible consequences of the situation worst case scenario – what could have happened
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Your answer
What caused the situation
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Your answer
Remedial Action Taken/Preventantive Action
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Remedial Action Taken/Preventantive Action; Assistance/Advice sought; Any action taken to make sure it didn’t happen again?
Your answer
Lessons Learned
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Your answer
What further follow-up action is necessary?
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Any further information?
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Submitted by:
Name
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Email
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Phone Number:
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