Hunter MH37 - Page 36

Documents and Forms
2.16
For each question below, please provide answers IF APPLICABLE AND IF KNOWN, otherwise leave blank.
ACCIDENT DETAILS – YOUR BOAT OPERATOR
OPERATOR INSTRUCTION
OPERATOR SAFETY MEASURES
Boating safety instruction completed
VHOHFWDOOWKDWDSSO\
On board, prior to accident, was operator wearing:
None
A lifejacket?
Yes
No
State course
An engine cut-off switch /DQ\DUGRUZLUHOHVV
GHYLFHif equipped?
Yes
No
USCG Auxiliary course
On board, prior to accident, was operator using:
Alcohol?
Yes
No
US Power Squadrons course
Internet QDPHRIVSRQVRULQJRUJDQL]DWLRQ
Drugs?
Yes
No
Other GHVFULEH
Operator arrested for Boating Under the Influence?
Yes
No
Weather reports consulted prior to accident?
Yes
No
OPERATOR EXPERIENCE
Experience operating this type of boat VHOHFWRQH
0 to 10 hours
Over 10, up to 100 hours
Over 100, up to 500 hours
Over 500 hours
ACCIDENT DETAILS – OTHER KEY PEOPLE
2QO\UHSRUWother key people QRWDOUHDG\GRFXPHQWHGas injured, died, disappeared or operator/owner of \RXU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) VHOHFWDOOWKDWDSSO\
2WKHUboat operator 2WKHUboat owner Owner of RWKHUdamaged property Passenger on \RXUboat Witness
First Name
MI
Last Name
Street
City
State
Zip
Phone
2WKHUboat name LIDQ\
2WKHUboat registration # LIDQ\
NAME/ADDRESS
This other key person was a(n) VHOHFWDOOWKDWDSSO\
2WKHUboat operator 2WKHUboat owner Owner of RWKHUdamaged property Passenger on \RXUboat Witness
First Name
MI
Last Name
Street
City
State
Zip
Phone
2WKHUboat name LIDQ\
2WKHUboat registration # LIDQ\
CG-3865 (1/11) Page 5 of 6