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Dive Accident Checklist

Dive Accident Information

Contact D.A.N. as soon as possible (919)684-4326

1. Type of Dive: Rescue ____ Commercial ____ Recreational ____
2. Type of Gas Used: Compressed Air ____ Nitrox ____ Heliox ____ Other _____________
3. Water Type: Contaminated ____ Fresh ____ Salt ____
4. Water Temperature: ___________
5. Number of Dives in the Past Several Days: _______
List Each Dive with:
Maximum Depth Bottom Time Surface Interval
_____________ ____________ ______________
_____________ ____________ ______________
_____________ ____________ ______________
_____________ ____________ ______________
6. Time of Last Ascent: _____________
7. Did Diver: Panic? ____ Emergency Ascend? ____ Run Out of Air? ____
Hold Breath Upon Ascent? ____ Miss a Decompression Stop(s)? ____
8. Problems During Dive (e.g., Buoyancy, Clearing Ears, Equipment):
___________________________________________________________________________
___________________________________________________________________________
9. Possible Contact with Dangerous Marine Life: _______
10. Fly After Diving: ______ How Long After: _____________
11. Alcohol Ingestion: _____ When: _____ Quantity: ____________________________
12. Dive Workload (e.g., Currents, Hard Work, Over-weighted):
___________________________________________________________________________
___________________________________________________________________________
13. Any Post-dive Physical Activity: _______________________________________________
14. Dive Buddy: _____ Is He/She Present? _____ Name and Phone Number:
___________________________________________________________________________
15. Other Witnesses (Names and Phone Numbers):
___________________________________________________________________________
___________________________________________________________________________
16. Statements and Other Information:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

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