Harbour incident/accident report
Below is a copy of the report that HAs must fill in the event of an incident or accident at the harbor.
To fill out a PDF form, you must:
- download it to your computer
- use PDF software to open it (such as, Adobe Reader or Foxit PDF)
For more information: How to download and open a PDF form
This report is required for every accident/incident that occurs on a habour managed by a harbour authority or an organization. It must be completed for any accident/incident causing property damage, personal injury or the death of third parties (members of the public). Please also complete this report any incident/accident involving harbour authority employees or volunteers.
For the purpose of the third party liability insurance (TPLI), this report is used to convey relevant information to our insurers and their solicitors. It is a confidential and privileged report. It serves as the basic material for their purposes in defending any claim or litigation which may arise.
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Name of harbour authority and harbour:
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Contact person's name:
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Telephone number:
Fax number:
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Contact person's email address:
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Region and address:
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Date of accident:
Date Reported:
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Time of accident:
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Weather conditions:
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Description of accident/incident:
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What is believed to be the cause of the accident/incident?
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Name, address, telephone number and email of owner of any property damaged:
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Description of property damaged:
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Amounts of any estimates of property damage received:
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Names, addresses, telephone numbers and emails of injured persons:
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Description of injuries:
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Names, addresses and telephone numbers of any harbour personnel involved:
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Names, addresses and telephone numbers of any witness:
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Accident also reported to: (e.g. RCMP, Fire Department, etc.)
Name:
Date:
Time:
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Name of person making this report:
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Date of report:
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Sketches, videos or photographs of accident/incident attached:
Yes
No
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Please provide a copy of the report to your Small Craft Harbours contact
NOTE: A copy of the accident report will be provided to Small Craft Harbours National Headquarters by your regional office. In the case of incidents/accidents eligible for the TPLI, a copy of the report is sent to the broker for evaluation.
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