Dims Form

Trimix Divers!!

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DIVING INCIDENT REPORT
Cave and Technical Diving

DEFINITION:	A Diving Incident is any error or unplanned event that could, or indeed did, reduce the safety margin for a diver on a particular dive. The error may have been made by anyone involved with the dive. It may also include equipment problems. The incident may have been preventable or unpreventable. Most incidents don't cause harm, but reporting such incidents will give valuable information when considered with other incidents. This form focuses on any incident occurring before, during or after a cave or technical dive. Definition: Planned decompression, overhead environment, planned depth>40m, gas other than air or EANx 22-40% oxygen, use of rebreather.
ANONYMITY:	Please DO NOT identify any person involved. This form will not be available to any legal process. Anonymity is assured.
QUALITY:	Please DO NOT report hearsay incidents.
INSTRUCTIONS:	Please read all boxes carefully. In addition to circling one or more options under each heading, write simply in your own words a description of what happened. This narrative is the most important component of the report.
Dr Richard Harris from the Diving and Hyperbaric Medicine Unit at the Royal Adelaide Hospital, Adelaide, South Australia will coordinate these cave and technical diving reports. Please complete this form with as much detail as possible and then press the submit report button at the bottom.

Q1:

Whose incident was it?
Yours Your Buddy Another Diver

Q2:

Did the diver have any health problems prior to incident?
Yes No Not Known
Specify:

Q3:

When was the incident detected?

Preparation	Entry	Descent
During the dive	Ascent	Exit
Following exit

Q4:

Did the incident cause harm?
Yes No Not Known
Specify:

Q5:

Did the incident occur in training?
Yes No Not Known

Q6:

Total dives ever, by diver involved if known?
1-20 21-100 101-500 500+

Q7:

Total years diving?
years

Q8:

Diver’s qualifications: (may tick more than 1)

Q9:

Does the diver take any medication?
Yes No Not Known
Specify:

DESCRIPTION OF THE INCIDENT

Q10:

Please describe incident in detail. Include ANY factor which you believe may have contributed to, or minimised the incident. If more than one incident occurred please fill out a separate form.

Q11:

Do you think the accident was preventable?
Yes No Undecided

FIRST AID

Q12:

Tell us more about the first aid applied:

No O2 available / limited O2 supply	Lack of trained 1st aid assistance
O2 ran out	Lack of first aid supplies
O2 used inappropriately	Poor first aid

GAS SUPPLY

Q13:

Gas supply in use during dive:
Air Nitrox Mixed Gas O2

Q14:

No/poor analysis pre-dive
Cylinder labelling issue
Confusion gas mix during dive

Q15:

Air/Gas consumption greater on this dive?
Yes No

CONTRIBUTING FACTORS

Q16:

Please outline any contributing factors, please tick as many as you feel are relevant to this accident.

DID THE INCIDENT INVOLVE ANY OF THE FOLLOWING?

Q17:

You may tick as many as you feel are related to this incident.

REBREATHER USE

Q18:

If a rebreather was in use, please tick as many as are related to the incident:
Semiclosed Fully Closed Not known
Production Model Significantly Modified Home / Custom Built
Manual Control Electronic Control
Brand:

Q19:

Possible problems:
Oxygen Toxicity Hypoxia High Carbon Dioxide Sensor / Readout problem Scrubber
Caustic Cocktail One Way Valve Lack of Precheck/Prebreath Buddy not familiar Flood
Other:

Q20:

Gas Used, please tick as many as applies:
100% Oxygen Air EANx 02 / He / N2 02 / He Not Known

Q21:

Bailout performed to open circuit?
Yes NO

Q22:

Inadequate Bailout?
Yes
Describe:

CYLINDER CONFIGURATION IN USE

Q23:

Please describe the tank configuration if known:
Single Tank

Q24:

Twin Tanks:
Independent back mounted
Independent side mounted
Manifolded
Isolator problem
Not known

Q25:

Sling Tanks or Stages?
Yes No Not Known
Number of Sling Tanks or Stages?
One Two Not Known
Configuration and contents if known:

EQUIPMENT INVOLVED IN THE INCIDENT

Q26:

Please tick as many as are applicable
Hired Borrowed New Misuse Essential equipment lacking Equipment forgotten

Q27:

Q28:

MISCELLANEOUS EQUIPMENT

Q29: