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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.

The plain text form on this page is for information purposes only. To access the fillable form, download the following PDF version. Depending on your browser settings, you may need to save this form to your device and open it using a PDF reader.

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.

Name of harbour authority and harbour:
Contact person's name:
Telephone number:
Fax number:
Contact person's email address:
Region and address:
Date of accident:
Date Reported:
Time of accident:
Weather conditions:
Description of accident/incident:
What is believed to be the cause of the accident/incident?
Name, address, telephone number and email of owner of any property damaged:
Description of property damaged:
Amounts of any estimates of property damage received:
Names, addresses, telephone numbers and emails of injured persons:
Description of injuries:
Names, addresses and telephone numbers of any harbour personnel involved:
Names, addresses and telephone numbers of any witness:
Accident also reported to: (e.g. RCMP, Fire Department, etc.)
Name:
Date:
Time:
Name of person making this report:
Date of report:
Sketches, videos or photographs of accident/incident attached:
Yes No

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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