KYC Incident Report

Need to report an incident, accident, or issue at the Kelowna Yacht Club?

Please, fill out the form below and your issue will be logged. If necessary, someone from the Kelowna Yacht Club will be in touch to discuss your report.

If possible, please include photos.

Non-Disclosure Agreement: All information and materials disclosed or provided under this submission, constitute Confidential Information regardless of when such information was provided.

Name of staff filling out report *

What type of incident do you wish to report? *

• Health & Safety
• Environmental

If this is an emergency please call 911 before completing this form

Contact Canadian Coast Guard Western Region:

• 1-800-889-8852
• Marine Communications and Traffic Services (MCTS) centre on VHF channel 16 (156.8 MHz)

Contact Emergency Management and Climate Readiness

• 1-800-663-3456

Date/Time of Incident *

Date

Time

Location of IncidentSelect Best OptionMarina1st Floor Clubhouse2nd Floor ClubhouseGalleyOther

Please Specify

Was a KYC Member involved? *

• Yes
• No

Member Number

Name of Injured Party *

Name of Responsible Party *

Contact Number for Injured Party

Contact Number for Responsible Party

Was first aid required? *

• Yes
• No

Who provided the First Aid *

Type a description (eg: medic, staff, member, citizen) if you did not get a name.

Type of First Aid Provided *

Which First Aid Kit? *Select best optionKitchenReceptionGalleyBack OfficeSailing CentreCommodores DockHouseboatBoat KitOther

Source of the spill *

Approximate size and quantity of spill *

Authorities Reported too *

• Canadian Coast Guard
• KYC Manaegment
• Climate Emergency Management and Readiness
• Other

Select all that apply

Who? *

Were containment measures taken? *

• Yes
• No

Were contaminated used materials disposed properly in the drums? *

• Yes
• No
• Unsure

Please Describe the Incident *

Suggested Preventative Measures or Comments *

Does this issue require follow-up? *

• Yes
• No
• Not Sure

Upload applicable photo(s)

Click or drag files to this area to upload. You can upload up to 2 files.

Please include photos to assist in the Kelowna Yacht Club and their ability to assess and remedy and / or prevent the this incident.

Submit