Global Shark Attack File
Incident Report Form

Date of Incident    

About the Victim:
First Name			Last Name
Address
City		State		Zip
Telephone		email
Date of Birth		Occupation
Height		Weight
Sex	Male        Female
Activity at time of incident

Describe type and color of equipment used, and color of clothing worn by victim

Victims Recovery,	Yes	No	Photographs of injury:	Yes	No
Photographer's Name
Address
Hospital Name
Address
Phone
Attending Physician
Address
Phone
Species of shark			Identified by
Number of sharks involved

 Description of shark:

Witness(es)
Name	Address	Phone

 

Length of time in water prior to incident
Location of incident
Distance from shore		Depth of water		Time of day
Water Temperature		Air Temperature		Estimated    Measured
Weather conditions

Sea conditions		Water visibility
Water depth at incident location
Description of ocean floor at incident location
Deep water channel or drop off nearby?		Yes    No
If yes, distance from incident location?
Kelp present?		Yes   No
Distance from kelp
Amount and location of kelp
Were marine mammals present or nearby?			Yes   No

If yes, location, number, and species of animals:

 

Was any unusual behavior of fishes, birds or marine mammals seen prior to incident?			Yes   No

If yes, type of animal and behavior observed:

 

Collecting of marine animals prior to incident?				Yes   No

Type of animals collected prior to incident:

 

 

Number of marine animals collected prior to incident
Method of collection and length of time
Aware of sharks presence prior to incident?:				Yes   No
Aware of prior attacks at the same location?				Yes   No
Sharks sighted at this location prior to incident?				Yes   No
If yes, date of previous sighting
Witness to previous shark sighting

 

Incident description:  Describe in detail the movement and behavior of the shark and victim prior to, during,

and following the incident.  Describe rescue, nature of injury, emergency and subsequent medical treatment

 

I understand that upon submission of this form I will have donated the above data to the

Global Shark Attack File for their ongoing research on shark attacks, their causes and avoidance.

I voluntarily donate this information to further the knowledge about shark interactions with humans.

First Name			Last Name
Address
City		State		Zip
Telephone		email