Drowning

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DROWNING
NAME OF DECEDENT:
This form is to be completed in addition to the ROD form in these guidelines
DECEDENT
HOW LONG WAS THE DECEDENT MISSING?
IF KNOWN, HOW LONG WAS THE DECEDENT SUBMERGED?
DID THE DECEDENT ENTER THE WATER VOLUNTARILY OR INVOLUNTARILY (EXPLAIN)?
DECEDENT WAS:
SWIMMING
WADING
RESCUE ATTEMPT
SCUBA DIVING
UNKNOWN
FELL FROM:
FLOOD
THROWN
OTHER :
HOW FAR FROM THE POINT OF ENTRY WAS THE BODY FOUND?
IF BODY WAS REMOVED BY OTHER THAN SWIMMERS, WHAT WAS USED?
GRAPPLE
OTHER:
DESCRIBE DECEDENT'S SWIMMING ABILITY:
NONSWIMMER
ADEQUATE
GOOD
EXPERT
HOW DID DECEDENT GET TO THIS AREA?
IF VEHICLE WAS USED, HAS VEHICLE BEEN CHECKED?
DID DECEDENT EAT OR DRINK ANYTHING PRIOR TO GOING INTO WATER?
WAS THE DECEDENT PLAYING - (IF YES, WHAT WAS THE GAME AND WHAT WERE THE GAME
PIECES, IF ANY, I.E., BATS, BALLS, ETC.)
WAS THE DECEDENT STRUCK BY ANY OBJECTS BEING USED IN THE GAME?
GENERAL QUESTIONS FOR ALL DROWNINGS
OTHER INDIVIDUALS PRESENT AT THE TIME OF THE DROWNING & THEIR RELATIONSHIP TO THE
DECEDENT?
POND/LAKE
STREAM
RIVER
FLOODWATER
ARROYO
IS THIS AREA USUALLY USED FOR SWIMMING?
ACCESS WAS:
FENCED IN
OPEN TO ANYONE
PUBLIC
PRIVATE
IF FENCED, DID FENCE HAVE A GATE:
YES - LOCKED
UNLOCKED
HOW HIGH WAS THE FENCE:
THE GATE:
IF WOODEN FENCE, MEASURE SPACE BETWEEN WOODEN SLATS:
IS IT POSSIBLE TO SCALE, CLIMB THROUGH, OR UNDER THIS FENCE?
TYPE OF BANK AT THE ENTRY POINT?
CLIFF/OVERHANG
WATER LEVEL
STEEP
GRADUAL
LEVEL
CAN HISTORIAN DESCRIBE TEMPERATURE OF WATER WHEN DECEDENT WAS FOUND IN THE
P/T/S?
ANY INDICATION THAT THE DECEDENT STRUCK ANY PORTION OF THE P/T/S OR THE DIVING
BOARD, OR THE BOTTOM?
ANY ELECTRICAL APPLIANCES NEAR THE P/T/S, AND IF SO, DESCRIBE:
DESCRIBE THE DRAINAGE SYSTEM AND INDICATE IF THE WATER DRAINED OUT:
ANY INDICATION THE DECEDENT WAS SUCKED INTO OR ONTO THE DRAINAGE SYSTEM?
BOATING/FISHING
BRAND NAME OF BOAT:
DID THE BOAT HAVE ANY KNOWN DEFECTS?
DID BOAT HAVE SAFETY GEAR?
DESCRIBE HOW DECEDENT FELL, JUMPED, OR WAS THROWN FROM BOAT?
WAS THE DECEDENT WEARING SAFETY GEAR (DESCRIBE INCLUDING BRAND NAMES)?
NAME OF INVESTIGATOR
DMI#
TYPE OF BOTTOM?
MUD
SAND
GRAVEL
BOULDERS
TYPE OF WATER?
MUDDY
CLEAR
FRESH
MOVING WATER
STILL WATER
WATER MOVEMENT:
DIRECTION FM
TO
APPROX. SPEED:
IS THIS AREA KNOWN FOR:
UNDERWATER HOLES
UNDERCURRENTS
SHIFTING BOTTOM
IS THIS AREA KNOWN FOR UNDERWATER OBSTRUCTIONS?
IF PRIVATE, WAS DECEDENT ALLOWED TO BE THERE?
IF PUBLIC, WAS DEATH DURING OPERATIONAL HOURS?
IS/WAS A LIFEGUARD PRESENT AT THE TIME OF THE DROWNING?
IF YES, ARE DETAILS OF THE DROWNING CONSISTENT WITH OTHER OBSERVERS?
WERE ALCOHOLIC BEVERAGES OR FOOD BEING SERVED OR SOLD ON THE PREMISES?
IF SAFETY DEVICES WERE INSTALLED OR WARNING SIGNS POSTED, DESCRIBE:
WAS THERE ANYTHING UNUSUAL/OUT OF THE ORDINARY ABOUT THE WATER THAT SHOULD BE
NOTED?
WHAT IS THE TEMPERATURE OF THE WATER AND HOW IS IT MEASURED?
IS THIS AREA KNOWN FOR PRIOR DROWNINGS?
MAXIMUM DEPTH AT ENTRY POINT:
MIDWAY:
WHERE BODY FOUND:
POOL/TUB/SAUNA
BRAND NAME OF POOL, TUB OR SAUNA:
WAS P/T/S KNOWN TO BE DEFECTIVE IN ANY WAY?
IF YES, EXPLAIN:
WAS DECEDENT IN P/T/S WHEN FOUND? IF YES, HOW IS BODY POSITIONED?
IF NO, WHERE IS BODY IN RELATION TO THE P/T/S? IN WHAT POSITION, AND WHAT IS HISTORY
BEHIND REMOVAL?
IS WATER STILL IN P/T/S?
IF NO, CAN FIRST RESPONDER INDICATE IF FACE OR
HEAD OF THE DECEDENT WAS UNDER WATER?
CAN FIRST RESPONDER DESCRIBE HOW DEEP THE WATER WAS WHEN THE DECEDENT WAS
FOUND IN THE P/T/S?