By completing this form you will help us prevent future accidents. This form takes around 4 minutes to complete.

If this is an emergency, call 111. Report urgent safety concerns by calling 0800 DOC HOT (0800 362 468).

Privacy disclosure: To process your request or information, we need to collect personal information about you. We'll only use your information for this purpose and we'll follow the principles of the Privacy Act 2020. See our privacy and security statement.

Where did it happen?

Select regions
Select regions

For example:

  • GPS coordinates if you have them
  • the name of any landmarks close to the location.

What happened?

Type of incident
What activity was the injured person doing? Select all that apply.

How serious was the incident?

How serious was the injury? Select all that apply.
If the near miss had happened, how serious could the situation have been?
Did you use a distress beacon in response to the incident?

Contact details

Can we contact you for more information if needed?
Back to top