Shallow Water Blackout Tracking

Shallow Water Blackout Tracking

Aquatic Safety Research Group is committed to tracking verifiable incidents of Shallow Water Blackout. Your help is needed in documenting incidents of SWB. Facility and Contact information will be kept confidential but is required for verification and data collection purposes.

Your First Name: Your Last Name:

Title:

Company:

Street Address:

City: State: Zip:

Country (if not US):

Telephone: Fax:

Email:

For incidents outside of the U.S. please include your full mailing address:

Date of Incident: Facility Type:

Gender of Victim: Age of Victim: year(s)

Activity Prior to Incident:

Number of People in Water at Time of Incident:

Outcome:

Additional information and/or links to media coverage of the incident: