Diving Rescue Plan Example Form PDF Details

A diving rescue plan is an important document to have when rescuing someone who is underwater. This document outlines the steps that will be taken in order to safely and effectively bring the person to the surface. It is important to create a diving rescue plan before any rescue attempt takes place, as this will help ensure that everyone involved knows what they need to do. In addition, a dive emergency action plan can be used to provide guidance in the event of an emergency.

Form NameDiving Rescue Plan Example Form
Form Length2 pages
Fillable fields0
Avg. time to fill out30 sec
Other namespadi rescue diver emergency action plan example, diving emergency action plan pdf, padi rescue plan, diving emergency action plan template

Form Preview Example

Swiftwater Rescue Emergency Action Plan



On Site Communications (REQUIRED)

Department Radio / Channel

Cell Phone / Dispatch #

Marine VHF Radio (Channel 16)

Ambulance for Transport?

On Site

By Radio or Telephone

Emergency Equipment in Vicinity

AED or other Cardiac Defibrillator (REQUIRED)

Oxygen Delivery Unit (REQUIRED)

First Aid Kit (REQUIRED) Advanced Life Support Equipment

Identify Trained EMS Providers in the Class




Other Items Recommended On Site

Program Training Manual

Department Training Standards

Agency's SOPs/SOGs for Water Operations

Action Plan

Recall all personnel, conduct head count (as needed) Notify dispatch

Time of Accident

River Velocity

Establish Last Seen Point (if necessary)

Request additional resources (as needed)

Stabilize the patient/incident

Conserve property (as appropriate)

Turn patient/scene over to the authority having jurisdiction

Pass on information (as needed)

Document the incident

Obtain statements from witnesses (as needed) Notify Supervisor

Contact Dive Team if needed

Emergency Phone Numbers


Local Emergency Transport

Air Transport


Dive Team

Divers Alert Network 1-919-684-9111

Dive Rescue International 1-800-248-3483

IADRS 1-800-IADRS-911

Dive Rescue International, Inc. 201 North Link Lane Fort Collins, CO 80524 (800) 248-3483 Fax (970) 482-0893 www.DiveRescueIntl.com

Swiftwater Rescue Emergency Action Plan

A written Emergency Action Plan (EAP) is an important component in mitigating an emergency. In an effort to make certain that a water rescue team is prepared Dive Rescue International requires all trainers to complete the following form and keep a printed copy in their instructor / trainer manual. A completed EAP form needs to be on file at the Dive Rescue International office prior to instructor / trainer certification and recertification. These forms should be updated as needed and resubmitted to Dive Rescue International at a minimum of every three years during the recertification process.

After filling in the necessary blanks on the previous page, complete the information on this page:


Instructor Name

Name of Agency
















Work Phone Number





















Alternate Phone Number





















Work Email















Home Email






Remember to keep a printed copy in your trainer manual and on your apparatus. Should an accident happen, all members of your team should be familiar with this plan. NIOSH investigators may likely ask to see a copy of your written Emergency Action Plan. You may also consider adding the Emergency Action Plan to your SOPs/SOGs.

Additional copies of this form are available online at DiveRescueIntl.com

Please note: The EMAIL TO DIVE RESCUE INTERNATIONAL button works with email applications such as Microsoft Outlook Express, Microsoft Outlook, Eudora or Mail. If you currently use an Internet email service such as Yahoo or Hotmail, you will need to save the form and return it manually to swatson@diverescueintl.com using your Internet email service.

Dive Rescue International, Inc. 201 North Link Lane Fort Collins, CO 80524 (800) 248-3483 Fax (970) 482-0893 www.DiveRescueIntl.com

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This PDF form requires particular details to be filled in, so be certain to take whatever time to provide what's asked:

1. Whenever submitting the dive rescue plan, be sure to complete all of the needed blank fields in its associated section. This will help to expedite the work, allowing for your information to be handled fast and appropriately.

Writing section 1 in dan emergency action plan template

2. Once your current task is complete, take the next step – fill out all of these fields - Emergency Equipment in Vicinity, Oxygen Delivery Unit REQUIRED, First Aid Kit REQUIRED, Advanced Life Support Equipment, Turn patientscene over to the, Pass on information as needed, Document the incident, Obtain statements from witnesses, Notify Supervisor, Identify Trained EMS Providers in, Contact Dive Team if needed, Paramedics, EMTs, Other, and Other Items Recommended On Site with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

dan emergency action plan template completion process clarified (stage 2)

As for Obtain statements from witnesses and Advanced Life Support Equipment, make sure you take another look in this current part. These two could be the most important fields in the PDF.

3. This step will be straightforward - fill out every one of the blanks in Date, Instructor Name, Name of Agency, Address, City, Work Phone Number, Alternate Phone Number, Work Email, Home Email, Zip, State, Ext, and Type in order to complete this part.

Stage number 3 for submitting dan emergency action plan template

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