Describe type and color of equipment used
in this activity
Victim's 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 attack
Location of attack
Distance from shore
Depth of attack
Time of day
Water Temperature
Air Temperature
Estimated Taken
Weather conditions
Sea conditions
Water visibility
Water depth at attack location
Description of ocean floor at attack location
Deep water channel or drop off at attack
location
Yes No
If yes, distance from attack
location
Kelp present at attack location
Yes No
Distance from kelp
Amount and location of kelp
Were marine mammals present at or near attack location
Yes No
If yes, location, number, and species of
animals:
Unusual behavior of fishes, birds or marine mammals prior to
attack
Yes No
If yes, type of animal and behavior
observed:
Collecting of marine animals prior to
attack
Yes No
Type of animals collected prior to
attack:
Number of marine animals collected prior to attack
Method of collection and length of time
Aware of sharks presence prior to attack:
Yes No
Aware of prior attacks at the same location:
Yes No
Sharks sighted at this location prior to your
attack:
Yes No
If yes, date of previous sighting
Witness to previous shark sighting
Attack description: Describe in detail the movement
and behavior of the shark and victim prior to, during, and following the attack. 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 Ralph S. Collier and/or the Shark Research Committee for their
ongoing white shark research projects including white shark/human interactions from the Pacific
Coast of North America. I voluntarily donate this information to further our knowledge of the white shark and its
interactions with humans.
First Name
Last Name
Address
City
State
Zip
Telephone
email
The material contained on this website is shared as a public service and to
further the scientific goals of the Shark Research Committee. All text and
images on this website are the exclusive property of the Shark Research
Committee. Information on this website may be used for private study, but
may not otherwise be published, duplicated, or modified in any way without the
prior written permission of Ralph S. Collier.
