Recurring concern

Unreliable pre-activity safety information for organised water activities

Get email alerts

Request correction

First reported 28 Feb 2018•Latest report 10 Apr 2025

Definition

What this concern includes

Includes failures of pre-booking or pre-session safety information and briefings for organised water activities, including disclosure of activity demands, health advice, hazard warnings, participant-suitability information and essential safety arrangements.

Not included

Excludes failures in the operation, supervision, rescue or emergency response of a water activity after participation has begun when pre-activity safety information is not deficient.
Excludes generic communication, training or risk-assessment deficiencies without a direct participant-facing pre-activity information or briefing failure.
Excludes ordinary swimming, boating or water-safety information that is not connected to an organised activity or a participant-safety decision.
Excludes information failures concerning unrelated travel, accommodation or non-water activities.

Reports: 5
Individual concerns: 7
Date range: 2018–2025
Stated actions: 9

Reports over time

Reports about this concern issued each year.

* 2026 is projected from reports observed to 7 Sep 2026.

Most frequent recipients

Reports about this concern sent to each recipient.

Health and Safety Executive2

ABTA Ltd1

Department for Digital, Culture, Media and Sport1

Foreign, Commonwealth & Development Office1

Grupo de Turismo Gaviota S.A.1

National Coasteering Charter1

Thomas Cook Tour Operations Limited1

Concerns and responses across reports

Only concerns grouped under this recurring concern are included. Select any concern, action or position to view the source wording.

10 Apr2025
Sunderland
Concerns raised1
1. Failure to provide specific pre-session safety briefings
This report raised 7 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.

No linked response statements
No respondent-stated action or position is linked to these concerns in the published data.
AI-generated summary

Mr Joel Kenneth Ineson · Prevention of Future Deaths report

This summary was generated using AI from the published report. Please read the original report for the complete account.

Report summary

Joel Kenneth Ineson died by drowning at Hetton Lyons County Park on 1 June 2023 after participating in an open water swimming event and suffering an unexpected cardiac event. The principal concerns were uncertainty about responsibility for safety measures, inadequate or absent safety briefings, lack of knowledge about participants and numbers in the water, and the absence of specific regulation, oversight and safety requirements for such events.

Read the report on judiciary.uk
Source evidence
How this individual concern was interpreted
PFD Monitor created a concise, searchable interpretation from the report wording shown below.
PFD Monitor interpretation
Failure to provide specific pre-session safety briefings
Wider context from the report
“Open Water Swimming is becoming a popular way of keeping fit. Mr Ineson was a keen participant in organised open water swimming events with safety at the forefront of his mind with a reasonable expectation that appropriate safety measures would be in place for an organised event. He attended such an event on 31st May 2023 which was well attended, and the organisers indicated that this had been a popular event when it had taken place. This event, like many similar events, charged participants a small fee for the session. The matters of concern were not found to be causative of Mr Ineson’s death but were such that there is a risk that future deaths could occur unless action is taken. I was concerned that the evidence highlighted uncertainty and confusion with regard to responsibility for aspects of safety measures leading to some participants not receiving a specific safety briefing, a lack of knowledge of the competency/capability of each and every participant and no understanding as to who was in the water and how many people were in the water at any one time. It became clear in evidence that the activity does not require a licence from the Adventure Activities Licensing Authority and can be undertaken and/or organised by anyone without regulation. Some organisations provide guidance on safety when organising such events, but there is no established UK body that provides regulation for this activity. It was confirmed there is no specific health and safety guidance, nor is there a regulatory compliance requirement regarding pre-session safety briefing, risk assessments, signing in and out of the water systems, emergency plans and/or training for organisers. The evidence indicated there is no oversight of these events which, by definition, take place in outdoor locations that may pose a risk. I shall be glad to be told of any learning arising from this death and timescales and results of your review. ”
Source location
Mr Joel Kenneth Ineson · Prevention of Future Deaths report
Page 2 · concerns
Open source report
13 Oct2023
Dorset
Concerns raised2
1. Failure to assess prospective participants’ swimming ability and physical fitness during coasteering booking
2. Failure to disclose the nature and potential physical demands of the proposed coasteering experience at booking
This report raised 3 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response 3
1. Action
  Produce a final updated Safety Advice for Coasteering Providers document incorporating consultation responses and advice.
  Stated by National Coasteering CharterStated planned
2. Action
  Consult NCC members by email and through a committee-led working group on updates to the Safety Advice for Coasteering Providers document.
  Stated by National Coasteering CharterStated planned
3. Action
  Produce a final updated Safety Advice for Coasteering Providers document incorporating member consultation responses and advice.
  Stated by National Coasteering CharterStated planned
AI-generated summary

Iain Richard Farrell · Prevention of Future Deaths report

This summary was generated using AI from the published report. Please read the original report for the complete account.

Report summary

Iain Richard Farrell became breathless and exhausted during a led coasteering activity on 26 May 2019, was swept back into the sea by a large wave after reaching a ledge, and was later confirmed deceased despite resuscitation efforts. The principal concerns were the risks of lone guiding, the delayed access to the sole means of communication, and the absence of assessment of participants’ swimming ability and physical fitness during booking.

Read the report on judiciary.uk
Source evidence
How this individual concern was interpreted
PFD Monitor created a concise, searchable interpretation from the report wording shown below.
PFD Monitor interpretation
Failure to assess prospective participants’ swimming ability and physical fitness during coasteering booking
Wider context from the report
“iv. At the time of booking a coasteering experience, the nature and potential physical demands of the experience at the coasteering location proposed should be made clear and a prospective participant should be asked about their swimming ability and physical fitness. ”
Source location
Iain Richard Farrell · Prevention of Future Deaths report
Page 4 · concerns
Open source report
Source evidence
How this individual concern was interpreted
PFD Monitor created a concise, searchable interpretation from the report wording shown below.
PFD Monitor interpretation
Failure to disclose the nature and potential physical demands of the proposed coasteering experience at booking
Wider context from the report
“iv. At the time of booking a coasteering experience, the nature and potential physical demands of the experience at the coasteering location proposed should be made clear and a prospective participant should be asked about their swimming ability and physical fitness. ”
Source location
Iain Richard Farrell · Prevention of Future Deaths report
Page 3 · concerns
Open source report
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Produce a final updated Safety Advice for Coasteering Providers document incorporating consultation responses and advice.

Verbatim wording from the response
“The current NCC document, ‘Safety Advice for Coasteering Providers 2015 Version 3’ will be updated to address the 4 points raised as concerns by the Coroner in Section 5.2 i-iv in the Prevention of Future Deaths report. The rewrite will also update the 2015 version with other practices and advice that may have changed since the writing of the original advice with an aim of continuing to promote safe coasteering.”

Source location
Response from National Coasteering Charter
Page 1 · response
Published 1 November 2023
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Consult NCC members by email and through a committee-led working group on updates to the Safety Advice for Coasteering Providers document.

Verbatim wording from the response
“The current NCC document, ‘Safety Advice for Coasteering Providers 2015 Version 3’ will be updated to address the 4 points raised as concerns by the Coroner in Section 5.2 i-iv in the Prevention of Future Deaths report. The rewrite will also update the 2015 version with other practices and advice that may have changed since the writing of the original advice with an aim of continuing to promote safe coasteering.”

Source location
Response from NCC
Page 1 · response
Published 1 November 2023
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Produce a final updated Safety Advice for Coasteering Providers document incorporating member consultation responses and advice.

Verbatim wording from the response
“The current NCC document, ‘Safety Advice for Coasteering Providers 2015 Version 3’ will be updated to address the 4 points raised as concerns by the Coroner in Section 5.2 i-iv in the Prevention of Future Deaths report. The rewrite will also update the 2015 version with other practices and advice that may have changed since the writing of the original advice with an aim of continuing to promote safe coasteering.”

Source location
Response from NCC
Page 1 · response
Published 1 November 2023
Open published response
9 Oct2023
Manchester South
Concerns raised1
1. Lack of warnings about local sea conditions, swimming risks and risk mitigation for weak swimmers
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response 4
1. Action
  Enhance Travel Advice on swimming safety by linking to the Royal Life Saving Society’s Water Safety on Holiday guidance.
  Stated by Foreign, Commonwealth & Development OfficeStated completed
2. Action
  Continue the Travel Aware campaign prompting British nationals to read destination advice and subscribe to travel alerts.
  Stated by Foreign, Commonwealth & Development OfficeStated completed
3. Action
  Enhance cooperation with the Royal Life Saving Society and support water-safety information on its website during the summer holiday season.
  Stated by Foreign, Commonwealth & Development OfficeStated completed
1. Action
  Continue disseminating swim-safety guidance through ABTA websites, social-media campaigns, and member and stakeholder channels.
  Stated by ABTA LtdStated in progress
AI-generated summary

Sandra Curran · Prevention of Future Deaths report

This summary was generated using AI from the published report. Please read the original report for the complete account.

Report summary

Sandra Curran died after becoming unresponsive while snorkelling in the sea off Bugibba Saint Paul's, Malta, on 4 July 2022; an investigation found that she died from asphyxia as a consequence of drowning. The principal concern was that UK tour operator welcome information did not warn about the risks and challenges of sea swimming or snorkelling in Malta, particularly for weak swimmers.

Read the report on judiciary.uk
Source evidence
How this individual concern was interpreted
PFD Monitor created a concise, searchable interpretation from the report wording shown below.
PFD Monitor interpretation
Lack of warnings about local sea conditions, swimming risks and risk mitigation for weak swimmers
Wider context from the report
“The inquest heard the Mrs Curran had booked her holiday through a UK Tour operator. Mrs Curran was not a strong swimmer and that she was unaware of the risks that swimming/snorkelling in the sea off the coast of Malta could present. No warnings were given in the welcome information/briefing about the challenge the sea around the coast in Malta could present to a weak swimmer. Previously when she had snorkelled it had been in far easier conditions where the risks of strong currents had not been present. The evidence given by her family at the inquest was that had her tour operator highlighted the need for caution Mrs Curran would not have snorkelled alone in the area where she drowned. A more proactive approach by UK tour operators highlighting the risk of getting into difficulties and how to mitigate them would reduce the risk of further deaths in circumstances such as Mrs Curran’s. ”
Source location
Sandra Curran · Prevention of Future Deaths report
Page 1 · concerns
Open source report
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Enhance Travel Advice on swimming safety by linking to the Royal Life Saving Society’s Water Safety on Holiday guidance.

Verbatim wording from the response
“In light of your report, we have considered further our advice on water risks in Malta:”

Source location
Response from Foreign, Commonwealth and Development Office
Page 2 · response
Published 30 October 2023
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Continue the Travel Aware campaign prompting British nationals to read destination advice and subscribe to travel alerts.

Verbatim wording from the response
“The FCDO’s established public-facing Travel Aware communications campaign will continue to prompt British nationals who are planning to travel abroad to read the latest FCDO travel advice for their destination and to sign up for e-mail alerts.”

Source location
Response from Foreign, Commonwealth and Development Office
Page 2 · response
Published 30 October 2023
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Enhance cooperation with the Royal Life Saving Society and support water-safety information on its website during the summer holiday season.

Verbatim wording from the response
“We work closely with foreign governments, partners in the travel industry and others to reduce the risks to British people when they travel abroad. This year we enhanced our cooperation with the Royal Life Saving Society and worked with them on the water safety information appearing on their website during the summer holiday season. We will continue to work with ABTA and the travel industry and fully endorse efforts to make their customers aware of the risks they may face during travel.”

Source location
Response from Foreign, Commonwealth and Development Office
Page 3 · response
Published 30 October 2023
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Continue disseminating swim-safety guidance through ABTA websites, social-media campaigns, and member and stakeholder channels.

Verbatim wording from the response
“ABTA runs a number of consumer campaigns where evidence from our members has highlighted that increased awareness on particular issues is important. We have been raising the importance of swim safety to consumers for over 20 years, and have been running a dedicated campaign on swim safety for around 10 years.”

Source location
Response from ABTA
Page 2 · response
Published 30 October 2023
Open published response
4 Oct2023
Derby and Derbyshire
Concerns raised1
1. Lack of pre-session health advice or warnings for cold water immersion participants
This report raised 10 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.

No linked response statements
No respondent-stated action or position is linked to these concerns in the published data.
AI-generated summary

Kellie Jean POOLE · Prevention of Future Deaths report

This summary was generated using AI from the published report. Please read the original report for the complete account.

Report summary

Kellie Jean POOLE died on 25 April 2022 after collapsing during a led cold water immersion session in the River Goyt. The report states that cold water likely triggered a heart rhythm disturbance and that she had an abnormal heart. The principal concerns were the limited oversight and regulation of cold water immersion providers, including health warnings, safety measures, leader training, first aid provision, insurance, risk assessments and guidance from relevant authorities.

Read the report on judiciary.uk
Source evidence
How this individual concern was interpreted
PFD Monitor created a concise, searchable interpretation from the report wording shown below.
PFD Monitor interpretation
Lack of pre-session health advice or warnings for cold water immersion participants
Wider context from the report
“There seems to be very little oversight of these businesses in their provision of cold water immersion covering matters such as pre-session health advice or warnings, public liability insurance, training and experience of the session leader, first aid training and equipment, or written risk assessments. I am not aware of the issuing of specific health and safety guidance. ”
Source location
Kellie Jean POOLE · Prevention of Future Deaths report
Page 2 · concerns
Open source report
28 Feb2018
Northamptonshire
Concerns raised2
1. Failure of participant waivers to mention the dangers of sea swimming for participants with epilepsy
2. Failure of participant waivers to request participants' past medical history
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response 2
1. Action
  Engage Gaviota to request adding epilepsy as a relevant medical condition to the Sunrise excursion waiver.
  Stated by Thomas Cook Tour Operations LimitedStated planned
2. Action
  Review whether to request further waiver amendments covering medical history that may make sea excursions dangerous.
  Stated by Thomas Cook Tour Operations LimitedStated planned
AI-generated summary

Andrea McHugh · Prevention of Future Deaths report

This summary was generated using AI from the published report. Please read the original report for the complete account.

Report summary

Andrea McHugh, who had epilepsy and continued to experience seizures after brain surgery, died after being found floating in the sea while snorkelling during a boat trip in Cuba on 17 June 2016. The report raised concerns that the participant waiver did not mention the dangers of swimming in the sea for people with epilepsy and did not request participants’ past medical history.

Read the report on judiciary.uk
Source evidence
How this individual concern was interpreted
PFD Monitor created a concise, searchable interpretation from the report wording shown below.
PFD Monitor interpretation
Failure of participant waivers to mention the dangers of sea swimming for participants with epilepsy
Wider context from the report
“1) Marinas Gaviota S.A allegedly require participants in the boat and snorkelling trip to sign a waiver. (copy attached). The waiver does not mention the dangers of swimming in the sea if a participant suffers from epilepsy. 2) Additionally the waiver does not request details of participants past medical history. ”
Source location
Andrea McHugh · Prevention of Future Deaths report
Page 1 · concerns
Open source report
Source evidence
How this individual concern was interpreted
PFD Monitor created a concise, searchable interpretation from the report wording shown below.
PFD Monitor interpretation
Failure of participant waivers to request participants' past medical history
Wider context from the report
“1) Marinas Gaviota S.A allegedly require participants in the boat and snorkelling trip to sign a waiver. (copy attached). The waiver does not mention the dangers of swimming in the sea if a participant suffers from epilepsy. 2) Additionally the waiver does not request details of participants past medical history. ”
Source location
Andrea McHugh · Prevention of Future Deaths report
Page 1 · concerns
Open source report
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Engage Gaviota to request adding epilepsy as a relevant medical condition to the Sunrise excursion waiver.

Verbatim wording from the response
“Thomas Cook has assessed the position carefully and has decided to immediately engage with Grupo Turismo Gavíota S.A. (“Gaviota”) to request that they amend their waiver form for the Sunrise excursion to include reference to epilepsy as a relevant medical condition which may make it dangerous for our customers to go in to the sea due to the increased risk of injury.”

Source location
2018-0060-Response-by-Thomas-Cook
Page 1 · response
Published 8 June 2018
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Review whether to request further waiver amendments covering medical history that may make sea excursions dangerous.

Verbatim wording from the response
“Thomas Cook then intends to review whether we request Gaviota make further amendment to their waiver to include reference to any medical history that may make it dangerous for our customers to go in to the sea and therefore should be included in the waiver. If further amendment is required it is envisaged that it will be necessary for Thomas Cook to obtain expert medical advice in respect of this to ensure appropriate relevant medical history is included.”

Source location
2018-0060-Response-by-Thomas-Cook
Page 1 · response
Published 8 June 2018
Open published response

Data last updated 7 September 2026

What this concern includes

Not included

Reports over time

Concerns raised1

Failure to provide specific pre-session safety briefings

Concerns raised2

Failure to assess prospective participants’ swimming ability and physical fitness during coasteering booking

Failure to disclose the nature and potential physical demands of the proposed coasteering experience at booking

Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.3

Concerns raised1

Lack of warnings about local sea conditions, swimming risks and risk mitigation for weak swimmers

Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.4

Concerns raised1

Lack of pre-session health advice or warnings for cold water immersion participants

Concerns raised2

Failure of participant waivers to mention the dangers of sea swimming for participants with epilepsy

Failure of participant waivers to request participants' past medical history

Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.2

Actions described in response 3

Actions described in response 4

Actions described in response 2