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Swimming Pool Incident Report Template

A swimming pool incident report template is used to record incidents such as injuries, vomit, fecal, blood contamination, near-drowning, drowning, or others. To help prevent incidents at the pool, regularly audit your lifeguards to ensure they are following pool safety compliance guidelines. Use this template to record specific details of the incident and help the establishment improve safety and security measures.

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Injured Person Background
Name of Injured Person
Date of Birth
Telephone Number
Injury Details
Date and time of incident
Exact pool/location of incident
Nature of the incident
Describe in detail
What part of the body was injured? Describe in detail
Take photo of the body part that was injured. Annotate as required
What was the nature of the injury? Describe in detail
Take photo of the injury/source of blood contamination. Annotate as required
Describe fully how the accident happened?
What was the person doing prior to the event?
Take photo of the surrounding environment the person was in prior to the event
What caused the incident?
Add supporting evidence of contributing factors
Were safety regulations in place and used?
What was wrong?
Recommended preventive action to take in the future to prevent reoccurence
Witness Statements
Were there any witnesses?
Add witness
Enter witness name
Contact number
Witness statement
Witness signature
Emergency Services
Person went to doctor/ hospital?
Doctor's Name
Hospital Name
Police were called to the scene
Police reference number
Sign off
Injured person signature
Pool Operator/Manager signature
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Stay Safe in the Pool: Use this Swimming Pool Incident Report Template

A swimming pool incident report template is a form used to document any incidents that occur in a swimming pool environment. It is used by facility managers and lifeguards to record information regarding the incident, including the date and time of the incident, the location, the type of incident, and the people involved. It should also include details about the actions taken to respond to the incident and any other relevant information.

The template is designed to help pool facility staff keep a record of any incidents that occur in the pool environment. This information can then be used to evaluate the safety of the pool environment and to ensure any necessary corrective action is taken. It is important that the report is completed accurately and promptly to ensure the safety and security of everyone using the pool.


The report should include a description of the incident, including the names of any people involved and the details of their injuries. It should also include any corrective measures taken in response to the incident, such as the removal of hazardous objects or the closure of the pool. The report should also include any follow-up actions, such as training staff on proper safety procedures.

Please note that this checklist template is a hypothetical appuses-hero example and provides only standard information. The template does not aim to replace, among other things, workplace, health and safety advice, medical advice, diagnosis or treatment, or any other applicable law. You should seek your professional advice to determine whether the use of such a checklist is appropriate in your workplace or jurisdiction.
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