A swimming pool incident report template is used to record incidents such as injuries, vomit, fecal, blood contamination, near-drowning, drowning, or others. Use this template to record specific details of the incident and help the establishment improve safety and security measures.
Digitalize this paper form now
Register for free on lumiformapp.com and conduct inspections via our mobile app
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
Were there any witnesses?
Enter witness name
Person went to doctor/ hospital?
Police were called to the scene
Police reference number
Injured person signature
Pool Operator/Manager signature
Please note that this checklist template is a hypothetical 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.
Please, finish the registration to access the content of the checklist.