Community Swimming Pool Accident Form
Date of Accident
Time of Accident
Exact Location (within pool area)
Type of Accident
Slip/Fall
Near Drowning
Injury
Other
Describe What Happened
Full Name of Injured Person
Age of Injured Person
Address of Injured Person
Contact Number of Injured Person
Witnesses (Names & Contact)
Action Taken
Name of Reporting Staff
Signature
Report Date