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Swimming Pool Incident Report Compliance Assurance Division Please Type or Print Clearly Section 1. Facility Information Name Permit Address County City State Zip Pool Type circle one A B C Phone Section 2. Owner Information Phone Number Section 3. Incident Information Type of Incident circle one a Drowning Date of Incident b Immersion c Cut/Abrasion Time Was 911 Ambulence or Emergency Room Visit Required circle one Name of Victim YES Age Witnes...

How to fill out pool report form

How to fill out a pool incident report:

1. Obtain the necessary form: Start by obtaining the pool incident report form from the appropriate authority. This could be the pool management, lifeguard, or the local authorities.
2. Gather essential information: Ensure you have all the relevant details before filling out the report. This may include the date, time, and location of the incident, as well as the names and contact information of those involved or witnesses.
3. Describe the incident: Provide a detailed account of what happened during the incident. Include information such as the nature of the incident, any injuries sustained, or any property damage that occurred.
4. Include witness statements: If there were any witnesses present during the incident, document their statements. This can help provide additional perspectives and evidence in the report.
5. Attach any supporting documents: If there are any relevant documents or photos related to the incident, make sure to include them with the report. This could include medical reports, incident scene pictures, or any other evidence.
6. Sign and date the report: Once you have completed all the necessary information, review the report for accuracy and completeness. Sign and date the report to indicate that the information provided is true and correct to the best of your knowledge.

Who needs a pool incident report:

1. Pool management: The pool incident report is crucial for the pool management to assess any potential risks or hazards that might exist in their facility. It helps them take appropriate steps to prevent future incidents and ensure the safety of their patrons.
2. Lifeguards: Lifeguards play a significant role in maintaining the safety and well-being of individuals at the pool. They need the incident report to understand the circumstances of any incidents that might have occurred on their watch and take any necessary actions or improvements in their protocols.
3. Insurance companies: In cases where injuries or damages are involved, insurance companies may require a pool incident report to assess liability and determine coverage.
4. Legal authorities: In some situations, particularly when serious injuries or accidents occur, local law enforcement or legal authorities may need access to the incident report for their investigations or any potential legal proceedings.
5. Individuals involved: The individuals involved in the pool incident may also personally benefit from having a copy of the report. It can serve as documentation for insurance claims, medical treatments, or any legal actions they may wish to pursue.

People Also Ask about pool report

What is the format of an incident report?

Incident reports include all of the facts related to the incident, such as the contact information of the people involved; a description of the incident itself; and any follow-up actions that were taken, like medical treatment.

What are the three 3 requirements for writing an incident report?

Keep in mind that these 3 considerations are not to be confused with the 3 requirements for writing an incident report: The report must be factual and without assumption. An incident report must be accurate and without bias. The incident report must be complete.

What should be included in an incident report?

It should include: the names and positions of the people involved. the names of any witnesses. the exact location and/or address of the incident. the exact time and date of the occurrence. a detailed and clear description of what exactly happened. a description of the injuries.

What are the 4 types of incident reports?

Common Types of Incident Reports Workplace. Workplace incident reports detail physical events that happen at work and affect an employee's productivity. Accident or First Aid. Safety and Security. Exposure Incident Report.

How do you write an incident report?

Step-by-step process to write an incident report Collect the information. The first step is to collect all the relevant information. Establish the order of events. Once you have collected all the information about an incident, you need to determine exactly what happened. Analyze the root cause. Formulate corrective action.

What should an incident report include?

The form should include the date and time of the incident, as well as the names of all those involved. The form should also list the sequence of events, and describe any injuries and damage sustained, only the essential information of the incident happened.

How do you start an incident writing?

Incident Report Sample Walkthrough: A Step-by-Step Guide Step 1: Provide Fundamental Information. Step 2: Take Note of Any Damages and Injuries. Step 3: Identify Affected Individual(s) Step 4: Identify Witnesses and Take Their Statements. Step 5: Take Action. Step 6: Close Your Report.

For pdfFiller’s FAQs

What is the penalty for the late filing of pool incident report?

The penalty for the late filing of a pool incident report varies by jurisdiction. It is best to check with your local health department or other authority to determine what the specific penalty is in your area.

What is pool incident report?

A pool incident report is a document that outlines the details of any accidents, injuries, or incidents that occur within a swimming pool facility. The report typically includes information such as the date, time, and location of the incident, a description of what happened, witnesses, any injuries sustained, and the actions taken by pool staff or authorities. The purpose of a pool incident report is to document and record any incidents for legal, insurance, and safety purposes.

Who is required to file pool incident report?

The person or organization responsible for the management and maintenance of the pool is usually required to file a pool incident report. This could be the pool owner, operator, or facility manager. Additionally, in some cases, lifeguards or pool attendants may also be required to file incident reports if they witness or are involved in any incidents at the pool. It is important to check with local regulations and specific pool policies to determine the exact requirements for filing a pool incident report.

How to fill out pool incident report?

When filling out a pool incident report, there are several steps you can follow: 1. Date and location: Begin by noting the date and location of the incident. Include the name and address of the pool facility. 2. Reporting person's information: Provide your contact information as the person filling out the report. This includes your name, address, phone number, and email. 3. Incident details: Describe the incident in detail. Include information such as the time it occurred, what specifically happened, and any factors that may have contributed to the incident (slippery floor, broken equipment, etc.). Be as specific and objective as possible. 4. Parties involved: Identify all individuals involved in the incident, including victims and witnesses. Record their names, contact information, and their relationship to the facility (guest, employee, etc.). 5. Injuries and medical response: Document any injuries sustained as a result of the incident, whether it is a minor scrape or a more serious injury. Note if any medical attention was provided on-site, such as basic first aid or calling emergency services. 6. Facility response: Record any actions taken by the pool facility staff or management following the incident. This includes details of immediate assistance provided, contacting authorities or medical professionals, or any attempts made to rectify the situation or prevent future incidents. 7. Witness statements: If there were witnesses to the incident, record their statements in a separate section. Include the witness's name, contact information, and their account of what they observed. 8. Photos or other evidence: If possible, take photos of the incident area or any relevant evidence. This visual documentation can help support your report. 9. Signature and submission: Sign and date the incident report, showing that all information provided is accurate to the best of your knowledge. Submit the report to the appropriate person or department, such as pool management or a supervisor, as per the facility's protocol. Remember to keep a copy of the incident report for your own records.

What is the purpose of pool incident report?

The purpose of a pool incident report is to document any accidents, injuries, or dangerous incidents that occur in or around a pool facility. It is used to record the details of the incident, including date, time, location, a description of what happened, people involved/witnesses, and any actions taken to respond to or prevent further incidents. This report serves various purposes such as: 1. Legal documentation: It provides an official record of the incident, which can be crucial in case of legal disputes or insurance claims. It helps establish liability and responsibility for the incident. 2. Safety improvements: Pool incident reports help identify trends or recurring issues, allowing pool managers or owners to take necessary measures for safety improvements. It helps in assessing risks and implementing corrective actions to prevent future incidents. 3. Compliance and regulation: Pool facilities are often required to adhere to safety regulations and standards set by government authorities or industry organizations. Incident reports can be used to demonstrate compliance and due diligence in enforcing safety protocols. 4. Training and staff development: Pool incident reports can be used as training tools to educate staff members about potential risks, hazards, or emergency situations. By analyzing incident reports, managers can identify areas where additional training or reinforcement is needed. Overall, the purpose of a pool incident report is to promote safety, document incidents, ensure accountability, and facilitate ongoing improvement in pool safety measures.

What information must be reported on pool incident report?

The specific information that must be reported on a pool incident report may vary depending on the jurisdiction and specific policies in place. However, some common information that should typically be included in a pool incident report includes: 1. Date and time of the incident 2. Location of the incident (name of the pool facility, address, etc.) 3. Name and contact details of the person reporting the incident 4. Name and contact details of the person(s) involved in the incident (e.g., victim, witnesses, etc.) 5. Description of the incident, including the nature of the injury or incident (e.g., slip and fall, near-drowning, equipment failure, etc.) 6. Details of any treatment provided to the victim or any actions taken by lifeguards or staff at the pool 7. Any pre-existing conditions or relevant medical history that may have contributed to the incident, if known 8. Names and contact details of any staff or lifeguards involved or present during the incident 9. Details of any equipment or maintenance issues observed that may have contributed to the incident 10. Any other relevant information, such as weather conditions, visibility in the pool, etc. It is important to note that this is not an exhaustive list, and specific reporting requirements may differ. It is advisable to consult the specific guidelines or policies established by the pool facility or the relevant authorities to ensure comprehensive reporting.

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