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SUBMERSION INCIDENT REPORT FORM (SIR) To be completed on all drowning incidents occurring in Riverside County fatal & nonfatal adults and children. 4 BASIC INCIDENT INFORMATION A: ADULT SUPERVISION

How to fill out submersion incident report form

How to fill out a submersion incident report form:

1. Start by gathering all the necessary information for the incident report. This includes the date and time of the incident, the location, and details about the individuals involved.
2. Begin by filling out the basic information section of the form. This typically includes your name, contact information, and job title or role.
3. Provide a brief description of the submersion incident. Be clear and concise in your explanation, detailing what happened and any relevant information surrounding the incident.
4. If there were witnesses to the incident, make sure to include their names and contact information. This can be crucial if further investigation is needed or if additional statements are required.
5. Use the provided sections on the form to document any injuries or medical attention required as a result of the incident. Include detailed information on the type of injuries sustained and the actions taken to address them.
6. If there was any property damage involved, document it accurately on the form. Include descriptions of the damaged items or equipment, the estimated value of the damage, and any necessary repairs or replacements.
7. Finally, sign and date the completed form. This indicates that the information provided is accurate to your knowledge.

Who needs a submersion incident report form:

1. Employers: Employers who want to ensure a safe working environment and keep a record of any submersion incidents will need to use a submersion incident report form. This helps them assess and address potential hazards in the workplace.
2. Employees: Employees who experience a submersion incident should also complete a report form. This provides them with a formal way to document the incident and any injuries or damages that occurred. It can also help protect their rights if they need to file a workers' compensation claim.
3. Insurance companies: Insurance companies may require a submersion incident report form when processing a claim related to property damage or personal injury resulting from a submersion incident.

In conclusion, filling out a submersion incident report form requires gathering all the necessary information, accurately documenting the incident, injuries, and damages, and signing and dating the completed form. This form is essential for both employers and employees to maintain a safe workplace and protect their rights in the event of a submersion incident.

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What is submersion incident report form?

The submersion incident report form is a document used to report incidents where a person or object has been submerged in water.

Who is required to file submersion incident report form?

Any individual or organization who experiences or witnesses a submersion incident is required to file the report form.

How to fill out submersion incident report form?

The form typically requires information such as date, time, location of incident, description of the incident, individuals involved, and any action taken.

What is the purpose of submersion incident report form?

The purpose of the form is to document submersion incidents for analysis, prevention, and safety improvement.

What information must be reported on submersion incident report form?

Information such as date, time, location of incident, description of the incident, individuals involved, and any action taken must be reported.