Gym Incident Report Form
Gym Incident Report Form
Please complete this form to report any incidents, accidents, or injuries that occur within the gym premises.
Date and Time of Incident
Location of Incident
Name of Individual Involved
Age
Phone number
Type of Incident
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Injury (e.g., sprain, fracture, bruise)
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Fall (e.g., slipping, tripping)
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Equipment Malfunction (e.g., broken machinery, faulty weights)
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Medical Emergency (e.g., heart attack, fainting)
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Description of Incident
Actions Taken
e.g., first aid, emergency response
Witnesses (if any)
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Name |
Phone |
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Follow-up Actions or Recommendations
Reported By
Name:
Date:
Thank you for your submission!
We appreciate you taking the time to report this incident.
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