Poolsafe Incident Notification Form
Full name (yours not the casualty)
*
Date of incident
*
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Type of Incident
*
Drowning - Fatal
Drowning - Non Fatal
Medical - Fatal
Medical - Non Fatal
Staff Incident
Customer Abuse (vs Staff or other Customers)
Chemical Incident
First Aid Incident
Facility incident occurred at
*
Organisation
*
Description of incident, include time, location within the facility, aftercare, etc.
*
Submit
Should be Empty: