Fitness Center Incident Report Form
Please complete this Fitness Center Incident Report Form to document details of any incident that occurs within the facility.
Date and Time of Incident
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Location of Incident (e.g., weight room, locker room, pool)
*
Type of Incident
*
Please Select
Injury
Property Damage
Equipment Malfunction
Rule Violation
Other
Describe the Incident
*
Name(s) of Person(s) Involved
*
Name(s) of Witness(es)
Actions Taken Immediately After the Incident
*
Was Staff Notified?
*
Yes
No
Your Name (Person Reporting)
*
First Name
Last Name
Contact Email for Follow-up
*
example@example.com
Submit Incident Report
Should be Empty: