Incident Report
Leongatha Gymnastics Club
Athlete
First Name
Last Name
Coach / person filling in the report
First Name
Last Name
Club Location
Leongatha
Toora
Incident Date & Time
/
Month
/
Day
Year
Date Picker Icon
Hour Minutes
AM
PM
AM/PM Option
Class Type
Play Gym
Kinder Gym
Kinder Ninja
Beginner
Gym Fun
Gym Skills
Advanced
Ninja
Pre - Comp
Competitive
School Gym
Other
Apparatus
Floor
Bar
Beam
Vault
Rings
P-Bars
Trampoline
Other
Witness
First Name
Last Name
Supervisor (Head coach / Supervisor coach)
First Name
Last Name
Please categorise the incident
Physical Violence
Serious Injury
Sexual offence / Harassment
Serious emotional or physical abuse / Harassment
Serious neglect
Threatening Behavior
Medical emergency
Minor injury
Unacceptable behaviour
Other
Please describe the incident
What did you see? What occured?
What immediate steps did you take to resolve the incident?
First aid given? Emergency services called?
Did the athlete rejoin the class following the incident?
Yes
No
Other
Did you talk to the parent / emergency contact following the incident?
Yes
No
Other
Was the head coach advised? (either in person or text)
Yes
No
Other
Other information
Submit
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