Poolsafe Incident Notification Form
Full name (yours not the casualty)
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Date of incident
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Day
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Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Type of Incident
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Drowning - Fatal
Drowning - Non Fatal
Medical - Fatal
Medical - Non Fatal
Staff Incident
Customer Abuse (vs Staff or other Customers)
Chemical Incident
First Aid Incident
Spinal Rescue
Facility incident occurred at
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Organisation
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Description of incident, include time, location within the facility, actions taken by staff, aftercare, etc. Age and gender of casualty are helpful but you do not need to include names or contact details.
*
Submit
Should be Empty: