Luna Fitness Club Incident Report Form
Please use this form to report any incidents or accidents that occur within the fitness center. Accurate and thorough information helps us ensure safety and proper follow-up.
Full Name of Person Involved (if applicable)
First Name
Last Name
Status of Person Involved
*
Luna Member
Non Luna Member
Staff/Employee
Other
Date and Time of Incident
*
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Location of Incident (e.g., weight room, group fitness studio)
*
Please Select
Reception Desk
Cardio Area
Weight Room (A/B)
Group Fitness Studio
Bathroom/Dressing Room
Type of Incident
*
Injury
Medical Emergency
Equipment Malfunction
Property Damage
Behavioral Issue
Other
Describe the Incident in Detail
*
Were there any injuries? If yes, please describe.
*
Actions Taken Immediately After the Incident
*
Contact Phone Number of Person Involved (if applicable)
Please enter a valid phone number.
Format: (000) 000-0000.
Were there any witnesses?
*
Yes
No
Witness Name(s) and Contact Information (if any)
Please upload any photos or documents related to the incident (optional)
Upload a File
Drag and drop files here
Choose a file
Cancel
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Your Full Name (Person Reporting the Incident)
*
First Name
Last Name
Your Email Address
*
example@example.com
Signature of Person Reporting the Incident
*
Submit Incident Report
Submit Incident Report
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