Accident Report Form

Date of report

Time of Incident

Location of Incident

Name*

Email*

Phone Number*

Trainer / Supervisor Present

Age

Description of Incident

Injury Description

Immediate Action Taken

Was Medical Assistance Required?

Yes

No

Was The Amublance Called?

Yes

No

Was you Taken To Hospital?

Yes

No

Name Of Hospital

Was there any Witnessess? (Please include names and contact details).

Further Medical Treatment Required

Recommended Preventive Measures

Additional Comments

Name of Inured Person

I acknowledge that I have read and understand the disclaimer previously signed and that participating in any physical activity at Flash Fitness involves inherent risks. I confirm that the information provided in this accident report is accurate to the best of my knowledge. I understand that Flash Fitness will use this information for record-keeping and to enhance safety measures.

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