Accident and incident Book
For recording accidents, incidents, near misses or any other concerns ocuring on or as a result of GoodGym activities.
Sign in to Google to save your progress. Learn more
Your full name *
Your role in relation to GoodGym
Clear selection
Your details
The details of the person reporting the accident.
Please indicate the city, town or borough where the accident, incident or near miss happened *
The accident, incident, near miss or concern
Details of the incident you're recording.
When did the accident / incident happen?
(Time and date)
*
Where exactly did the accident / incident happen? *
What caused the accident / incident? *
Did the accident / incident result in an injury or harm being caused? *
If so describe the injury.
Name of the person who had the accident / incident *
Role of the person who had the accident / incident *
Risks and mitigations
What was done on the session to reduce the likelihood this happening?
How might we avoid this type of accident or incident happening again?
Do you have any other thoughts or things that should be noted about this accident or incident?
What is your email address? This optional. In some cases it may be beneficial to contact you in order to discuss what happened.
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of GoodGym. Report Abuse