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PB Gym Incident Report Form
Please complete this form to report an injury, incident, or safety concern. Your input helps us keep PB Gym safe and supportive for everyone.
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* Indicates required question
Full Name
*
Your answer
Email address
Your answer
Date of Incident
*
MM
/
DD
/
YYYY
Time
:
AM
PM
Location in Gym (
e.g. Free weights upper gym area
)
*
Your answer
Describe what happened
*
Your answer
Was anyone injured?
*
Yes
No
if yes, who was injured?
Your answer
Actions Taken
panic button pressed
999 called
First aid Used
Evacuation occurred
CCTV footage may be relevant
Other:
Any additional Comments
Your answer
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