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gym incident report

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Page 1 of 2 HEALTH CLUB INCIDENT REPORT FORM Information Member Involved / Witnesses Member s Name Involved in Incident Member s Phone Number Home Sex Work Street City Male Female Age Zip State Member Address Report Date Today s Date Manager on Duty at Time of Incident Witness Name 1 Phone Number Accident / Injury Report Date of Incident Time of accident AM PM Cause of injury Client injured by Incident Occurred Specific area where injury occurred Type of injury Action Taken Self-inflicted...
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What is Health club incident report form?

Operators of health and fitness facilities know that claims and incidents are part and parcel of their operations. Thus, it is important that each and every owner create an effective and efficient incident reporting protocol to enable people involved in the defense of claims (the insurance company, investigators and attorneys) to complete the most comprehensive and helpful investigation possible. Using a template allows the individual preparing the report to concentrate on gathering relevant information, rather than worrying about what should or should not be included in the document. This is especially important since the person will be completing the report after the occurrence of an incident, which undoubtedly will be a stressful time.
 

Who should file Health club incident report form?

You should keep in mind that the individual who prepares your incident reports could be asked to testify if the claim turns into a lawsuit. Thus, you want someone who not only feels comfortable dealing with the pressure of creating this important document, but also someone who is familiar with your facility’s policies, procedures and operations. Usually, the designated person will be someone in management or a supervisor. This individual generally will be employed with your facility on a long-term basis, and therefore will be available to testify and to discuss the incident with your insurance company’s investigator and attorneys.
 

What information do I provide in ? Health club incident report form?

Information: (Member Involved / Witnesses). Member’s Name Involved in Incident, Sex, Age, Member’s Phone Number: (Home/Work), Street, City, State, Zip, Member Address, Report Date, Manager on Duty at Time of Incident, Witness’ Names and Phone Numbers. Accident / Injury Report: Date of Incident, Time of accident, Cause of injury, Specific area where injury occurred, Type of injury, First Aid treatment by Staff, Other action taken (if referred to Doctor/Hospital add details), Treatment Provided, Describe Clearly How the Incident Occurred. Witnesses Account of Incident. Analysis (What Acts and / or conditions directly contributed to the incident?), Corrective Action (What actions have or will be taken to prevent recurrence), Corrective Action Follow-Up Date, Investigated By (Signature), Date, Reviewed By (Signature).
 

When and Where do I send form?

Philadelphia Indemnity Insurance Company One Ball Plaza, Suite 100, Ball Crowd, PA 1900

Video instructions and help with filling out and completing gym incident report
Instructions and Help about health club incident form
Okay leaders I am here to show you a new report form that we have if someone in your classroom gets injured please come find me I will grab one of these for you, and you need to fill out this top portion right here, and I will fill out the bottom but then just give it back to me, we'll figure it all out, but that's it I just wanted you to see it come find me if someone gets injured
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