Free Gym Accident Report Form

Please complete this form to report any accidents or incidents occurring within the gym.
Date and Time of Accident
Location (Area)
Weightlifting Zone
Cardio Section
Locker Room
Reporter Name
Job Title/Role (if applicable)
Trainer
Staff
Visitor
Gym Name
Phone number
Name of Injured Employee
Incident Description
Provide a detailed description of the incident. Include events leading up to, during, and after the occurrence.
Type of Incident
Slip, Trip, or Fall
Equipment Malfunction or Misuse
Overexertion or Strain
Collisions or Accidental Impact
Witness Name 1
Phone number
Witness Name 2
Phone number
Upload Relevant Files
Were there any injuries?
Yes
No
Description of Injuries or Damages
Describe the type and severity of injuries. Specify who was injured and their condition.
Was medical attention provided?
Immediate Actions Taken
Describe actions taken to address the incident, such as first aid, equipment repair, or area inspection.
Was the incident reported to a manager or trainer?
Yes
No
Manager/Trainer Name
Phone Number
Additional Comments
Include any further information, suggestions, or recommendations to prevent future occurrences.
Reporter | [Your Name] Manager/Trainer |
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