Public Swimming Pool Accident Form Mobile App

Included Fields

Customize to add, remove, or edit any of the fields below.

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  (MUST Be Completed for ANY Accident or Rescue)

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  Pool Name:

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  Accident Date:

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  Accident Time:

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  Injured Person/Victim:

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  Address:

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  City:

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  Zip:

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  Phone No.

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  Age:

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  Sex:

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  Lifeguard on Duty:

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  Name of Family Member Notified:

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  Relationship to Victim:

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  Phone No.

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  Name of Employee Care Giver/Employee Completing Report

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  Supervisor’s Review

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  Air Temperature:

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  Water Temperature:

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  Visibility:

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  Sunny and clear

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  Sunny with partial cloud coverage

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  Cloudy

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  Rain, no lightening

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  Rain with Lightening

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  Electrical Storm

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  Verbal

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  Whistle Blows

• ...and More!