Incident Report
Any Incidents Today?
Shift
Injured Person Name
*
Gender
*
Female
Male
Phone Number
Email
Incident Date and time (MM/DD/YYYY):
*
Incident Location:
*
Nature of incident:
*
Blood Contamination
Drowning
Fecal Matter
Injuries
Near Downing
Vomit
Incident details:
*
Was 911/EMS called:
*
Yes
No
Did the injured person go to the hospital:
*
Yes
No
Pool Manager Name:
Arujan Sooryakumar
Danny Zheng
Joshua Liao
Karen Lam
Screen Schedule Bullock
Screen Schedule Warden
Shirley Xie
Stephanie Rieger
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