Pool incident report template 2025

1. Click ‘Get Form’ to open the pool incident report template in the editor.
2. In Section 1, enter the facility information. Fill in the name, address, city, state, zip code, and phone number of the facility on the left side. On the right side, input the permit number and county, then circle the appropriate pool type (A, B, C, D, E, F).
3. Move to Section 2 and provide the owner’s information. Enter their name, address, city, state, zip code, and phone number.
4. In Section 3 for incident information, circle the type of incident (drowning, immersion, cut/abrasion or other). Record the date and time of the incident. Indicate if emergency services were required by circling YES or NO.
5. Fill in the victim's name and age along with their sex. List any witnesses' names and ages as well.
6. Describe the incident briefly along with any actions taken. Finally, indicate whether a police report is attached by circling YES or NO before signing and dating at the bottom.

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