Public pool and spa injury incident report form - Toledo Lucas ... 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out the 'Facility Information' section. Enter the facility name, address, city, state, type, and phone number. Ensure all details are accurate for proper reporting.
3. In the 'Description of Injured Person' section, provide information such as age, sex, race (without personal identifiers), and resident county.
4. Next, detail the 'Description of Incident'. Include the incident date and time, a brief description of what happened, and whether the pool/spa was open at that time.
5. Indicate if any rescues or medical interventions were required. Check all applicable boxes regarding lifeguard presence and care provided.
6. Complete the 'Description of Injury' section by selecting the type of injury sustained and specifying the area injured.
7. Finally, ensure that a pool operator reviews and completes their information before submitting the form to your local health district.

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