Get Pool Injury Report Form - Waupaca County

Filling out the Pool Injury Report Form for Waupaca County is a crucial step in documenting incidents that occur in swimming pools and water attractions. This guide will provide you with clear and structured instructions to ensure that you complete the form accurately and efficiently.

Follow the steps to complete the form correctly.

1. Click ‘Get Form’ button to obtain the form and open it in the appropriate editor.
2. Begin by clearly printing all information requested in the designated fields. Start with the establishment name, facility ID number, and establishment address, including city, state, and zip code.
3. Next, fill in the legal licensee and contact person's name along with their telephone number.
4. Indicate the type of pool or water attraction involved in the incident, followed by the name of the injured party, their date of birth, age, and gender.
5. Provide the address, city, state, and zip code for the injured party. Specify whether the injured party was an employee, patron, or other.
6. Enter the contact person for the injured party, including their telephone number.
7. Select the type of incident from the choices: death, injury, or illness, and include the date and time of the incident.
8. In the description of the incident field, provide a detailed account of what occurred. If there is not enough space, you may use the back of the form for additional information.
9. List the names of any lifeguards who were on duty at the time of the incident.
10. Complete the form by entering your name, printing it clearly, providing your signature, position or title, and the date signed.
11. Once all fields are filled, ensure that you save changes, then download, print, or share the completed form as needed.

Complete the Pool Injury Report Form online today and ensure that all necessary details are reported correctly.