Swimming Incident Report Form PDF Details

Accidents can happen anytime, anywhere. No matter how careful you or your staff may be while swimming at your facility, it’s important to be prepared with the right paperwork in case of an incident. This is why having a complete and comprehensive Swimming Incident Report Form on hand is necessary. In this blog post, we’ll discuss what information needs to go into this form and how it can best be used by pool owners and operators. It’s essential that you have the right forms ready if something unexpected happens so that appropriate follow-up measures can be taken!

QuestionAnswer
Form NameSwimming Incident Report Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesswimming injury report form, DHEC, SC, descriptive

Form Preview Example

Swimming Pool

Incident Report

Compliance Assurance Division

* Please Type or Print Clearly

Section 1. Facility Information

Name :

Permit # :

 

 

Address :

County :

 

 

City, State, Zip :

Pool Type (circle one) : A B C D E F

 

 

Phone :

 

Section 2. Owner Information

Name :

Address :

City, State, Zip :

Phone Number :

Section 3. Incident Information

Type of Incident (circle one) :

a) Drowning

b) Immersion

c) Cut/Abrasion

d) Other

 

 

 

 

 

 

 

 

 

Date of Incident :

 

 

Time:

 

 

 

 

 

 

 

 

 

 

 

 

Was 911, Ambulence, or Emergency Room Visit Required (circle one) : YES

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

Name of Victim :

 

 

Age :

 

 

 

Sex :

 

 

 

 

 

 

 

 

 

Witnesses

Name :

 

Age :

 

 

 

Name :

 

Age :

 

 

Description of Incident and Action Taken:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Police Report Attached (circle one) : YES

NO

 

 

 

Owner Signature:

 

Date:

 

 

 

 

 

DHEC 3785 (07/01)

Purpose: This form is to be used by public pool owners or operators in the event of a patron death, injury, or accident requiring an EMS response, an emergency room visit, or hospitalization.

This application must be submitted to the following address:

SC DHEC

2600 Bull St.

Columbia, SC 29201

or faxed to: (803) 898-4215, Attn: Recreational Waters

ITEM BY ITEM INSTRUCTIONS FOR COMPLETING THIS FORM

SECTION 1. FACILITY INFORMATION:

In the left column of section 1, enter the FACILITY’s information including: name of facility, address, city, state, zip, and phone number.

In the right column of section 1, enter the FACILITY’s information including: permit number, county, and circle the pool type (A, B, C, D, E, F).

SECTION 2. OWNER INFORMATION:

In section 2, enter the FACILITY OWNER’s information including: name of facility owner, address, city, state, zip, and phone number.

SECTION 3. INCIDENT INFORMATION:

Circle type of incident (drowning, immersion, cut/abrasion, other). If other, please provide descriptive name.

In the left column enter the date of the incident. In the right column enter the time of the incident.

Circle (YES or NO) whether 911, ambulance or emergency room visit was required.

In the left column, enter the victim’s name. In the center column, enter the victim’s age. In the left column, enter the sex of the victim (male or female).

In the left column enter the names of witnesses to the incident. Enter the age of each witness in the right column.

Describe briefly the incident and any actions taken.

Circle (YES or NO) whether a police report is attached.

Owner sign and date the bottom of the form.

Office Mechanics and Filing: The form should be filed in the Recreational Waters File Room according to facility permit number.

DHEC 3785 (07/01)

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Step 1: Simply click on the "Get Form Button" at the top of this site to launch our pdf form editor. Here you will find everything that is necessary to fill out your document.

Step 2: When you open the tool, you will find the document made ready to be filled out. Aside from filling out various blanks, you might also do other sorts of actions with the Document, that is putting on any text, editing the original text, inserting images, signing the document, and more.

Concentrate while completing this pdf. Ensure that every single blank field is done correctly.

1. You'll want to fill out the swimming pool incident report properly, therefore be mindful while working with the parts comprising all of these blanks:

Part no. 1 in filling in template incident report form swimming pool

2. After performing the previous step, head on to the next step and enter all required particulars in all these fields - Name, Name, Description of Incident and Action, Police Report Attached circle one, Age, and Age.

template incident report form swimming pool writing process outlined (stage 2)

Regarding Age and Description of Incident and Action, make sure you get them right in this section. Both these are the most important ones in the PDF.

Step 3: Before moving forward, ensure that blank fields are filled in right. When you are satisfied with it, click “Done." Go for a 7-day free trial plan with us and acquire direct access to swimming pool incident report - download or modify from your personal account. At FormsPal.com, we do everything we can to be certain that all your details are stored secure.

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