Accident/Injury Report

We value the safety and health of our students and take accidents, incidents and injuries seriously. After an incident, we evaluate and file all situational data to review against our procedures and policies and ensure we are able to uphold the highest safety standards.

Please complete the form below

Your Name

First Name

Last Name

Your Email Address

Date of Report

YYYY

Date of Incident

YYYY

Time of Incident

Hour

Minute

Second

Name of Class Instructor

First Name

Last Name

Name of Injured Person

First Name

Last Name

Describe injury and how it occurred

Was student able to continue class?

Type of Injury:

Describe 'Other':

Describe any treatment given in studio:

Were Emergency Services called?

Was Emergency Contact notified?

Additional comments regarding the time of incident: