City Pools - Report of injury incident or dangerous event

This form is for the use of Brisbane City Council Pool Lessees to report incidents of injury or dangerous events.

Reporting of these incidents should take place within 24-hours of an injury or incident occuring.

Data collected within this for is treated in accordance with Council's privacy policy.

 
1 Incident details 2 Investigation details 3 Actions taken 4 Review and submit

Incident details

Type of incident: *
:
Location of incident:
Details of the injured person(s)
You can add up to 3 injured persons on this form
Person 1
e.g left wrist, right lower leg
e.g. cut, sprain, fracture
Did anyone witness the incident: *

Witnesses

You can add up to two (2) witnesses on this report.

Witness 1
14 November 2018