KIDS CITY Guest Accident/ Incident Report

INFORMATION ABOUT PERSON INVOLVED IN THE INCIDENT

Gender
Waiver Attached
Were you wearing socks?

INFORMATION ABOUT THE INCIDENT

Medical Attention
Police Notified
Were there any witnesses to the incident?

ANSWER IF THE PERSON INVOLVED WITH THE INCIDENT IS A MINOR

Were parent/s or guardian notified?
Did this incident happen during parent/s or guardian supervision?

INFORMATION ABOUT WITNESS (If Any)

Were parent/s or guardian notified?
Did this incident happen during parent/s or guardian supervision?

REPORTING STAFF

MANAGER / SUPERVISOR ON DUTY