forms | Prominence Pilates Salts Mill

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Please complete this form in the event of an accident or incident at Prominence Pilates Studios. For use by the owner and self-employed instructors at Prominence Pilates Studios Ltd.

Accident/Incident Form

Date and time of incident*

Day

Month

Year

Time

:HoursMinutes

Class Type*

Equipment involved*

Instructor*

Name of Person involved

Email

Phone

Role

Client

Instructor

Visitor

Other

Incident Type*

Description of what happened*

Injury details*

Immediate action taken (tick all that apply)

First aid provided

Client rested/recovered

Emergency services called

Client left session

No action needed

Other

Was emergency care required?*

Yes

No

If Yes

Ambulance called

Hospital attended

Accompanied by:

Names of witnesses (if applicable)

Follow up required (tick all that apply)*

Owner to contact client

Equipment inspection

Instructor review

Insurance notification

No action needed

Other

Report completed by *

Date*

Day

Month

Year

Client to confirm. The information provided in this form will be used to record and manage health and safety incidents at Prominence Pilates Studios Ltd. It will be stored securely and only accessed where necessary for safety, legal, or insurance purposes.

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