Vulnerable Accident / Incident Report Form
​
Please telephone the CHSG Chair as soon as possible to notify details of the incident
This notification of incident form will be submitted to the CHSG Chair
The Chair will then take the appropriate action
​
This form will be reviewed at the next Trustees meeting to ascertain any actions thought to be appropriate
Vulnerable Adult
Accident Date/Time
If you have answered yes to any of the questions above you are strongly recommended to seek medical advice before using gym facilities.
Emergency Contact Details
I declare that I am not aware of any medical reason why I should not use the exercise facilities at this Centre.
I understand that I use the facilities at my own risk and that I agree to adhere to the centre's rules and etiquette and use the equipment in the manner I have been shown in order to prevent injury to myself or others and damage to the equipment.