Studio Person Making Report

Name of injured Person Have parents/guardian been informed? (For under 18 Only) When did the accident/incident occur? date: time: Name(s) of any witnesses (Use comma to separate the names)

Where did it happen? (what studio, piece of equipment, area etc...) Give a detailed account of the incident/illness Describe the injury/illness Was first aid administered? Describe first aid treatment administered Give details of action taken, or planned, to prevent incident from occurring in future