Skip to the content
Incident Report
Step
1
of
7
14%
Reporter Information
Your Name
(Required)
First
Last
Your Role
(Required)
— Select Role —
Lifeguard
Pool Monitor
Supervisor
Location
Location
(Required)
— Select Location —
Canyon Estates
Greentree
HB Waterfront
Lido
Nellie Gail
Trabuco Highlands
Villeurbanne
Westminster Village
Woodbury
SOKA University
Maryvale
Pick where this happened – the report routes to that location’s manager.
Sub-facility (Woodbury)
(Required)
— Select —
Lagoon
Resort
Cypress
Date Palm
Peppertree
Promenade
Competition
Which Woodbury facility?
Sub-facility (Westminster Village)
(Required)
— Select —
Town Hall- 5200 Blackpool Rd.
Baker- 14294 Bolsa Chica
St. George- 5230 Tufton
Victoria- 14400 Pimlico
Which Westminster Village facility?
Sub-facility (Villeurbanne)
(Required)
— Select —
260 N. Stillwater
5722 E. Stillwater
Which Villeurbanne facility?
Area at Facility
(Required)
— Select Area —
Wader
Spa
Pool
Pool Deck
Locker / Restroom
When did it happen?
Date
(Required)
MM slash DD slash YYYY
Time
(Required)
Hours
:
Minutes
AM
PM
AM/PM
Type of Incident
Incident Type
(Required)
Injury / Medical
Pool Closure
Rule Violation
Pool Rescue
Service Animal Reported on Deck
Facility Issue
Pick the one that best fits — the right questions will then appear.
•
Injury / Medical
— someone got hurt or feels sick
•
Pool Closure
— the pool had to be closed (contamination, weather, equipment)
•
Rule Violation
— someone broke a rule and you stepped in
•
Pool Rescue
— you went in or assisted someone in the water
•
Service Animal Reported on Deck
— a guest brings an animal and identifies it as a service animal
•
Facility Issue
— something is broken or needs fixing
Person Involved
Who was hurt, broke the rule, or was rescued. Fill in what you know.
Person Involved – First Name
If known. Leave blank if unknown.
Person Involved – Last Name
If known. Leave blank if unknown.
FOB # / Keycard # or Unit #
If known.
Parent Name (if applicable)
Only if the person involved is a minor or in a guardian’s care.
Injury / Medical Details
Shown because you selected Injury / Medical.
Who was injured?
Adult guest / resident
Child (under 18)
Staff member
Multiple people
How did the injury happen?
Slip / fall on deck
Diving incident
Submersion / near-drowning
Collision (with person, wall, etc.)
Struck by object
Cut / laceration
Medical event (seizure, fainting, cardiac)
Allergic reaction / sting
Heat / sun-related
Other
Body part affected
Head / face
Neck / back
Shoulder / arm
Hand / wrist / finger
Chest / torso
Hip / leg / knee
Foot / ankle / toe
Multiple areas
Internal / not visible
Severity
Minor – no first aid needed
Minor – first aid given on scene
Moderate – needs follow-up care
Serious – 911 / EMS called
Lifeguard response
No rescue needed
Assist from water
Active rescue
CPR performed
AED used
Was 911 / EMS called?
Yes
No
Did the injured person refuse treatment / transport?
Yes
No
N/A
Pool Closure Details
Shown because you selected Pool Closure.
Reason for closure
— Select —
AFR (Accidental Fecal Release)
Blood or other contaminant
Equipment malfunction
Weather
Medical event
Poor water visibility
Time pool was closed
Hours
:
Minutes
AM
PM
AM/PM
Has the pool been reopened?
Yes
No – still closed
Rule Violation Details
Shown because you selected Rule Violation.
Which rule was violated?
Type the rule that was broken.
What action was taken?
Verbal warning
Written warning
Removed from facility
Pool Rescue Details
Shown because you selected Pool Rescue.
Type of rescue
Assist (reach / throw, swimmer aware)
Active rescue (swimmer in distress)
Submersion rescue (swimmer under water)
Spinal / suspected spinal injury rescue
Was the victim conscious throughout?
Yes – conscious throughout
No – unconscious on rescue
Lost consciousness
Regained consciousness on scene
Emergency actions taken
Rescue breathing
CPR
AED used
Backboard / spinal precautions
Oxygen administered
None needed
Tap all that apply.
Was 911 / EMS called?
Yes
No
Outcome
Released on scene
Refused transport
Transported by EMS
Transported by family / self
Service Animal Details
Shown because you selected Service Animal Reported on Deck. ADA only allows two questions of a handler — answer what they told you.
Type of animal
(Required)
— Select —
Dog
Miniature horse
Other
ADA only recognizes dogs and, in some cases, miniature horses as service animals.
Did the handler state it's a service animal for a disability?
Yes
No
Not asked
What task did the handler say the animal performs?
Short answer. This is the second ADA-permitted question.
Facility Issue Details
Shown because you selected Facility Issue. Covers damage, hazards, and maintenance needs.
Is this an immediate safety risk?
(Required)
Yes – area is secured / closed off
Yes – still present and not secured
No – needs repair but not urgent
Photo of the issue
(Required)
Drop files here or
Select files
Accepted file types: jpg, jpeg, png, gif, pdf, heic, Max. file size: 32 MB, Max. files: 5.
A photo is required. Up to 5 files, 10MB each.
Summary
Description / Details
(Required)
Write a short description of what happened, or describe the issue.
Attachments (optional)
Photos or documents
Drop files here or
Select files
Accepted file types: jpg, jpeg, png, gif, pdf, doc, docx, heic, Max. file size: 32 MB, Max. files: 5.
Optional. Snap a photo of the scene, damage, or anything relevant. Up to 5 files, 10MB each.
Anything else? (optional)