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Incident Report
This form is designed to collect information about incidents that impact the safety and well-being of swimmers and their families.
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* Indicates required question
Approximately when did the incident occur?
*
Your answer
At which site did the incident occur?
*
Dishman Community Center
Mt. Scott Community Center
Parkrose High School
Southwest Community Center
Other:
Where did the incident occur? (Please check all that apply.)
*
Building Entrance
Hallway
Locker Room
Lobby
Parking Lot
Pool
Pool Deck
Other
Required
Who was involved? (Please provide a general description or names if appropriate.)
Your answer
What happened? (Please describe the incident in detail.)
*
Your answer
Was anyone on site notified of the incident? This could include community center staff, management, or PAC coaches.
*
Yes
No
How would you describe the on-site response (if any)?
Your answer
Would you like PAC leadership to follow up with you?
*
No
Yes
If Needed
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