POOL RENTAL NEAR ME SERVICES

IMPORTANT: Complete this form immediately after any incident, accident, injury, property damage, or safety concern. Submit to PRNM within 24 hours. Failure to report incidents may affect insurance coverage and legal protections.

REPORT INFORMATION

Report Number: _________________________ (PRNM Internal Use)

Date of Report: ________________________________________

Time of Report: ________________________________________

Reported By: __________________________________________

Position/Relationship: ☐ Host ☐ Guest ☐ Witness ☐ Emergency Personnel ☐ Other: ____________

Contact Information: ___________________________________

INCIDENT DETAILS

Date of Incident: _____________________________________

Time of Incident: ____________________________________

Weather Conditions: ☐ Clear ☐ Cloudy ☐ Raining ☐ Windy ☐ Other: ________________

Lighting Conditions: ☐ Daylight ☐ Dusk ☐ Dark ☐ Artificial Lighting ☐ Poor Lighting

INCIDENT LOCATION

☐ Pool Area (specify): ☐ In Pool ☐ Pool Deck ☐ Pool Steps ☐ Diving Board ☐ Pool Equipment Area

☐ Property Areas: ☐ Backyard ☐ Patio ☐ Deck ☐ Driveway ☐ Walkway ☐ Parking Area