Image Fitness Training · Health & Safety

Accident / Incident Report

Record the incident fully and factually. You sign first; the student is then emailed a secure link to review and counter-sign. The report is saved the moment you send it.

Reporting Tutor

Your full name*

Your email*

Injured Person

Student full name*

Student email (they will be emailed a link to sign)*

Student phone

The Incident

Date of incident*

Time of incident*

Venue / location*

Course / class*

Description of what happened*

Nature of injury / complaint*

Body part(s) affected

Cause / contributing factors

Equipment involved (if any)

Conditions (floor, lighting, space, footwear, etc.)

Response & Action Taken

Immediate action & first aid given*

First aider name

Medical attention

Witnesses (name & contact)

Follow-up & preventative action taken

Photo Evidence (optional)

Add up to 6 photos (scene, injury, equipment). Stored securely with the report. Photos are resized on your device before uploading.

Your Declaration & Signature

“I confirm that the details recorded above are a true and accurate account of the incident to the best of my knowledge, and that appropriate care and first aid were provided at the time.”

I confirm the above declaration.

Signature — type your full name*

Your typed name acts as your digital signature and is stamped with the date, time and IP address on submission.

On submit, the report is saved and the student is emailed a link to review and sign. A copy goes to education@imageft.ie.