ACCIDENT/INJURY REPORT - Downtown Cabaret Downtown Cabaret

ACCIDENT/INJURY REPORT

FOH Accident Report

To be filled out and submitted by House Manager in the event an audience member sustains an injury

Date of Accident(Required)

Time of Accident(Required)

Location:(Required)

Production

PATRON INFORMATION

Name of Patron(Required)

Patron who was involved in the accident

First Last

Phone Number(Required)

Email Address(Required)

Table Number

Name of Reservation Holder

The person who who purchased the tickets

First Last

ACCIDENT INFORMATION

Description of Accident

Description of First Aid Given

Which Emergency Services Were Contacted?

None

EMT

Police

Fire Department

Other (List Below)

Other Emergency Services

Was Any Further Action Taken?

STAFF INFORMATION

Name(Required)

Staff who responded to incident

First Last

Staff Phone Number

Staff Email Address

Title

Name

First Last

Staff Phone Number

Staff Email Address

Title

Name

First Last

Staff Phone Number

Staff Email Address

Title

REPORT SUBMISSION

Report Submitted By

Date

Time

Liability(Required)

I submit that all above information is accurate to the best of my knowledge

FOH Accident Report

PATRON INFORMATION

ACCIDENT INFORMATION

STAFF INFORMATION

REPORT SUBMISSION

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