ACCIDENT/INJURY REPORT

FOH Accident Report

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

MM slash DD slash YYYY
Time of Accident(Required)
:

PATRON INFORMATION

Name of Patron(Required)
Patron who was involved in the accident
Name of Reservation Holder
The person who who purchased the tickets

ACCIDENT INFORMATION

Which Emergency Services Were Contacted?

STAFF INFORMATION

Name(Required)
Staff who responded to incident
Name
Name

REPORT SUBMISSION

MM slash DD slash YYYY
Time
: