Procedure For RECORDING AN INCIDENT OR FILING A CLAIM
Actions to be Taken in the Event of an Injury, Property Loss or Other Reportable Incident
Should an incident occur on your premises, you must address the situation immediately and appropriately:
- Administer first aid, call first responders, evacuate the facility, or take other emergency measures as appropriate for the incident type.
- Create a written record of each incident by downloading, printing and completing the Incident Report Form or Curves Incident Report Form as appropriate for your facility. Include in your incident report, all actions taken in response to the incident and the names of all witnesses. See below for assistance with completing the Incident Report Form.
- If there is property loss associated with the incident, please also download, print and complete the Property Loss Notice Form or Curves Property Loss Notice Form as appropriate for your facility.
- To file a claim, email email@example.com or fax (601.707.1040) your completed claim form to our office.
- Notice: Sports & Fitness Insurance Corporation cannot accept Incident Reports or Property Loss Notices via telephone or voicemail. However, we are happy to answer your questions by phone: 800-844-0536.
- IMPORTANT: If the on-site manager or corporate management feel that the incident report involved significant injury and/or any potential for a claim, forward the documentation to SFIC even though no contact has been requested. The carrier’s claims department will determine if they will contact the other party.
- Any incident involving a call to 911 should be forwarded for review by the insurance company.
How to Complete an Incident Report Form
A PDF version of How to Complete an Incident Report Form is available here.
Use this guide to help you complete your Incident Report Form.
SECTION 1: Basic Facts
- Incident report must be prepared as soon as possible following the incident, while the other party and any witnesses are still present if possible.
- Handwriting must be legible.
- Date and time as accurate as possible.
- Specify the location where the incident occurred and the on-site contact name and telephone number, preferably the manager who was on duty at the time of the incident.
SECTION 2: Other Party Information
- Obtain the correct spelling of the other party’s name, best telephone contact number, and their correct home address.
- Add the other party’s membership or account number and include a copy of their signed waiver—if possible.
SECTION 3: Description of Incident/Injuries
- Clearly and concisely describe the incident.
- Include only facts, no assumptions or conclusions about what happened.
- Describe injuries in as much detail as is known.
- If other party shows signs of illness, describe symptoms before, during and after the incident.
- Describe the other party’s condition when they left the premises and the means by which they left ( i.e., Did they drive themselves home or to emergency room? Did someone else drive them? Did they leave in an ambulance?)
SECTION 4: Property Involved
- If equipment was involved in the incident, provide the name, manufacturer, model and serial number, if possible.
- Save any equipment or parts involved in an incident so that they can be inspected if needed. This includes cardio equipment, such as, balls, mats, cords, ropes, steps, hand weights, etc.
- If a staff member suspects that a piece of equipment may have malfunctioned or broken, prevent further use of the equipment until a qualified repair technician has serviced the equipment. Save all parts being replaced or take pictures to document potential product liability.
SECTION 5: Employee Involved or Other Witness
- Record the best contact information for any employee who was a witness to the incident or was involved in administering first aid.
- Record the names and contact information for other members who were witnesses to the incident if applicable.
- Use a separate sheet for multiple employees and witnesses.
SECTION 6: Actions Taken up to This Point
- Describe any actions taken by staff members including but not limited to first aid, calling 911, calling a family member, etc. Provide as much detail as possible on first aid administered.
- If staff member or witness was involved in extensive first aid or CPR, instruct them to prepare a statement on a separate piece of paper stating what actions they took in as much detail as they can remember.
- Other relevant information could include any of the following:
- The other party denied first aid or staff member’s offer to call 911 or a family member
- The other party stated that they were “fine” after the incident
- The other party finished their workout or did not finish their workout after the incident
SECTION 7: Action Requested/Recommended
- Does the other party want to be contacted by your insurance carrier? This is an indication of whether or not they want to file a claim. Forward the incident report to Sports & Fitness Insurance at the fax number or email address below, if they do want to be contacted.
- If the other party does not want to be contacted after the incident, then indicate that the incident report is “Submitted for Reporting purposes only” and save all of the documentation.
- Note: If the on-site manager or corporate management feel that the incident report involved significant injury and/or any potential for a claim, forward the documentation to Sports & Fitness Insurance even though no Contact has been requested. The carrier’s claims department will determine if they will contact the other party. Any incident involving a call to 911 should be forwarded for review by the insurance company.
Injured Party’s Signature
- Make every effort to have the other party review the incident report and sign it.
- Note if the other party is unable to sign due to their physical condition or if the other party is unwilling to sign for any reason.
- Forward all relevant documentation to Sports & Fitness Insurance if the claimant has requested contact or if it likely a claim will be filed.
- Keep all incident reports on file and make note of any future contact from the injured party. Claims can be turned in years after the incident occurred.
- Submit completed Incident Report Forms and any supporting documents by fax to 601.707.1040 or by email our claims department at firstname.lastname@example.org.
Below are links to all claim-related forms