GLSH INCIDENT REPORT

MM slash DD slash YYYY
Time(Required)
:
Name(Required)
Address(Required)
Medical Attention Required?(Required)
Please indicate if medical assistance was required or requested at time of incident (i.e. Ambulance, physician, sent to Urgent Care, etc.
Please list all staff members who were present at time of incident
Please indicate if any property was damaged in incident at the Great Lakes Sports Hub or personal property.
This field is for validation purposes and should be left unchanged.