SW Incident Report

Santa’s Wonderland Incident & Hazard Report

    Royal Adelaide Showgrounds

    Name of the Device Affected:

    Time of Incident:

    Date of Incident:

    Has the Incident resulted in Injury to a Person or People?


    Names of Employee/s, Patron/s or Public Bystander/s Injured:

    Injured were Employees, Patrons or Bystanders:

    Injury Details:

    Treatment: NoneFirst AidNurseDoctorHospitalization

    Emergency Services Required:

    Names and Contact Details of any Witnesses:



    Write a Detailed Description of the Hazard or Incident:

    —————— DECLARATION ——————

    I, (Enter Your Full Name Below)
    state clearly that I have entered a true and accurate account of the Noted Santa’s Wonderland Hazard / Incident.