top of page

Foresight Fitness

Injury Report Form

Complete this form and notify your Regional Fitness Manager immediately following the incident. Email any photos taken to  Regional Fitness Manager. If for any reason you cannot transmit the form, you are required to contact your Regional Fitness Manager immediately following the incident. If you cannot reach the Regional Fitness Manger, call 540-419-5310 to report the incident.

​​

Date and time
Year
Month
Day
Time
HoursMinutes
Was 911 caled?
Yes
No
Did injured refuse care?
Yes
No
Staff person acquire photos of injury or site?
Yes
No

CALL TO BOOK AN APPOINTMENT

540-419-5310
bottom of page