RIDE ON CAR Hire
incident report Form

REPORT BY

INCIDENT DETAILS

PERSONS INVOLVED

Affected Person (Primary):

Other Persons Involved:

INCIDENT DESCRIPTION

[Example – replace with actual details:] A 4-year-old child (accompanied by parent) was operating a red Little Ride on Car hired from Little Rex. At approximately 1:35PM, while navigating a gentle slope on the grassed area, the child lost balance and the car tipped sideways. The child fell out and landed on their right arm and shoulder. The parent immediately stopped the car and comforted the child. Child has been taken to hospital.

INJURIES AND DAMAGE

Injuries Sustained:

Damage to Equipment:

WITNESSES

ACTIONS TAKEN

CONTRIBUTING FACTORS

DECLARATION

I declare that the information provided in this report is true and accurate to the best of my knowledge.