Technocopia

Technocopia is maker space located in Worcester, MA.  We provide our members with workspace and access to a bunch of tools to work on whatever they can dream up!

Safety Incident/Injury Report

Please fill out this form factually, to the best of your ability and memory, if you observed an injury or incident occur at Technocopia.  Your information will help us correctly address the situation and develop better policies and procedures to make our community even safer.

Name *
Name
Name of person involved in incident/injury.
Parent/Guardian
Parent/Guardian
If involved person is a minor, please include name of parent/guardian.
Age of the involved person.
Sex
Contact information of involved person, so we can follow up on the incident.
Date of Incident/Injury *
Date of Incident/Injury
Time of Incident/Injury *
Time of Incident/Injury
What was the injured doing before the incident?
What happened to the injured?
What happened after the injury occured?
Parts of body injured & nature of injuries.
Specific treatments administered to injuries.
Please include any additional relevant information
Name of Individual Filling out Report *
Name of Individual Filling out Report
We may want to contact you for additional information. Thank you!

 

Sponsors

Monster Movers

Monster Movers

Earth Works

Earth Works

Technocopia 
44 Portland Street 6th Floor
Worcester MA, 01608
Ph. (774) 420-2244