Did you have sunglasses on or anything to obstruct your view at the time
Do you wear prescription glasses or contacts and were you wearing them at the time
Was the light on in the area where you were at
What type of floor was it
How wet was the floor
What time was it when this incident occurred
Was there a checklist for cleaning
Were there any wet floor signs or caution signs
When was the last time the area was checked prior to the fall
Did you actually fall on the floor
Did you brace yourself and How
What was on the floor
How did the incident happen
What kind of shoes were you wearing
How old or new were your shoes
Do you still have those shoes
Do you know if this spill was reported prior to you falling
Were your clothes wet or damaged after the incident
Was anyone else walking in the area prior to you falling
Did manager and/or employee look at substance after you fell
Was there an incident report done
Who took the report
Were there any witnesses to the incident
What did you do immediately following the incident
Did anyone help you after the incident and who
Did the manager and/or employee acknowledge the spill and incident
If it was a stranger, did you get their contact information
Any prior accidents? Any Injuries
Any prior S&F ? Any Injuries
Any prior injuries such as birth defects or child hood injuries
Did you or anyone else take any pictures

Slip and Fall Questionnaire

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