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2020/2021 Athletic Injury Report **For Coaches use only**

Please fill out the form using the following guidelines:

1. Demographic Information

2. Parent/Guardian must be notified at the time of the accident. Note date/time/and how the parent was notified (phone/in Person), and who notified them.

3. Date accident occurred and date the accident is reported to the nurse/administration.

4. Location of accident.

5. Describe the injury. Write down what you see. Example - Bruise, swelling, bleeding, bone sticking out of skin, etc. DO NOT diagnose injury. Example - Do not put down sprain, strain, or fracture. Indicate what body part(s) is injured. Example - Ankle injury, knee injury.

6. What was the cause of the accident? How did the accident occur? Any witnesses? Anyone else involved?

7. Supervisor at the time of the accident? Who was in charge?

8. First aid provided. Who provided care (coach, EMT, doctor, trainer, nurse)? Disposition of case. Example - Student left with parent to see own doctor. Student transported to emergency room (which one) via ambulance.


Accident Injury Report - July 01, 2020 to July 01, 2021
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