Inwood Athletics Injury Report

Inwood Athletics Injury Report

Please complete the following form with as much detail as possible, in regards to Student-Athlete Injury.
Staff Email*
example@example.com
Name of Person Submitting Report

First NameLast Name
Title
Phone Number of Person Submitting Report
Please enter a valid phone number.Format: (000) 000-0000.
School

Middle SchoolHigh School
Sport
Student Name

First NameLast Name
Injury Date

MonthDayYear
Date
Hour MinutesAM/PM Option
Location of Incident

ClassroomFieldGymLocker RoomOther
Injury Occurred During

GamePracticeTransportationOther
Please list any witnesses
Body Part Injured (Select all that apply)
Describe 'Other'
Type of Injury (Select all that apply)
Describe 'Other'
If suspected concussion does the athlete have a pre-concussion test on file?

YesNoNot Sure
First Aid Given (Select all that apply)
Describe 'Other'
Action Taken

Parent Took HomeReturned to SportTransfer to HospitalParent took to ERParent took to DoctorCalled 911Other
Please describe the specifics of how the injury occurred.
Parent Name and Number
Time Parent was Notified

Hour Minutes

AM/PM Option
Should be Empty: