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 Name
Last Name
Title
Phone Number of Person Submitting Report
Please enter a valid phone number.
School
Middle School
High School
Sport
Please Select
MS Boys Wrestling
MS Flag Football
MS Volleyball
MS Track & Cross County
MS Boys Basketball
MS Girls Basketball
MS Softball
MS Baseball
MS Soccer
MS Field Hockey
HS Wrestling Dual (PSAL)
HS Flag Football Girls (PSAL)
HS Flag Football
HS Volleyball Boys (PSAL)
HS Volleyball Girls
HS Track & Cross Country
HS Basketball Girls Varsity (PSAL)
HS Basketball Boys Varsity (PSAL)
HS Basketball Boys JV
HS Basketball Girls JV
HS Baseball
HS Softball
HS Soccer
Student Name
First Name
Last Name
Injury Date
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Location of Incident
Classroom
Field
Gym
Locker Room
Other
Injury Occurred During
Game
Practice
Transportation
Other
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?
Yes
No
Not Sure
First Aid Given (Select all that apply)
Describe 'Other'
Action Taken
Parent Took Home
Returned to Sport
Transfer to Hospital
Parent took to ER
Parent took to Doctor
Called 911
Other
Please describe the specifics of how the injury occurred.
Parent Name and Number
Time Parent was Notified
Hour Minutes
AM
PM
AM/PM Option
Submit
Should be Empty: