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Sports Injury Report Form

This injury report form collects information about an injured player, including their name, contact details, date and location of injury. It documents the type of activity during injury, suspected cause, body parts injured, treatment provided, and signatures of those involved. Information recorded includes the player's gender, date of birth, date and time of injury, event type (game/practice), location, team, injury status (new/aggravated/recurrent), nature of injury, contributing factors, protective equipment worn, initial medical attendance and advice given.

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697 views1 page

Sports Injury Report Form

This injury report form collects information about an injured player, including their name, contact details, date and location of injury. It documents the type of activity during injury, suspected cause, body parts injured, treatment provided, and signatures of those involved. Information recorded includes the player's gender, date of birth, date and time of injury, event type (game/practice), location, team, injury status (new/aggravated/recurrent), nature of injury, contributing factors, protective equipment worn, initial medical attendance and advice given.

Uploaded by

Nin
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
  • Injury Report Form

Injury

Report Form
Player Name: ______________________________________ Phone Number: ___________________________
Gender: M F D.O.B.: ___/___/_____ Date: ____/____/____ Time: ___:___ am / pm
Event: Game Practice Location: _______________________ Team: ______________________
Team Official Present: Coach Manager Assistant Coach

TYPE OF ACTIVITY: SUSPECTED CAUSE OF INJURY: ADVICE GIVEN
Training
Warm-up Collision with fixed object Unable to return at present
Competition Collision with another player
Cool-down Fall from height/awkward landing Jumping Referred for further assessment before
Other: ____________________ to shoot or defend Overexertion returning to activity
Overuse
INJURY STATUS:
Slip/trip/fall/stumble Immediate return to activity
New injury
Struck by ball/object
Aggravated injury
Temperature related Return to play with restrictions
Recurrent injury
Other: _______________________ ___________________________________
Illness
_____________________________ ___________________________________
Other: _____________________
________________________________

BODY PARTS INJURED EXPLAIN HOW THE INCIDENT OCCURRED NOTICE The injured person was advised
Circle and Name ________________________________ that if the injury/illness does NOT improve
________________________________ in the following 24 hours they MUST seek
________________________________ further medical advice from their medical
________________________________ professional.
________________________________
________________________________
Yes No

IN YOUR OPINION, WERE THERE ANY
CONTRIBUTING FACTORS TO THE INCIDENT? i.e. Signature of Team Official:
unsuitable footwear, playing surface, equipment,
foul play. X: _________________________
________________________________
________________________________ Date: ____/____/____
________________________________


_________________________________
NATURE OF INJURY/ILLNESS WAS PROTECTIVE EQUIPMENT WORN ON THE Signature of Witness (i.e. trainer, parent):
INJURED BODY PART?
Bruise/contusion Yes No X: _________________________
Cardiac problem Cold/flu Concussion
Dislocation/subluxation If yes, what? (mouthguard, etc.) Date: ____ /____ /____
Fracture (including suspected) Loss of ___________________________________
consciousness INITIAL ATTENDANCE None given Signature of Injured Person/Legal
Overuse injury CPR Dressing Immobilization Guardian:
Respiratory problem RICER
Skin injury Splint/sling Strapping/taping X: _________________________
Sprain (i.e. ligament tear) Transport from field
Strain (i.e. muscle tear) Unspecified SCAT2 Date: ____ /____ /____
medical condition Other: Other: ___________________________
______________________

Injury Report Form Player Name: ______________________________________ Phone Number: ___________________________ Gender:

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