Report of Accident in the Alma Public Schools
School *
Required
Date of accident *
MM
/
DD
/
YYYY
Time of accident
Your answer
Injured's Name *
Your answer
Address
Your answer
Telephone
Your answer
Age *
Your answer
Grade
Your answer
Sport
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Nature of Injury
Part of the Body Injured
Specific Location:
Description of Accident *
Your answer
Degree of Injury:
Number of days absent
Your answer
Person in charge when accident occurred
Your answer
Present at scene of accident?
First Aid treatment given *
Your answer
Treatment provided by *
Your answer
Next step *
Required
Exam Date
MM
/
DD
/
YYYY
Transported by
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Parent notified *
Required
Other individual notified
Your answer
Witnesses
Your answer
Plan of care
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Signature of Submitter *
By typing your name, you are signing this form electronically.
Your answer
Additional people to email this document to
This form will be transmitted electronically to the required people- Diane Stankewitz, Eric Huff and Michelle Richards. Please mark additional people needing this report.
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