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NPSC Injury Report
Injury Report
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* Indicates required question
Injured Person(s) First/Last name
*
Your answer
Date of Injury
*
Your answer
Sport
*
Rec Soccer
Travel Soccer
Rec Volleybal
Travel Volleyball
Basketball
Lacrosse
Flag Football
Type of Activity at time of injury
*
Practice
Technical Training
Game
Body part of injury
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Your answer
Nature of Injury
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Bruise/contusion
Possible concussion
Dislocation
Inflammation/Swelling
Loss of consciousness
Skin Injury - graze, cut, blisters
Possible Sprain/strain
Other:
Cause of Injury
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Collision with fixed object
Collision with another player
Slip/trip/fall/stumble
Struck by ball
struck by another player
Explain how the injury happened
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Your answer
What actions were taken if any
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Your answer
Were the parents notified of the incident
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Yes
No
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