CRMS Accident/Injury Report
Coaches, please complete this form if a student injury leads to one of these outcomes:

          -You withdrew an athlete from the entirety of a game/practice after the injury occurred
          -You called a parent to inform them of an injury
          -You called 911 or you advised medical treatment for a student
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Name of Person Filing Report *
Name of Injured Person
First Name *
Last Name *
Grade *
School *
Time and Place of Accident/Injury
Date *
MM
/
DD
/
YYYY
Time *
Time
:
Location *
Please be specific as to the building and location.
Type of Accident/Injury *
Check any that apply. If OTHER, please specify.
Required
Affected Side
Part of the Body *
Required
Cause of Accident/Injury
Description of how the accident/injury occurred. *
Did teacher/staff member/coach witness incident? *
Name(s) of witness(es):
Action Taken
Give specific details for any that apply.
First Aid *
Transported by: *
Required
Transported to: *
Required
Notes
Notifications
Parent/Guardian at event? *
Date Parent/Guardian was notified
MM
/
DD
/
YYYY
Time Parent/Guardian was notified
Time
:
Who notified the Parent/Guardian or "other"? *
Thank You
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