Sports Injury Report Template: Care Details & Signatures

Sports Injury Report Template

[School / Club / League / Facility Name]

[Department or Program Name, if applicable]

[Street Address]

[City, State/Province, ZIP/Postal Code]

Phone: [Phone Number]

Email: [Email Address]

1. Basic Incident Information

Date of Injury: [MM/DD/YYYY]

Approximate Time of Injury: [HH:MM a.m./p.m.]

Location of Incident (field, court, gym, pool, weight room, etc.):

[Specific area, e.g., “Main gym – Court 2,” “Football field – south end,” “Outdoor track – lane 3”]

Type of Event (check one):

• Practice / training session

• Game / match / competition

• Scrimmage

• Conditioning / weight training

• Physical education class

• Camp / clinic

• Other: [Describe]

2. Injured Participant Information

Full Name of Injured Participant: [First, Middle, Last]

Date of Birth: [MM/DD/YYYY]

Age: [Age]

Gender: [Gender]

Participant Status (check one):

• Student-athlete

• Recreational league participant

• Club team member

• Gym member

• Camper

• Other: [Describe]

Team / Class / Program: [Team name, age group, level, or class name]

School / Organization (if different from above): [Name]

Parent / Guardian Name (if minor): [Name]

Parent / Guardian Phone: [Phone Number]

Parent / Guardian Email: [Email Address]

3. Sport and Activity Details

Sport: [e.g., Soccer, Basketball, Football, Volleyball, Gymnastics, Track and Field, Swimming, Wrestling, Rugby, Hockey, etc.]

Position / Role (if applicable): [e.g., Goalkeeper, Forward, Guard, Pitcher, etc.]

Activity at Time of Injury (check or describe):

• Warm-up / stretching

• Drill or skill practice

• Conditioning / fitness

• Game play / competition

• Scrimmage

• Weight training / strength work

• Cool-down

• Other: [Describe]

Playing Surface or Environment:

• Indoor court (wood, synthetic, etc.)

• Outdoor grass / turf field

• Track

• Pool / aquatic area

• Weight room / gym floor

• Other: [Describe]

Weather Conditions (if outdoors):

• Clear

• Cloudy

• Rain

• Snow / ice

• Hot / humid

• Cold

• Other: [Describe]

4. Protective Equipment and Gear

Was the participant using required protective equipment?

• Yes – fully

• Partially

• No

• Not applicable for this activity

Check equipment used (if applicable):

• Helmet

• Mouthguard

• Shoulder pads

• Shin guards

• Knee or elbow pads

• Wrist guards or braces

• Protective eyewear / goggles

• Athletic footwear (cleats, court shoes, etc.)

• Other: [Describe]

If equipment was not used or was damaged, briefly describe:

[Description]

5. Description of Incident (What Happened)

Person Completing Report: [Name]

Role / Title: [Coach, Trainer, Teacher, Referee, Staff, etc.]

Phone / Email: [Contact Details]

In your own words, describe what happened. Focus on facts, not opinions or blame.

Incident Narrative:

On [Date] at approximately [Time], during [practice/game/other] for [Team/Program], the injured participant was:

[Describe what the participant was doing just before the injury, e.g., “running a sprint drill,” “attempting a layup,” “tackling an opponent,” “performing a vault,” etc.]

Then:

[Explain step by step how the injury occurred. Include: contact with another player, fall, collision with equipment or surface, awkward landing, twist, overextension, etc.]

Any notable details (check and describe if applicable):

• Contact with another player – [Describe]

• Non-contact injury (e.g., sudden twist, stop, or turn) – [Describe]

• Contact with equipment (goalpost, net, ball, bat, bar, etc.) – [Describe]

• Contact with ground or wall – [Describe]

• Possible foul, rule violation, or unsafe play – [Describe]

• None observed

6. Injury Details and Observed Symptoms

Body Part(s) Injured (check or list all that apply):

• Head / scalp

• Face / eye / nose / mouth / jaw

• Neck / cervical spine

• Shoulder / arm / elbow

• Wrist / hand / fingers

• Chest / ribs

• Back (upper / mid / lower)

• Hip / pelvis

• Thigh / hamstring / quadriceps

• Knee

• Lower leg / shin / calf

• Ankle

• Foot / toes

• Other: [Describe]

Type of Injury Suspected (check all that apply):

• Bruise / contusion

• Cut / laceration

• Abrasion / scrape

• Sprain (ligament)

• Strain (muscle / tendon)

• Possible fracture / dislocation

• Concussion or head injury signs

• Cramp / spasm

• Other: [Describe]

Immediate Signs and Symptoms Observed (check and describe):

• Pain – [Location and description]

• Swelling – [Where?]

• Deformity or abnormal position – [Describe]

• Bleeding – [Location and severity]

• Dizziness or balance problems – [Describe]

• Headache – [Severity]

• Nausea or vomiting – [Details]

• Confusion, memory issues, or disorientation – [Describe]

• Loss of consciousness (suspected or confirmed) – [Duration]

• Vision changes – [Describe]

• Numbness or tingling – [Where?]

• Difficulty breathing – [Details]

• Other: [Describe]

Participant’s Pain Level (0–10; 0 = no pain, 10 = worst pain):

Reported Pain Score: [0–10]

7. First Aid and Immediate Response

Person(s) Providing First Aid or Initial Care (name and role):

[Name 1 – Coach, Trainer, Nurse, EMT, etc.]

[Name 2 – if applicable]

Immediate Actions Taken (check and describe):

• Activity stopped / player removed from play

• Basic wound care (cleaning, bandage, ice)

• Immobilization (splint, brace, sling, etc.)

• Rest and observation on sideline

• CPR / AED (describe actions and outcome)

• Other first aid: [Describe]

Was emergency medical service (EMS/ambulance) called?

• Yes – Time called: [HH:MM] – Time arrived: [HH:MM]

• No

Was the participant transported from the site?

• Yes, by ambulance to: [Hospital/Clinic Name]

• Yes, by parent/guardian or other adult to: [Facility Name]

• No, remained on site

• Unknown

8. Follow-Up and Notifications

Parents / Guardians Notified (if minor):

• In person at site

• By phone call

• By text/email

• Notified later (explain): [Description]

Name of Person Who Notified Parent/Guardian: [Name]

Time and Date of Notification: [MM/DD/YYYY, HH:MM]

Was school administration, league administration, or facility management notified?

• Yes – Name/Position: [Name, Role] – Date/Time: [Details]

• No

• Not applicable

Did the participant return to play the same day?

• Yes – with no restrictions

• Yes – with restrictions (describe): [Description]

• No – removed from play for remainder of session/event

• Not applicable (end of session)

Is follow-up medical evaluation recommended or required?

• Yes – by primary care provider

• Yes – by sports medicine / orthopedist

• Yes – by emergency department / urgent care

• Yes – concussion evaluation / clearance

• No (based on current observations)

• Unknown / pending parent decision

9. Witnesses

List any witnesses to the incident (players, coaches, officials, spectators).

Witness 1:

Name: [Name]

Role / Relationship: [Teammate, Coach, Referee, Parent, etc.]

Phone / Email (if available): [Contact]

Witness 2:

Name: [Name]

Role / Relationship: [Role]

Phone / Email: [Contact]

[Add additional witnesses as needed.]

10. Additional Notes and Risk Factors

Playing Conditions or Contributing Factors (check and describe if relevant):

• Wet or slippery surface – [Describe]

• Uneven or damaged surface – [Describe]

• Poor lighting – [Describe]

• Overcrowded playing area – [Describe]

• Equipment or facility issue (loose goal, broken floorboard, etc.) – [Describe]

• Inadequate warm-up or fatigue observed – [Describe]

• Rule violation or unsafe behavior – [Describe]

• Other: [Describe]

Additional Comments (optional):

[Free-text for any extra context, concerns, or recommended changes to drills, rules, or safety procedures.]

11. Attachments Checklist

Check any items attached or available with this report:

• Photos of area or equipment

• Photos of visible injuries (if allowed by policy)

• Game or practice incident notes

• Referee or official’s report

• Medical or trainer’s notes (if available)

• Written statements from witnesses

• Other documents: [Describe]

12. Signatures and Acknowledgments

Person Completing This Report

Name (print): _______________________________

Role / Title: _______________________________

Signature: __________________________________

Date: [MM/DD/YYYY]

Coach / Program Representative (if different)

Administrator / Athletic Director (Optional)