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]

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]

Student-athlete

Recreational league participant

Club team member

Gym member

Camper

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]

Warm-up / stretching

Drill or skill practice

Conditioning / fitness

Game play / competition

Weight training / strength work

Cool-down

Playing Surface or Environment:

• Indoor court (wood, synthetic, etc.)

• Outdoor grass / turf field

• Track

• Pool / aquatic area

• Weight room / gym floor

• Other: [Describe]

Indoor court (wood, synthetic, etc.)

Outdoor grass / turf field

Track

Pool / aquatic area

Weight room / gym floor

Weather Conditions (if outdoors):

• Clear

• Cloudy

• Rain

• Snow / ice

• Hot / humid

• Cold

• Other: [Describe]

Clear

Cloudy

Rain

Snow / ice

Hot / humid

Cold

4. Protective Equipment and Gear

Was the participant using required protective equipment?

• Yes – fully

• Partially

• No

• Not applicable for this activity

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]

Helmet

Mouthguard

Shoulder pads

Shin guards

Knee or elbow pads

Wrist guards or braces

Protective eyewear / goggles

Athletic footwear (cleats, court shoes, etc.)

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

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]

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

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]

Bruise / contusion

Cut / laceration

Abrasion / scrape

Sprain (ligament)

Strain (muscle / tendon)

Possible fracture / dislocation

Concussion or head injury signs

Cramp / spasm

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]

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]

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]

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

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

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

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]

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

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

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)

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

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]

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]

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]

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)