General Injury Report
To report an injury, please provide the following information.
Submitter's Name
*
First Name
Last Name
Submitter's CR Email
*
example@example.com
Date and time when injury occurred:
*
-
Day
-
Month
Year
Date Picker Icon
Time
*
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Who was hurt?
First Name
Last Name
Grade/Staff
*
9th
10th
11th
12th
Staff
Important Details
*
Please include the location where the injury occurred (gym, Harrison Park, another school) AND what steps were taken after the injury occurred.
Do you wish to add a file?
Browse Files
If there are any images or documents related to this incident, please attach.
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of
Student was removed from play due to possible concussion.
*
Yes
No
Is follow up required from a member of the Administration or Athletics Staff?
*
Yes
No
ADMIN - please add notes below indicating what the follow-up was.
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