Accident Report

ACCIDENT REPORT FORM 

Date of this report___________________ 

Name of school official in charge _________________________________________________________ 

Assigned officials’ names ______________________________________________________________ 

Date of incident ____________________________ Time of incident____________________________ 

Name of injured _______________________________ Level of competition______________________ 

Sport ___________________________________________________________________________ 

Location of contest ________________________________________________________________________________ 

Schools competing ________________________________________________________________________________ 

Weather conditions ________________________________________________________________________________ 

Type of suspected injury _______________________________________________________________ 

Name(s) of school official(s) treating suspected injury if any treatment was given ________________________________________________________________________________ 

Description of incident ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ 

Name(s) and action taken by others administering to suspected injury ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ 

________________________________________________________________________________ 

________________________________________________________________________________ 

Name and address of official making this report _______________________________________________ ________________________________________________________________________________ 

Save a copy for yourself and email a copy to Lou Bonacci Ump1213@stny.rr.com