Describe the nature
of injuries:
_____________________________________________________________
Names
of other persons
involved:____________________________________________________________
Names of
witnesses:______________________________________________________________________
Describe action taken by
teacher:____________________________________________________________
Describe first aid treatment given and by
whom:__________________________________________________
Name of persons
notified:__________________________________________________________________
Dismissal when with
whom:__________________________________________________________________
Treatment required outside of
school:_________________________________________________________
Action taken by school, as a result of the
accident:________________________________________________
Signature of
Teacher/Coach__________________________________ Date____________
Signature of Athletic
Director________________________________
Date____________
Signature of
Nurse_________________________________________
Date____________
Signature of
Principal_______________________________________
Date____________
An
accident report should be filed by the coach for
every accident or incident involving bodily injury
which occurs in school, on the grounds, going to or
from school, on excursions or field trips, and in
athletic events, or elsewhere under school control.
