Cheer Injury Form

    Cheer Injury Report

    Please complete one report for each injury from the first day of cheer through the end of the season.

    Name

    School:

    Coach:

    Date of Injury:

    Athlete Gender:

    FemaleMale

    Type of Injury:

    BruiseTearCut/AbrasionFractureNosebleedConcussionStrainSprain

    Anatomical area involved:

    Extent of Injury:

    MildModerateSevere

    First Aid/Treatment/RX/ Administered:

    YesNo


    Type of first aid/treatment/rx:



    The injury occurred during the following:

    Which part of the stunt did the injury occur?

    StuntTransitionDismount

    What position did the injury occur?

    BaseTopSpotter



    Surface:

    FloorMatGrassTrackOther



    Occurred During:

    PracticeCompetitionGameOther



    Referral Action:

    Seen by TrainerSeen by DoctorSeen by NurseNone