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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