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: StuntPart of StuntPosition of participationTumblingJumpsOther
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
Δ