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