Head Injury Report for Girl's Lacrosse
Athletic Trainers are to complete this report during the season but no later than June 17, 2009.
* Required
What Section are you reporting from?
*
choose your Section Athletic Council 1-11
Section 1
Section 2
Section 3
Section 4
Section 5
Section 6
Section 7
Section 8
Section 9
Section 10
Section 11
At what level of play did the injury occur?
*
Varsity
JV
Freshman
Modified (Junior High)
Did the injury occur during a practice(scrimmage) or a game?
*
Practice Situation
Game Situation
Type of Injury
*
Facial contusion
Facial laceration
Concussion
Head fracture
Neck strain
Head laceration
Other (please describe in Comments if not specified above)
Disposition of injury
*
Sideline first aid
Emergency room
Family doctor
Other (please describe in Comments if not specified above)
Return to play?
*
Did the injured athlete return to the field on the day of injury?
YES
NO
Type of protective head gear worn
*
Cage goggle
Glasses type goggle
Helmet
Other (please describe in Comments if not specified above)
Was a penalty issued during the incident?
*
YES
NO
Weather Conditions
*
Sunny
Overcast
Rain
Field Conditions
*
Poor
Fair
Good
Comments
add any pertinent comments that you feel necessary