Sports Injury Report

HF-L Accident/Injury Report

Report of Athletic Injury: When a student is injured during a district athletic practice or competition, it is the responsibility of the coach or his/her designee to complete this form by the NEXT school day after the injury occurred. This form will be directed to the appropriate school nurse upon submission. Each field is "REQUIRED", therefore a response must be entered in each field in order to submit the form.

Sports Injury Report

Student's Grade

Student's Name

Date of Accident

Time of Accident

Location of Accident (where did it occur)

Sport/Activity Involved

Description of How the Injury Occurred. Also Include type of Injury.

Part of Body Injured (Indicate Left or Right if appropriate)



Type of First Aid Administered

Was the Student Transported to a Medical Facility?

Was Parent/Guardian Notified of the Injury?

Who was the Adult Witness?

Enter Date of Report

Form Completed By


Security Measure

The Honeoye Falls-Lima Central School District does not discriminate on the basis of race, color, national origin, sex, disability, or age in its programs, activities, employment, and admissions; and provides equal access to the Boy Scouts and other designated youth groups.

The following person has been designated to handle inquiries regarding the non-discrimination policies: David Leahy, Compliance Officer/Coordinator, at: Email -, Telephone - (585) 624-7181, Address - 20 Church Street, Honeoye Falls, NY 14472. Inquiries concerning the application of the Honeoye Falls-Lima Central School District non-discrimination policies may also be referred to the U.S. Department of Education, Office for Civil Rights (OCR), 32 Old Slip, 26th Floor, New York, NY 10005, Telephone (646) 428-3800 (voice) or (800) 877-8339 (TTY).

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