Immediate Actions:

  • If in doubt about the severity, call 911 immediately.
  • Advise the injured party to seek professional medical advice without delay.

Injured Person's Details:

  • Name: ____________________________________________________
  • Date of Injury: //____ Time: : AM/PM

Description of Injury:

  • Brief Description:

Circumstances of the Injury:

  • Detailed Account of Incident:
  • If more space is needed, use the back of this form or attach extra pages.

Response and Witnesses:

  • Staff Member(s) Present:
  • List of Class Attendees or Witnesses:

Immediate Care Provided:

  • Actions Taken by Staff:

Notifications:

  • If under 18, was a guardian notified? Yes/No
  • Person to whom the injured was released:
  • Was medical treatment recommended? Yes/No
  • Mode of transportation to medical facility:

Documentation by Witnesses:

  • Please have all witnesses provide a written account of what they observed, attaching their statements to this form.

Follow-Up:

  • Notify the school manager immediately. Retain a copy of this form for the school’s records and forward the original to the corporate office.

Staff Confirmation:

  • Signature of Staff Completing This Form: __________________________

Note: This form serves as a critical document to ensure timely and appropriate responses to accidents within the martial arts school setting, safeguarding both students and staff.