Sports Contact Drill Safety Checklist Form
Use this form before a contact drill to check participant readiness, equipment, environment, and final safety approval.
Athlete and Session Information
Athlete Name
*
First Name
Last Name
Team or Organization
*
Coach or Supervisor Name
*
First Name
Last Name
Session Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Session Time
*
Hour Minutes
AM
PM
AM/PM Option
Venue or Location
*
Sport
*
Please Select
Football
Rugby
Lacrosse
Soccer
Basketball
Hockey
Martial Arts
Wrestling
Other
Contact Drill Name or Session Identifier
*
Safety Readiness and Equipment Check
Helmet or face protection in place?
*
Yes
No
Mouthguard available and worn?
*
Yes
No
Protective gear present for this drill
*
Pads
Shin guards
Chest protector
Gloves
Other
Appropriate footwear checked?
*
Yes
No
Hydration available at the drill site?
*
Yes
No
Field or court condition safe for play?
*
Yes
No
Missing or damaged equipment details
Health Status and Restriction Screening
Are you currently experiencing any pain or discomfort?
*
No
Yes, mild
Yes, moderate
Yes, severe
Which of the following apply today?
Recent injury
Dizziness or lightheadedness
Head impact concern
Recent illness
Medication or treatment affecting participation
None of the above
Have you had any concussion-related concerns recently?
*
No
Yes, but cleared
Yes, not yet cleared
Describe any condition, symptom, or restriction that may affect participation
Participation status for today
*
Please Select
Full participation
Modified participation
No drill participation
Pending review by coach or medical staff
Coach or medical staff notes
Incident Notes and Final Approval
Incident Notes
Final Safety Approval
*
Approved to proceed
Not approved to proceed
Coach/Supervisor Signature
*
Submit Checklist
Submit Checklist
Should be Empty: