Sports Session Risk Assessment Form

Participant full name

First NameMiddle NameLast Name

Age

Phone number

Please enter a valid phone number.Format: (000) 000-0000.

Emergency contact name

First NameMiddle NameLast Name

Emergency contact phone number

Please enter a valid phone number.Format: (000) 000-0000.

Sport / Session Type

Session Date

Date

Session Time

Hour Minutes

AM/PM Option

Location / Venue

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

Coach or Organizer Name

First NameMiddle NameLast Name

Attendance Type

Current injury or pain affecting participation today?

Recent concussion or head injury?

Chronic conditions that affect exercise

Asthma or other breathing issues that may affect activity?

History of dizziness or fainting?

Recent surgery or medical procedure?

Medication affecting performance or alertness?

Current physical condition for sport participation

Prior experience with this sport

Level of proficiency

Date last practiced

Date

Expected activity intensity

Contact or collision exposure

Surface, weather, triggers, or hazards

Required Protective Gear

Equipment Source

Equipment Requirements

Supervision Level Required

Safety Controls Required Before Participation

Accommodations or Modified Participation Requirements

Overall Risk Rating

Final Participation Decision

Required Restrictions or Modifications

Follow-up Actions

Assessor Name

First NameMiddle NameLast Name

Sports Session Risk Assessment Form

Participant Details

Sports Session Information

Health and Physical Readiness Assessment

Risk Factors and Activity Exposure

Equipment, Supervision, and Safety Controls

Assessment Summary and Approval