Athletic Training Room Injury Treatment Log Form
Log details of injuries treated in the athletic training room for accurate clinical and sports records.
Athlete Full Name
*
First Name
Last Name
Date and Time of Injury or Treatment
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Sport/Team
*
Please Select
Football
Basketball
Soccer
Baseball
Track and Field
Volleyball
Other
Injury Location / Body Part
*
Please Select
Ankle
Knee
Shoulder
Wrist/Hand
Elbow
Back
Head/Neck
Other
Injury Type or Description
*
Mechanism of Injury
*
Pain Severity (0 = No Pain, 10 = Worst Pain)
*
No Pain
0
1
2
3
4
5
6
7
8
9
Worst Pain
10
0 is No Pain, 10 is Worst Pain
Immediate Treatment Provided
*
Return-to-Play / Follow-Up Status
*
Returned to Play
With Restrictions
Referred for Further Evaluation
Out – Not Cleared
Other
Additional Notes or Restrictions
Submit Log
Should be Empty: