Get the free Concussion Form - City of DuPont

City of DuPont Parks & Recreation A concussion is a brain injury and all brain injuries are serious. They are caused by a bump, blow, or jolt to the head, or by a blow to another part of the body

How to fill out concussion form - city

How to Fill out Concussion Form - City:

1. Start by reading the instructions on the concussion form thoroughly to understand the information required.
2. Provide your personal details, such as your full name, address, contact number, and date of birth.
3. Fill in the date and time of the concussion incident if applicable. Include any relevant details, such as the location or cause of the injury.
4. Describe the symptoms you experienced after the concussion, such as headache, dizziness, nausea, or memory problems.
5. Provide details about any medical treatment you received for the concussion, including the healthcare provider's name, date of treatment, and prescribed medications.
6. If you were seen by a specialist or received additional medical care, indicate this and provide their contact information if available.
7. Answer any additional questions or sections on the form related to your concussion, such as any previous head injuries or related medical conditions.
8. Review the completed form to ensure all sections are filled correctly and legibly.
9. Sign and date the form to indicate that the information provided is accurate and complete.

Who Needs Concussion Form - City:

1. Athletes participating in sports activities organized or sanctioned by the city.
2. Physical education students involved in city-sponsored programs or activities.
3. Individuals who have experienced a head injury while on city property or during city events.

For pdfFiller’s FAQs

What is concussion form - city?

Concussion form - city is a document that must be filled out to report instances of concussions within the city.

Who is required to file concussion form - city?

Anyone involved in activities within the city that result in concussions is required to file the concussion form - city.

How to fill out concussion form - city?

To fill out the concussion form - city, you will need to provide information about the incident, including the date, location, individuals involved, and details of the concussion.

What is the purpose of concussion form - city?

The purpose of concussion form - city is to track and monitor instances of concussions within the city to ensure appropriate care and attention is given to affected individuals.

What information must be reported on concussion form - city?

The concussion form - city requires reporting of information such as the date of the incident, location, individuals involved, symptoms experienced, and any medical treatment received.

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