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33.14 E/S Rev. 9/05 LOS ANGELES UNIFIED SCHOOL DISTRICT Student Health and Human Services CAUTIONS REGARDING HEAD INJURY School Date To the Parents or Guardian of Student name Birth date Grade/Room/Try

How to fill out lausd head injury form

How to Fill Out LAUSD Head Injury Report:

1. Obtain the LAUSD Head Injury Report form, which can be obtained from the LAUSD website or your school's administrative office.
2. Begin by providing your personal information on the form, including your name, contact information, and student identification number.
3. Indicate the date and time of the head injury incident, as well as the location where it occurred.
4. Describe the circumstances of the head injury in detail, including any witnesses present at the time.
5. Note any symptoms or signs of injury that you or others observed, such as loss of consciousness, dizziness, nausea, or bleeding.
6. If medical attention was sought, provide details on the healthcare professional or facility that provided treatment.
7. If applicable, attach any relevant medical documentation, such as discharge summaries or doctor's notes.
8. Sign and date the form to certify the accuracy of the information provided.
9. Submit the completed LAUSD Head Injury Report to the designated school authority, typically the school nurse or an administrator.

Who needs LAUSD Head Injury Report?

1. Students who have experienced a head injury while on LAUSD premises or during a school-related event.
2. Parents or guardians of students who have suffered a head injury should also complete the LAUSD Head Injury Report.
3. School staff, including teachers, coaches, and administrators, who witness a head injury incident involving a student.

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What is lausd head injury report?

The LAUSD head injury report is a document used to record incidents of head injuries sustained by students within the Los Angeles Unified School District.

Who is required to file lausd head injury report?

Teachers, school nurses, and other school personnel are required to file a LAUSD head injury report whenever a student is involved in an incident resulting in a head injury.

How to fill out lausd head injury report?

To fill out the LAUSD head injury report, individuals must provide specific details about the incident, including the date and time of the injury, a description of what happened, and any observed symptoms or medical attention provided.

What is the purpose of lausd head injury report?

The purpose of the LAUSD head injury report is to ensure that all head injuries are documented properly for the safety and health of students, as well as to facilitate communication with parents and medical personnel if necessary.

What information must be reported on lausd head injury report?

The information that must be reported includes the student's name, date of birth, the specifics of the injury, the response provided, and any follow-up actions taken, along with the names of staff involved in the reporting.