Get the free CJSA Injury Report Form

NOTIFICATION OF INJURY In accordance with NW10300, this form is to be completed and faxed to the district office at (203) 7589122 within seventy-two hours of an injury requiring a minimum of first

How to fill out cjsa injury report form

How to fill out cjsa injury report form

1. Obtain a copy of the CJSA injury report form from the appropriate authority or organization.
2. Start by completing the personal information section, including your name, date of birth, contact information, and player ID number if applicable.
3. Provide details about the injury, including the date and time it occurred, the location, and a brief description of what happened.
4. Indicate the severity of the injury and any symptoms experienced.
5. If medical attention was sought, provide information about the healthcare provider, diagnosis, treatment, and any prescribed medications.
6. Include information about any previous injuries or medical conditions that may have contributed to the current injury.
7. If there were any witnesses to the injury, provide their names and contact information.
8. Sign and date the form to certify the accuracy of the information provided.
9. Submit the completed injury report form to the appropriate authority or organization as instructed.

Who needs cjsa injury report form?

1. Anyone who sustains an injury while participating in activities under the Connecticut Junior Soccer Association (CJSA) may need to fill out the CJSA injury report form. This form is typically required for players, coaches, referees, or any other individuals affiliated with the CJSA who experience injuries during soccer-related activities.

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What is cjsa injury report form?

The cjsa injury report form is a document used to report injuries that occur during soccer activities under the Connecticut Junior Soccer Association.

Who is required to file cjsa injury report form?

Coaches, team managers, or designated officials are required to file the cjsa injury report form for any injuries that occur during soccer activities.

How to fill out cjsa injury report form?

To fill out the cjsa injury report form, you need to provide details of the injury, including the date, time, location, and nature of the injury, as well as the name and contact information of the injured person.

What is the purpose of cjsa injury report form?

The purpose of the cjsa injury report form is to document and track injuries that occur during soccer activities, and to ensure proper medical attention is provided to injured individuals.

What information must be reported on cjsa injury report form?

The cjsa injury report form must include details such as the date, time, location, nature of the injury, name of injured person, contact information, and any first aid or medical treatment provided.