Monitor and Document Your Athletic Injuries
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Name: _________________________
Date of Birth: __________________
Sport/Activity: _________________
Date of Injury: __________________
Time of Injury: __________________
Location: _______________________
Body Part Affected: _____________
Side: □ Left □ Right □ Bilateral
Type of Injury:
Pain Level (0-10): _______________
Pain Description:
First Aid Applied: _______________
Time to Medical Attention: _______
Provider Seen: __________________
Diagnosis: _____________________
Treatment Plan: ________________
| Date | Pain Level | Activities | Notes |
|---|---|---|---|
Clearance Date: ________________
Restrictions: __________________
Identified Causes: ______________
Preventive Measures: ___________
Keep this log updated and share with your healthcare providers
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