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Writing Assignment 6

John Smith, age 8, injured his head while playing pretend baseball at an event at the ARC. He slid into a drinking fountain base and hit his head on the fountain, receiving a small red bump. The injury was checked and showed no signs of bleeding, bruising, or concussion. First aid was offered but declined, as the boy seemed aware and unharmed. His parents were notified of the minor accident.

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84 views

Writing Assignment 6

John Smith, age 8, injured his head while playing pretend baseball at an event at the ARC. He slid into a drinking fountain base and hit his head on the fountain, receiving a small red bump. The injury was checked and showed no signs of bleeding, bruising, or concussion. First aid was offered but declined, as the boy seemed aware and unharmed. His parents were notified of the minor accident.

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© © All Rights Reserved
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CLUB SPORT ACCIDENT REPORT

www.campusrec.illinois.edu

PRINT CLEARLY

All accidents are to be reported immediately. Forward this Accident Report to Ed Morford, Assistant Director of Risk Management.
Name of Injured:
Local Address:
Phone:

John Smith

1108 Galen Dr. Champaign, IL 61821

(217) 351- 4920

Parents E-mail:

[email protected]

Time and Date of Injury:

3/3/2016 at 7:30 PM

Was emergency dispatch (911) called?

Yes

No

Exact location where accident occurred

Main floor of ARC by the water fountains outside of gym 2

Describe the accident as accurately as possible:


What activity was the injured engaged in?

The two boys (age 8) were at the ARC for the Mike Matheny Cardinals
event and were wandering
around the gym and fooling around and horse-playing in the hallways.

Describe how the injury occurred

The boys were pretending to be baseball players in the hallways and were
running around trying to hit
made up baseball bases. One of the boys slid into a base and his head
collided with one of the drinking
fountains.

Describe the nature of the injury

Hit head on drinking fountain: Small red bump with no bleeding or


bruising. No signs of trauma
and the boy was conscious and aware of his surroundings and actions- No
concussion.

What steps did you take to address the injury?

I ensured the boy was safe and well and not concussed or seriously
injured before asking him any
questions. I checked where he hit his head to see if it was bleeding or had a
bump, and then
asked him a series of questions to ensure he was not concussed. I then
found the child

Continue to describe the accident:


What options did you make available to the injured party?

I told both the parents and the young boy that I could call for medical
assistance (911) or I could
try finding a lifeguard or someone who was first aid certified to come
and look at him. I also offered
them ice, water, or a snack to ensure that he was staying hydrated and would not
faint. They decided to let a

first aid certified employee check out the injury, which the employee
deemed that the injury
was not harmful to the boy.

Minors:

Read the following statement to the injured party when possible

You have the right to refuse medical treatment as recommended and decline
the help of Emergency Medical Personnel and an
ambulance as
recommended. In addition, you should know that the University of Illinois is
not financially responsible for any costs incurred by use of an outside medical
facility. Do you have any questions?

Please indicate below if the individual:


Declined

or

Accepted

treatment Declined

or

recommended
Accepted

transport
Declined

or

Accepted

EMS assistance

Signature of Club Sport Officer


Name of Club Sport Officer completing the
form (PRINT)Farzan Rostam-Abadi
Signature of Club Sport Officer completing the
form

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