Facilities and Equipment Checklist

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Chastity Howard
6 years ago
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1 Facilities and Equipment Checklist The stairs and corridors leading to the gym are well lit. The stairs and corridors are free of obstruction. The stairs and corridors are in good repair. Exits are well marked and illuminated. Exits are free of obstruction. Uprights and other projections are padded, including the basket standards or poles. Walls are free of projections. Windows are located high on the walls. Wall plugs and light switches are insulated and protected. Lights are shielded. Lighting is sufficient to illuminate the playing area well. The heating and cooling system for the gym is working properly and is monitored regularly. Ducts, radiators, pipes, and so on are shielded or designed to withstand high impact. Tamper-free thermostats are housed in impact-resistant covers. If there is an overhanging track, it has secure railings with a minimum height of 3 feet, 6 inches. The track has direction signs posted. The track is free of obstructions. Rules for the track are posted. Projections on the track are padded or illuminated. Gym equipment is inspected before and during each use. The gym is adequately supervised. Galleries and viewing areas have been designed to protect small children by blocking their access to the playing area. The gym (floor, roof, walls, light fixtures, and so on) is inspected on an annual basis for safety and structural deficiencies. Fire alarms are in good working order. Fire extinguishers are up to date, with note of last inspection. Directions are posted for evacuating the gym in case of fire. 247

2 Informed Consent Form I hereby give my permission for to participate in during the athletic season beginning on. Further, I authorize the school or club to provide emergency treatment of any injury or illness my child may experience if qualified medical personnel consider treatment necessary and perform the treatment. This authorization is granted only if I cannot be reached after a reasonable effort to do so. Parent or guardian: Address: Phone: ( ) Cell phone: ( ) Other person to contact in case of emergency: Relationship to person: Phone: ( Family physician: Phone: ( ) ) Medical conditions (e.g., allergies, chronic illness): My child and I are aware that participating in is a potentially hazardous activity. We assume all risks associated with participation in this sport, including but not limited to falls, contact with other participants, the effects of weather and traffic, and other reasonable conditions of risk associated with the sport. All such risks to my child are known and appreciated by my child and me. We understand this informed consent form and agree to its conditions. Child s signature: Date: Parent s or guardian s signature: Date: 248 Adapted, by permission, from M. Flegel, 2008, Sport first aid, 4th ed. (Champaign, IL: Human Kinetics), 15.

3 Injury Report Form Date: Time: a.m. p.m. Location: Player s name: Age: Date of birth: Type of injury: Anatomical area involved: Cause of injury: Extent of injury: Person administering first aid (name): First aid administered: Other treatment administered: Referral action: Signature of person administering first aid: Date: 249

4 Emergency Information Card Player s name: Sport: Age: Phone: ( ) Provide information for parent or guardian and one additional contact in case of emergency: Parent s or guardian s name: Phone: ( ) Other phone: ( ) Additional contact s name: Relationship to player: Phone: ( ) Other phone: ( ) Insurance Information Name of insurance company: Policy name and number: Medical Information Physician s name: Phone: ( ) Is your child allergic to any drugs? Yes No If so, what? Does your child have any other allergies (e.g., bee stings, dust)? Does your child have any of the following? Asthma Diabetes Epilepsy Is your child currently taking medication? Yes No If so, what? Does your child wear contact lenses? Yes No Is there additional information we should know about your child s health or physical condition? Yes No If yes, please explain: Parent s or guardian s signature: Date: 250

5 Emergency Response Card Be prepared to give the following information to an EMS dispatcher. Caller s name: Telephone number from which the call is being made: ( ) Reason for call: How many people are injured: Condition of victim(s): First aid being given: Location: City: Directions (e.g., cross streets, landmarks, entrance access): Note: Do not hang up first. Let the EMS dispatcher hang up first. 251

Property Inspection Guidelines

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