FOOTBALL GAME DAY EMERGENCY ACTION PLAN
Date: ________________________
Visiting Team: __________________________
Location: (name of field and address)
Ambulance Access: (list directions or address for the ambulance)
Emergency Phone Numbers
Ambulance/Fire/Police - 911
Nearest Hospital: (give address and phone number)
Alternate Hospital: (give address and phone number)
Taxi:
Host Charge Person: ________________ Visiting Charge Person: _________________
Call Person: _____________________ Control Person: ________________________
Emergency Phone Locations: (give location and phone number)
Medical Supplies/Personnel Available:
q Ice
q Crutches
q Splints
q Sport Medicine Physician’s Kit
q Team Physician Present ________________________________________________
Signals:
Ø Doctor Needed: Hand on top of head
Ø Ambulance: Arms held out to side
Ø Life Threatening- Cross arms over chest
Host Therapist Signature: _________________
Visiting Therapist Signature:_______________