Returning Student-Athlete Checklist

Transcription

1 Returning Student-Athlete Checklist Pre-Participation Physical Update Complete Athletic Training Forms online (see attached instructions) Should you have any questions or require further information, please do not hesitate to contact us at or by . Chris Thew, LAT, ATC Head Athletic Trainer Isaac Perry, LAT, ATC Assistant Athletic Trainer

2 CWU Athletics Pre-Participation Evaluation Update Name: SIN#: Birthdate: Street address: Local Phone: Sport: City: State Zip: Yes No 1. [ ] [ ] Have you had any illness/injury recently or do you currently have an injury or illness? 2. [ ] [ ] Have you had a medical problem, illness, injury, or surgery since your last physical exam? 3. [ ] [ ] Do you have any chronic or recurrent illness (e.g. diabetes, asthma, arthritis, etc.)? 4. [ ] [ ] Do you have any organs missing other than tonsils (e.g. appendix, eye, kidney, testicle, etc.)? 5. [ ] [ ] Are you presently taking ANY medications (including birth control pills, vitamins, aspirin, inhaler, or supplements?) 6. [ ] [ ] Have you ever had chest pain, dizziness, fainting, or passing out during or immediately after exercise? 7. [ ] [ ] Have you ever had any problem with your blood pressure or your heart? 8. [ ] [ ] Have any close relatives had heart problems, heart attack, or sudden death before the age of 50? 9. [ ] [ ] Have you ever experienced fainting, convulsions, seizures, or sever dizziness? 10. [ ] [ ] Do you have frequent, severe headaches? 11. [ ] [ ] Have you ever had heat exhaustion, heat stroke, heat cramps or similar heat related problems? 12. [ ] [ ] Other than needing corrective lenses, have you had any problem with your eyes or vision? 13. [ ] [ ] Do you have any joint pain or injury? 14. [ ] [ ] Have you ever suffered a head injury? (e.g. concussion) if yes please explain 15. [ ] [ ] Have you any medical problem that you think might cause a problem? 16. [ ] [ ] Have you any medical concerns about trying out for this sport? 17. [ ] [ ] Do you feel that you need to discuss your health status with the team doctor before trying out for this sport? 18. [ ] [ ] Are you under physicians care at the present time. 19. [ ] [ ] Do you have an intense fear of gaining weight? 20. [ ] [ ] Do you often have trouble sleeping? 21. [ ] [ ] Do you wish you had more energy most days of the week? 22. [ ] [ ] Do you think about things over and over again even after the situation is passed? 23. [ ] [ ] Do you feel anxious or nervous most of the time? 24. [ ] [ ] Do you feel sad or depressed? 25. [ ] [ ] Do you struggle with being confident? 26. [ ] [ ] Do you have trouble feeling hopeful about the future? 27. [ ] [ ] Do you have a hard time managing your emotions (frustration, anger, impatience)? 28. [ ] [ ] Do you/have you had feelings about hurting yourself or others? 29. [ ] [ ] Have you ever been restricted from participation in sports in the past? 30. [ ] [ ] Have you ever had testing for the heart (EKG, electrocardiogram, etc)? 31. [ ] [ ] Women- Do you have a monthly menstrual period? If NO please explain. CERTIFICATION: I/we confirm by our signature(s) below that the above information is complete and true to the best of my/our knowledge. I/we understand that falsification and/or forgery of this information will result in disciplinary action by the CWU Athletics Department. Date Student- Athlete s Signature

3 CWU Athletics Pre- Participation Evaluation Update BLOOD AGE: PULSE: PRESSURE: HEIGHT: WEIGHT: IN THE SPACE BELOW, ATHLETE SHOULD BRIEFLY EXPLAIN ALL "YES" ANSWERS TO ABOVE QUESTIONS, REFERRING TO QUESTION NUMBER FOR EACH EXPLANATION CONCLUSIONS ON FINAL REVIEW: [ ] Athlete must be seen by team physician prior to participation [ ] Athlete is cleared for full participation in sports Date Examiner s Signature TEAM PHYSICIAN COMMENTS: Return by first day of practice to (athlete will not be allowed to participate until this form is in the possession of the athletic training department): Kari Johnson Head Athletic Trainer Senior Woman Administrator Central Washington University Dept. of Athletics 400 E. University Way Ellensburg, WA Fax:

4 Step by Step Instructions for Athlete Portal Some tips that should make the process easier -Use a mouse to fill out the online forms. Don t use a trackpad. The mouse is necessary to sign the forms. You can also use a stylus or your finger to sign on a touchscreen device. -Use Chrome, Mozilla or Safari to access the Athlete Portal. Internet Explorer does not work with system. -If you have any trouble please contact the Athletic Training Staff and we can help you. 1. Type cwu2.atsusers.com in web address box a. The database should say ATSCWU b. For Athlete ID : Enter- new c. For Password: Enter- new 2. Athlete Information Page-General a. Select your team/teams from the drop down menu. (Example-if you are going to play football and run track, you need to add both teams). b. Complete all the information in the yellow boxes. The information in the yellow boxes is mandatory. Please fill out all information as completely as possible. c. Enter an Athlete ID and password that is unique to you. This should be something that you will remember when you need to update or change any information in the Athlete Portal. d. If you have any medical alert or allergies please fill out these sections. For example this includes ADHD, Diabetes or Asthma. If you have no medical alert or allergies please type none. Can use drop down options too. e. Please fill out any and all current medications. Current medications could include birth control, ADD medications, other medications including over the counter medications which are taken on a daily basis. It is important that we have a list of current medications in case of emergency or need for further medical care. If you are not taking any medications, please type none.

5 3. Insurance a. Click on insurance tab i. If you don t have primary health insurance, please click the box that says No Primary Insurance. 1. It is a requirement that you have primary health insurance by the time you report for your sport. You cannot participate in any practice or weight/conditioning session without insurance. b. Complete all of the yellow boxes c. If name of your insurance company is not available on the drop down menu you can add the information for the insurance company d. You will need to scan the front and back of your insurance card. You can also take a picture of the front and back of your card and them to yourself so you can save a copy on your computer if you don t have access to a scanner. Picture size must be under 1 MB or you will get an error message when you try to save. i. Please make sure card image is readable 4. Contacts-Emergency Contacts a. Click on contact tab i. Please add someone you want us to contact in case of an emergency. b. Complete all of the yellow boxes C/S/Z=City, State, Zip Athlete s Relationship to Insured = Child if the insurance is through your parents. 5. Click Save Athlete Information Button-More Tabs will now appear

6 6. Athlete Forms a. Click on Form Tab b. Click on the drop down menu titled Form Name i. You must complete every form listed under this drop down menu c. Select Form from the drop down menu titled Form Name d. Click the New Button e. After reading all the information on this form, and answering the questions when required go down to the athlete/student signature box. i. Using a mouse, stylus or finger: sign your name ii. Type your name in the signed by box and click on the Sign button iii. If you are a minor: repeat this process for parent/guardian signature box. f. Click save when finished. You should see a box that says Save Complete. Do not move on to next form until you see this. 7. E-files a. Click on the E-file Tab b. The physical forms are located here. c. Please follow the instructions listed with the correct form. 8. Paperwork Tab a. You can check here to make sure you have submitted all the required forms