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Williamson County School System Student Treatment Form
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Williamson County School System
Student Treatment Form
Williamson County Risk Management
1320 West Main Street, Suite 108
Franklin, Tennessee 37064
Telephone: (615) 790-5466 Fax: (615) 591-8516
Date of Loss/Time of Day:
Loss Location / School (incl. city/state):
Area of Facility Where Accident Occurred:
Equipment Involved In Injury
Was The Accident Witnessed By The Teacher
Description of Accident:
Was First Aid Administered?
Explanation of Procedure:
Was 911 Dispatched?
Was Parent/Guardian Notified?
Name of Parent/Guardian/Telephone
Additional Remarks or File Notations:
Note to Parent(s) or Guardian(s):
The above stated medical treatment was administered to your child by an employee of the school system. The
treatment provided was within the limits of basic first-aid and should not be considered definitive care for the
If you believe further medical care is needed, it is recommended that you seek medical attention from your
personal family physician or a medical care facility
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