Stockton Unified School District

Student & Athletic Injury Reporting

In alignment with SUSD guidelines, all on-site student and athletic injuries must be immediately reported to school staff, coaches, or administrators. Proper documentation is required, and medical attention should be provided as needed. Parents/guardians will be notified, and follow-up procedures ensure student well-being and recovery.

Site information
1. If a student is injured, complete the online form within 1-2 business days of a minor injury and immediately after the student is treated for major injuries - Student Accident Report
2. This form is routed to Risk Management.
3. If a parent/guardian requests a copy of the accident/injury report, direct them to Risk Management.
Parent/Guardian Information
1. If your child has been in an accident or is injured at school, and you are requesting the record of the incident, please complete the Student Incident Request Form and submit it to the SUSD Risk Management at 55 S. Lincoln St, Stockton, CA 95203.
2. Student Incident requests will be processed within 5-7 business days - Student Incident Request Form
Site/Coach Information
1. If an athlete is injured, the coach is responsible for completing this Athletic Accident/Injury Report Form.
2. Send completed form to Risk Management within 24–48 hours of the date of incident to Riskmgt@stocktonusd.net (form needs to be completed, signed by coach, and dated before sending to Risk Management)
3. Give a copy of the report to student/parent(s)/guardian(s).
Parent/Guardian Information
1. If your child athlete has had an accident/injury while playing a sport, please request information from your child’s coach.
2. If you would like to file a claim, please submit the claim form provided in the Student Accident and Sickness Insurance Claim Form (Myers-Stevens &Toohey Co., Inc.) that is mailed to you once Risk Management receives the completed injury report from the students' coach.
1. Complete the Student Accident and Sickness Insurance Claim Form - English or Spanish
2. Attach Itemized Bills pertaining to the student's accident/injury
3. Provide other insurance/health plan EOBs (when applicable)
4. Mail all items to: MYERS-STEVENS & TOOHEY, Attn: Claims Department, 26101 Marguerite Parkway, Mission Viejo, CA 92692
5. Or Fax: (949) 348-9350 or Email: claimsinfo@myers-stevens.com
6. Need Asisstance? Call (800) 827-4695
Release of Liability - Release of Liability Form
Student Activities - Student Activities Form
Voluntary Activities - Voluntary Activities
Send completed forms to Riskmgt@stocktonusd.net
If you have questions or need help with your student accident reporting, please contact the Risk Management Department:
Email: Claudia Agnos and cc: Adelita Valadez
Phone: (209) 933-7110 Ext. 2558