Brian Anderson
banderson@csm-institute.com
954-204-5428
"Improving the Day to Day of Athletic Healthcare"
Athletic Training Program Self Assessment Form
Grade youself on how well you feel your athletic training / sports medicine program does in the areas below.

A, B, C, D, F or NA (Not Applicable) - on the left 

Importance Factor (1 - 10) with 10 being the highest importance - on the right

Emergency Action Plan: Grade                                                 Importance 

          Coaches Compliance and Understanding of EAP: Grade                                                  Importance 

          Coaches CPR and AED Training: Grade                                                  Importance  

          AT Staff Training and Prepardeness: Grade                                                  Importance

          Involvement with Local and Campus Public Safety / EMS: Grade                                                  Importance  

          Location and Number of AEDs: Grade                                                   Importance 

          Oxygen Administration Program: Grade                                                  Importance

          Access / Distance to ER Facilities: Grade                                                   Importance



Catastrophic Preparedness: Grade                                                   Importance 

          Clear Line of Communication Grade:                                                  Importance 

          Access to Grief Counselors Grade:                                                   Importance  

          Consistency of Catastrophic Injury  Defintion Amoung All ATCs Grade:                                                 Importance



Disordered Eating Program: Grade                                                   Importance  

          Coaches Compliance and Support: Grade                                                 Importance  

          Student Athlete Education of Nutrition and Disordered Eating: Grade                                                 Importance   

          Access to Nutritionist: Grade                                                  Importance  

          Access to Counseling Services: Grade                                                Importance  


Overall Access to Specialist (Cardio, Neuro, Etc.,): Grade                                                   Importance

​          Cardiology: Grade                                                   Importance  

          Neurology: Grade                                                    Importance  

          Clinical Neuropsychologist: Grade                                                 Importance   

          Podiatry / Foot and Ankle: Grade                                                  Importance   

          Spine: Grade                                                    Importance  

          Dermatology: Grade                                                 Importance  

          Women's Health Specialisy / OBGYN: Grade                                                  Importance  

          Vision / Optometry Grade:                                                 Importance   

          Dentistry Grade:                                                  Importance   



Overall Student Health: Grade                                                 Importance  

          Communication with Student Health Personnel: Grade                                                  Importance  

          Student Health Services for Student-Athletes: Grade                                                  Importance  

          Utilization of Student Health for Labs (Blood, Urine, Etc.,): Grade                                                   Importance  



Overall Access and Qaulity of Diagnostics: Grade                                                   Importance    

​          X-Ray: Grade                                                  Importance  

          MRI / CT: Grade                                                  Importance    

          Labs (Blood, Urine, Etc.,): Grade                                                  Importance   



General Access to Complimentary Medicine: Grade                                                    Importance  

          Chiropractic Care: Grade                                                  Importance  

          Massage: Grade                                                   Importance  

          Yoga / Similar: Grade                                                  Importance  



Rx and OTC ​Drug Administration: Grade                                                  Importance    

          Storage and Security of Rx and OTC Medications: Grade                                                  Importance  

          Documentation of Medication Inventory: Grade                                                  Importance    

          Presence of Expired Medications: Grade                                                   Importance     

          Availability / Access to Rx Medications: Grade                                                   Importance  

          Epi-pen Administration Policy: Grade                                                    Importance    



Medical Disqualification Process: Grade                                                   Importance    


PPE Process: Grade                                                  Importance      

          Ability to Acquire Early and Accurate Medical History Information: Grade                                                 Importance   

          Timeframe between PPE and Activity to Allow for Follow-up and Referral: Grade                                              Importance

          Privacy of Examination: Grade                                                 Importance  

          Time Athletes have with physicians: Grade                                                  Importance  

          Availability of phyisicians: Grade                                                    Importance    

​          Frequency of PPEs: Grade                                                  Importance  

          Facilities for PPE: Grade                                                  Importance  



Sickele Cell Program: Grade                                                   Importance  

          Ability to Obtain SCT Status: Grade                                                  Importance 

          Access to SCT Screening / Labs: Grade                                                   Importance  

          Student Athlete Education Regarding SCT Status: Grade                                                  Importance   



Team Phyisician Relationship: Grade                                                   Importance  

          Relationship with PCP / General Medical Physician: Grade                                                  Importance  

          Relationship with Ortho Phsyician: Grade                                                    Importance  

          Overall Availability for On-Campus Clincs: Grade                                                   Importance 

          Overall Availability for In-Office Visits: Grade                                                    Importance  

          Physician Communication Regarding Player Status Grade:                                                  Importance   

          Physician Game Coverage Grade:                                                  Importance   



Drug Testing Program: Grade                                                   Importance  


Insurance Process / Program: Grade                                                   Importance 


Mental Health Program: Grade                                                   Importance     

          ADD / ADHD Medication Program: Grade                                                   Importance  


Concussion Managment Program: Grade                                                  Importance  

          Student Athlete Education Regarding Concussion Grade:                                                 Importance

          Coaches Support of Concussion Program Grade:                                                  Importance   

          Baseline Testing Program Grade:                                                    Importance  

          MD Role in Concussion Program Grade:                                                   Importance  

          Confidence with Return to Play Decisions Grade:                                                Importance  



Lightning / Inclement Weather Policy Grade:                                                  Importance  

          Lightning Detection Equipment / Service Grade:                                                  Importance   

          Coaches Compliance with Plan Grade:                                                 Importance  



2nd Opinion / Referral Process Grade:                                                  Importance  



Pregnant Athlete Participation Process / Policy Grade:                                                  Importance  



Event Coverage / Ability to Cover Practices and Games Grade:                                                   Importance  



Student Athlete Rehabilitation Grade:                                                  Importance   



Injury Prevention Progams Grade:                                                   Importance  



Heat and Hydration Program Grade:                                                 Importance  

          Coaches Compliance with Heat Related Recommendations Grade:                                                  Importance   

          Appropriate Hydration Grade:                                                   Importance   

          Dehydration and Heat Stress Treatment Grade:                                                Importance  



Medical Documentation Grade:                                                  Importance  

          Injury Documentation Grade:                                                  Importance  

          Treatment Documentation Grade:                                                  Importance  

          Return to Play / Discharge Grade:                                                  Importance  



​Overall Sports Medicine Grade:                                                    Importance   


​Demographic / School Information:

          Classification:

          AMCIA Recommendation (If Known):

          # of Sports:

          # of Student Athletes:

          # of Full Time ATCs:

          # of Part Time / GA ATCs:

          Title that best descriptes your position:

          School (Optional but requried if doing a school self assessment):
                Note:  School Names will NOT be released to other schools.

          Level of Job Satisfaction:

          Email Address (If you would like to obtain a copy of these results when completed):




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