Injury / Concussion Report Form – Medics only

What's the best number to contact you on?
What's your email address?
Which sport was the injured person (IP) playing participating in?
Please confirm the concerned squad
Parent present, notified or not applicable?
*Required* if Player from a M&Y Squad / under 19 years of age
What's the best number to contact the player or parent on?
What's the preferred email address of the player or parent
Please confirm the date and time (approx.) of injury/incident
What type of injury/ies were sustained?
Please describe the injury (Eg. head-to-head) and how it occurred
Was the Parent/Player advised to attend hospital?
Please confirm
Please confirm
Please confirm