Injury Report Form (Oshawa Community Hockey League)

Please fill this out as soon as possible and make sure trainer has a copy and Convener and VP are aware of incident

Team/Player Info

Team^*

Required

Select Team from dropdown list. The list is auto-generated from the website to include all teams. Please ensure you have picked correctly!

Player Last Name^*

Required

Player First Name^*

Required

Trainer Attending (Last Name, First Name)^*

Required

Last Name, First Name

Any other persons involved list here

Call Person, Control Person, EMS, Doc, etc?

Trainer Email^*

Required

Email so you get a copy of this injury form emailed back for your records

General

Date of Injury^*

Required

Injury Conditions^*

Required

Select from dropdown list.

If Other/Other Sport - Please give details

Give details of when/where the injury occurred.

Was EMS called?^*

YesNo

Required

If Yes to EMS, where were they transported?

E.g. Medial facility/Hospital name; treated and released, etc

Managment of Injury

What was done to Manage the injury^*

Required

Eg. ice/bandage/tape/etc

Continued Care^*

Returned to Play
Did Not Return to Play
Further Care at a Medical Facility

Required

Select most appropriate statement. Remember, if player requires continued medical care that a Hockey Canada Injury Report must be filled out by the doctor/EMS.

Follow Up/Recommendations

What did you recommend to the player/parents?

Describe any followup to player or parents^*

Required

e.g. recommend to see family doctor, other, etc

Any other Comments?

Someting else you may want to pass along to the Head Trainer.

I agree to the terms and conditions stated above^*

Injury Report Form (Oshawa Community Hockey League)

OMHA Digital Network

Team/Player Info

General

Injury Description

Managment of Injury

Follow Up/Recommendations