Burnside Hockey Club

South Australian Hockey Club – Metropolitan Competition – est. 1949

Injury Procedure

An injury Report Form needs to be completed for any injury that is sustained during a game or training that warrants any level of treatment. Please fill out this form and Submit

The club need to be aware of these incidents as part of our Risk Assessment and Management policies.

Name of Injured Person *

First

Last

Grade *

Gender

Male
Female

Status

Player
Coach/Support staff
Spectator/Other

What were they doing:

Warm Up/Cool Down
Training/Practice Game
Match
Other

Date and time of Injury *

Venue/Location *

First Aid Provided By: *

First

Last

This is a:

New Injury
Aggravation of an existing injury
Illness/Other

Equipment Worn:

Mouth Guard
Shin Guards
Face Shield
Goal Keeper Kit
Helmet

Nature of Injury/Illness *

Body Part Injured: *

How did the injury occur:

Collision / contact with other person
Collision / contact with fixed object
Struck by ball / stick
Fall / Awkward Landing
Other:

If "Other" is selected add to Further Notes at bottom of the form.

Action Taken

Ice Applied
Compression / Elevation
Wound Dressing / Band Aid
Referred for Medical Review / Follow-up
Ambulance Called
Other:

If "Other" is selected add to Further Notes at bottom of the form.

Were they able to continue playing / training?

Has the players Next of Kin (NOK) been advised:

NOK / Contact Details: *

Was the injury recorded on the Match Card?

Further Notes:

(1) Any Head Injury should be assessed using the Concussion Recognition Tool (2) A copy of the completed form will be auto sent to

Website

Kaurna Acknowledgment

We acknowledge the traditional custodians of the land on which we gather & play sport, the Kaurna people. We pay respects to Elders, past, present & future.

Connect with Us

Rules Guru – The Overhead

SunSmart

Widget Ready

This left column is widget ready! Add one in the admin panel.