Injury Report (St Catharines Minor Hockey)

Please fill out all information. This form will be sent automatically to the Director of Risk, the President and the Secretary. It is imperative that any injury be documented in a timely fashion. Only when an injury is documented can we properly investigate and appropriately follow up.

I will also fill in the ALLIANCE INJURY REPORT FORM. This form is to be filled in by a physician and mailed to the address located at the bottom of the form.

I understand that I must fill in the OHF injury report form and send to Alliance^*

Where did this happen?

Date and Time injury occured^*

Required

Arena/Place the injury occured^*

Required

Who was injured

Name of person injured^*

Required

please enter first and last name of injured person

Parish/Program^*

Required

enter the parish or program this person is affiliated with

Team name^*

Required

Division^*

Required

Trainers Information

Trainer's name^*

Required

Trainer's phone number^*

Required

Trainer's email^*

Required

Example: [email protected]

What happened

Was the injured person sent to Hospital or Urgent Care?^*

No
Yes, by car
Yes, by ambulance

Required

Brief Description of Injury

To receive a copy of this submission please enter your email address here^*

Required

Example: [email protected]. Your submission will be sent to this address.

Injury Report (St Catharines Minor Hockey)

ALLIANCE HOCKEY Digital Network

Where did this happen?

Who was injured

Trainers Information

Identify the nature of the injury

What happened