Injury Report (CYO Minor Hockey)


Print Injury Report
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.

  1. 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.

Where did this happen?
Who was injured
  1. please enter first and last name of injured person
  2. enter the parish or program this person is affiliated with
Trainers Information
Identify the nature of the injury
  1. If YES, Hockey Canada concussion protocols must be followed.
  2. Check All That Apply
  3. Check All That Apply
  4. Check All That Apply
  5. Check All That Apply

  6. Check All That Apply
  7. Check All That Apply

  8. Check All That Apply
What happened
  1. Example: yo[email protected]. Your submission will be sent to this address.
Human Validation