Injury Record

It is highly recommended that coaches record details of any injury to a player and any treatment
administered. See example form that can be used.

INJURY RECORD FORM

Date:
Players name:
DOB:

Male:

Female:

INJURY DETAILS
injury:
How injury occurred:

Place:

Time of injury:

Name of witnesses:

CARE AND TREATMENT

Briefly detail initial care rendered:

Who administered care:

Was the player referred to other treatment? If so, record details:

REMEDIAL ACTION TAKEN

NOTIFICATION
Tick appropriate boxes:

SUGGESTED REMEDIAL ACTION TO BE

TAKEN:

SIGNED:

Parent(s) / Carer(s)

Competition organiser

Club officials

Other:

DATE: