Sun 02 Jan 2022 21:36

 

High Wycombe Online Injury Reporting

 

We have a duty of care to all our players. To assist the club and the RFU we need to know about certain types of injuries. This is so we can see if there are any trends we need to be aware of so that appropriate action to redress the situation can be put in place.

For all head injuries to Junior/Mini players click the link below.

This form must be completed in all cases where a mini or junior player has received an injury to the head which results in a concussion or suspected concussion.

Player Name:

Date of Birth:

Age Group:

Date of injury:

Time of injury:

Injury occurred during: Training Match

Description of injury:

Details of incident: including Notable Symptoms:

Person Reporting:

Role/Position:

For All RFU Reportable Injuries (hospital admission or death) click the link below.

Please use this form to report any injuries that occur whilst playing rugby or taking part in organised rugby squad training sessions that fit any of the following definitions.

  • An individual who sustains an injury which results in their being admited to a hospital. This does not include those taken to Accident and emergency Department and allowed home from there.
  • Deaths occurring during or within 6 hours of the game finishing.

Date of injury:

Player Name:

Date of Birth:

Player Phone:

Details of next of kin (name, contact phone no. and relationship to injured player:


Team:

Category:

Injury occurred during: Training Match

Type of Pitch: Grass Artificial Grass Other Surface

Was there appropriate First Aid in place? Yes No

Was there any alledged foul play relating ot the injury event? Yes No

Nature of injury:

Circumstances of injury event:

Complete this section where the injury event occured during a match.

Opposition Club/School/etc.:

Team:

Name of Referee:

Venue:

Person Reporting:

Position within Club:

Contact Phone No.:


When Submitted the club safeguardig officer will recieve the report. They will then check it before submitting the report to the RFU.

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