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Auckland Hockey Serious Injury Form
Serious injury reports must be completed for the following injuries:

- Any injury that requires the player to be transported directly from the ground to an emergency department,
hospital or after hours medical centre.
- Any injury that results in the admission of a player to an emergency department, hospital or after hours
medical centre after a game.
- Any injury that is expected to prevent a player from playing for a period of 3 weeks or longer.


Serious Injury reports must be forwarded to the Auckland Hockey office within 48 hours of the injury coming to the notice of the Team Management or Umpires.
___________________________________
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Name of Injured Person *
Date of Birth *
MM
/
DD
/
YYYY
Gender *
Club/School of Injured Person *
Grade *
Type of Injury *
Required
Site of Injury *
Treatment Provider *
Required
Method of leaving field *
Phase of Play *
Accident Details *
MM
/
DD
/
YYYY
Accident Details *
Time
:
Accident Details - Place (eg which turf) *
Contact Phone Number *
Brief Description of the Accident *
Name of Person completing form and designation eg Umpire, Team Official, Family Member etc *
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