Concussion Reporting in Ringette (SRRA)
Help us track concussions in Southern Region Ringette by completing the form below. This information is being collected to create a larger sample size of data to analyze how serious concussions are in Southern Region Ringette.

If you would like to see the April 2016 report on Concussions in SRRA feel free to email me and I will forward it to you.

Jim File
Vice Chair SRRA
jfilesrra@gmail.com

Ringette......lets keep it safe
Player Name *
Your answer
Date of concussion *
MM
/
DD
/
YYYY
Email contact *
Your answer
Association *
Team *
Did the injury occur in a game or practice? *
Cause of Concussion - question #1 *
Cause of Concussion - question #2 *
Where did the concussion occur on the ice?
Was medical attention required? *
If concussion was the result of an interaction with another player was a penalty assessed?
Time injury occurred on the ice "if in a game"
Is your coach aware of the concussion? *
Have you returned to play? *
How many weeks of ringette have you missed? *
Does your association have a "Return to Play" policy? *
Did you file an ORA "Injury Report Form"? *
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