OC Sport Injury Form
This form is for reporting injuries that have taken place at OC sanctioned activities.  All injuries must be reported within five (5) days of the initial incident.  You must be either the athlete, their coach, a trainer, the club or team Ride Leader, medical services on site or a family member of the injured member to submit this form. Email to be that of person completing form. 

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Email *
Name of the Injured Person *
Contact information for injured person *
OC Membership Number *
Bib Number if Applicable
For follow up purposes, please provide contact information for the injured member (parent/legal guardian) if the injured person is under 18 years of age. Please include name, email and phone number.
Birthdate of the injured person *
MM
/
DD
/
YYYY
In what role was the person injured in *
Date of injury *
MM
/
DD
/
YYYY
Name of venue and/or event where the injury occurred (if applicable) *
Type of activity at time of injury *
Required
If the Injury occurred during a Club Ride/Activity, please enter the name of your club below
Injured body part (please check all which may apply) *
Required
Type of Injury (please check all which apply) *
Required
What is the status of the injury? *
Cause of Injury (check all which apply) *
Required
Contributing to Cause of Injury (check all which apply) *
Required
Please use the space below to provide any further details on how the injury incident occurred.
Were there any witnesses to the incident during which the incident occurred? *
Required
If yes, please provide the witness names, roles and contact information.
Initial treatment provided *
Required
Immediate Referral *
Required
Immediate advice given *
Required
Treating person if on-site care was provided.  *
Required
Please tell us who completed this form *
A copy of your responses will be emailed to the address you provided.
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