SPORTS INJURY REGISTRATION FORM
This form is designed to collect information that occurs when an accident or near miss occurs during a Roncalli sporting activity that may involve staff, students or members of our community.
Injuries that should be reported are those when a player is forced from the court/field due to injury and are unable to take part in this or furture fixtures for a period of time, and professional advice has been obtained (doctor/physio etc).
Date of Injury/Incident
Time of Injury/Incident
Where did Injury/Incident occur
Name of person completing this report:
Name of person affected:
Details of injury
Near miss; no injury
Action taken to address the injury:
What do you think is the likelihood of this incident/ injury occurring again?
How would you rate the severity of this incident?
See image below for descriptions
Incident Severity Scale
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This form was created inside of Roncalli College.