TCLL Injury Report
Form to report injuries that happen either home or away. The email address field (first field) is for the coach's email address. If there is a Near Miss issue (field issue), please report this on a different form.
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Email *
Date of Incident: *
MM
/
DD
/
YYYY
Field Name/Location *
Injured Person's Name *
Age *
Sex *
Parent's Name *
Parent's Email Address *
Parent's Phone Number *
Incident Occurred during: *
Type of incident and location: *
Position/Role *
Type of Injury (sprained ankle, jammed finger etc.) *
Please give short description of Incident *
Was First Aid Required? *
Was Professional Medical Treatment Required? *
Prepared by: *
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