National Helmet Survey
Please fill out the following survey. Be sure to have your/your child's helmet on hand to answer several questions. This survey should take approximately 5 minutes.
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Province or Territory *
Player Gender *
Player Age *
Sport *
Sports League *
Condition of Helmet- Stickers
CSA STICKER- Manufacture date *
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Condition of Helmet- Structure
Shell- Does the outside of the helmet have damage, cracks or cuts that penetrate the shell? *
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Stickers- Have other stickers beside HECC and CSA been added to the shell after the helmet was manufactured? *
Lining- Does the lining show damage as a result of impact? Is the lining loose-fitting or have missing liner pieces? *
Buckle- Does the buckle allow you to safely adjust the helmet? *
Straps- Are the straps in good condition and snap securely to the helmet? *
Shield/Cage- If the shield/cage is present, are there signs of damage, wear, denting, rust or loose pieces on the cage (e.g. J Clips)? *
Chin Cup- Is the chin cup present and in good condition? *
Ear protectors- Are the ear protectors present and in good condition? *
History of Helmet
Has the helmet ever received an impact that required the wearer to miss playing time or be observed by a parent/trainer/medical staff due to a possible brain injury or concussion? *
History of Helmet *
What are your plans for this helmet when it is no longer required? *
Thank you for taking this survey.
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