Concussion Reporting 2017-18 (SRRA)
Help us track concussions in Southern Region Ringette by completing the form below. This information will be used to corroborate the data the ORA is collecting to confirm the seriousness of concussions in Southern Region Ringette.
If concussions are not reported the ORA does not know there is a problem.....please report concussions.

Jim File
Chair SRRA
2017 Co-Chair ORA Concussion Committee
jfilesrra@gmail.com

Ringette......lets keep it safe
Player Name *
Your answer
Date of concussion *
MM
/
DD
/
YYYY
Reporting party - name *
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 did the injured player miss? *
Does your association have a "Return to Play" policy? *
Did you file an ORA "Injury Report Form"? *
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms