Cambridge City HC Injury Reporting Form
To be completed by a coach, captain, or CCHC club officer in the event of any incident or injury.

This information will be used to complete the England Hockey online ‘Injury Monitoring Form’ following injuries sustained that require one or more of the following:

- Treatment from a first aid specialist (e.g. Team doctor/ first responder)
- Hospital treatment
- Subsequent visit(s) to a GP

The reporting of injuries sustained on the field of play is a requirement for all clubs/ organisations who are affiliated to England Hockey as part of England Hockey's Injury Reporting Policy.
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Email *
Who is reporting the injury (full name)? *
What is your role? If 'Other' please specify. *
Who was injured (full name)? *
Date of injury *
MM
/
DD
/
YYYY
In what type of game did the injury take place? If 'Other' please specify. *
Did the injury occur during a Penalty Corner, Open Play or Other? If 'Other' please specify. E.g. warm-up. *
What was the injury caused by ? If 'Other' please specify *
Details of incident - please give a brief description of what happened. Include details of any injuries. *
What treatment was given and by whom? *
If a junior player, have the parents/carers been notified? *
Did the Injury Require Hospital Treatment ? *
What, if any, protective equipment was worn at the time of injury ? Please select all that apply. If 'Other' please specify. For example, protective glove. *
Required
Additional Information
A copy of your responses will be emailed to the address you provided.
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