NFFLA INJURY REPORT FORM
This form is for informational purposes only and does not replace professional medical advice. It is essential to consult with a qualified medical professional for accurate diagnosis and treatment of injuries.  
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Player Information:
Player Name:
 *
Player Information:
Team Name:
 *
Player Information:
Date of Injury
 *
MM
/
DD
/
YYYY
Player Information:
Time of Injury
 *
Time
:
Injury Details:
Type of Injury:
 *
Injury Details:
Location of Injury:
 *
Injury Details:
Description of Injury:
 *
Injury Details:
Did the injury occur during a game or practice?
 *
First Aid Provided:

 *
Required
If first aid was provided, describe the first aid provided immediately after the injury:
Medical Assessment:
Was the player assessed by a medical professional?  If yes, type out the name of the professional/member and what they did to assist the patient/player. 
Medical Assessment:
If yes, please provide the following details:
Medical Professional's Name:
Medical Assessment:
Medical Facility:
Medical Assessment:
Date of Assessment: 
MM
/
DD
/
YYYY
Diagnosis: 
Treatment Provided: 
Player's Status:
Is the player able to continue participating in the league? 
 *
Required
Player's Status:
If no, please provide an estimated date, or time of recovery:
 *
MM
/
DD
/
YYYY
Player's Status:
Has the player been cleared to return to play by a medical professional?
 *
Additional Information:
Please provide any additional information or comments regarding the injury: 
 *
Player's Name & Date:

 *
Captain's or players:  Name & Date

 *
Administration use only: Is the player release to play and all documents have been recorded and filed?   *
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