2021-22 Player Injury Report Form (Halton Hills Minor Hockey)

Print 2021-22 Player Injury Report Form
  1. 2021-2022 Player Injury Log

    Note : This log should report, at minimum , each time;
    • A player is removed for the remainder of the game due to an injury sustained during play.
    • A player is injured during a practice whether on or off ice.
    • A player is forced to leave a game or practice for unknown medical reasons.
    • A player is injured during a hockey related event.

    Note : If an injury requires medical referral and/or hospitalization, you will be required to complete and submit a Hockey Canada Injury Report.   LINK HERE.

    For COVID or suspected COVID cases, please follow appropriate protocols.  This form is NOT used for COVID related issues.  

Team/Player Info
  1. E.g. U12 AA, U15 H/L Blue Bruins
  2. Last Name, First Name
  3. Call Person, Control Person, EMS, Doc, etc?
  4. Email so you get a copy of this injury form emailed back for your records
  1. RadDatePicker
    Open the calendar popup.
  2. Select from dropdown list.
  3. Give details of when/where the injury occurred.
  4. E.g. Medial facility/Hospital name; treated and released, etc
Injury Description
  1. What/how it happened.
Managment of Injury
  1. Eg. ice/bandage/tape/etc

  2. Select most appropriate statement. Remember, if player requires continued medical care that a Hockey Canada Injury Report must be filled out by the doctor/EMS.
Follow Up/Recommendations
What did you recommend to the player/parents?
  1. e.g. recommend to see family doctor, other, etc
  2. Someting else you may want to pass along to the Head Trainer.
  1. I understand that if there is any potential of the player seeking further medical attention (i.e. doctor) that the following form is to be provided to the parents which can also be downloaded from the HHMH Website on the Trainer page.  LINK HERE

    I certify that the given information above is true and correct to my knowledge.

    I understand that I will be contacted by the Head Trainer if more forms or information are required and will comply with any instructions given.

    I understand that any false or misleading reports or not completing further forms or instructions may be cause for removal of from Trainer Duties.

    I understand that I will follow the applicable return to play protocols applicable to the injury.
Human Validation