National Helmet Survey

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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.

Province or Territory *

Player Gender *

Male

Female

Non-binary

Prefer Not Say

Player Age *

Sport *

Ice Hockey

Ringette

Ice Skating

Lacrosse

Other

Sports League *

Recreational: (Pick up, Just for fun)

Minor Non-Competitive: (House League, Local League)

Minor Competitive: (AAA, AA, A, B, C)

Major

Adult League

School

Power Skating / CanSkate (Skate Canada Programs)

Condition of Helmet- Stickers

CSA STICKER- Manufacture date *

HECC STICKER- Expiry Date MONTH *

HECC STICKER- Expiry Date YEAR *

Condition of Helmet- Structure

Shell- Does the outside of the helmet have damage, cracks or cuts that penetrate the shell? *

Yes

Stickers- Have other stickers beside HECC and CSA been added to the shell after the helmet was manufactured? *

Yes

Lining- Does the lining show damage as a result of impact? Is the lining loose-fitting or have missing liner pieces? *

Yes

Buckle- Does the buckle allow you to safely adjust the helmet? *

Yes

Straps- Are the straps in good condition and snap securely to the helmet? *

Yes

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)? *

Yes

Shield or cage not present

Chin Cup- Is the chin cup present and in good condition? *

Yes

Chin cup not present

Ear protectors- Are the ear protectors present and in good condition? *

Yes

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? *

Yes

Unknown

History of Helmet *

Helmet was purchased brand new for player

Helmet was donated to the player from a previous owner (sibling, friend, etc.)

Helmet had previous owner and was purchased online or through classified ad

Helmet had previous owner and was purchased from used sport's equipment store

Helmet history unknown

What are your plans for this helmet when it is no longer required? *

Dispose of it in garbage/recycling

Sell it

Bring to a used sports equipment store

Pass down to a sibling, friend, family member, etc.

Unknown

Thank you for taking this survey.

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