Fastpitch Injury Reporting Form
Melbourne Softball Association
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Email *
Name *
Your involvement at the time of injury *
Gender *
Date of Birth *
MM
/
DD
/
YYYY
Date of Injury *
MM
/
DD
/
YYYY
Venue *
Team *
Association (if not a Melbourne member) *
Type of activity at the time of injury *
Reason for presentation *
List the part/s of the body affected *
Nature of Injury/illness *
Required
Mechanism of injury *
Required
Explain exactly how the incident occurred *
Were there any contributing factors to the incident, unsuitable footwear, playing surface, equipment, foul play? *
Protective Equipment - Was protective equipment worn on the injured body part? *
If yes, What type eg mouthguard, ankle brace, taping, glove.   *If no, N/A *
Initial treatment *
Action *
Referral *
Required
Treating person *
A copy of your responses will be emailed to the address you provided.
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