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C and F HC Head Injury Reporting Form (All Ages)
This form is to be completed whenever there is a head injury. If you have any questions, please contact Alison Butler, C and F HC Welfare/Safeguarding - 07879 650074 or email
jsec@candfhockey.co.uk
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* Indicates required question
In what type of game did the injury take place?
*
Adult match
Junior match
Adult training
Junior training
Who was injured?
*
Adult player - male
Adult player - female
Junior player - male
Junior player - female
Did the injury occur during a penalty corner or open play?
*
Penalty corner
Open play
Was the injury caused by a ball, stick or body?
*
Ball
Stick
Body
Did the injury require hospital treatment?
*
Yes
No
Please provide brief details of the injury
*
Your answer
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