VMHA Team Injury Log

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Note: This log should report, at minimum, each time;

- A player is removed for the remainder of the game or practice due to an injury sustained during play.
- A player is forced to leave a game or practice for unknown medical reasons.

Email *

Name of person filling out form (first and last) *

Team Position *

HCSP

Manager

Coach (Head or Assistant)

Phone number

Player Name (first and last) *

Division *

Team *

Date of incident *

YYYY

Location (Arena Name, City) *

Incident Response *

First Aid Kit utilized (minor injury)

Ice pack required

Parent/Guardian took for further medical attention

Ambulance Called

Concussion protocol initiated

Other:

Required

Brief Description/Comments

Submit

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