Injury Report Form 2023

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Fill out this form for any injuries that occur at a MONCAD training or any other official event or camp. This form is designed to be used as a part of the MONCAD Injury Response Plan, which can be found here: https://drive.google.com/drive/u/3/folders/1uZzWhDtH7Rr3C9VM0rxgp4saPkle163l

Name of injured athlete *

Name of person filling out this form *

Jane Karopoulos

Aly Engelman

Other:

Date of injury: *

YYYY

Time of injury: *

Time

Training at which injury occurred: *

OR use 'other' to describe if at event/camp/duo training etc.

Athena

Apollo

Artemis

Atlas

Moneta

Mercury

Minerva

Helios

Hercules

Hybris

Harmonia

Hemera

Dance PT

Other:

Coach/es present at the training: *

If none present (e.g. at duo training), write N/A.

Location of injury: *

Chisholm Hall, Monash Sport Caulfield

VSC Oakleigh

Group Fitness Room, Monash Sport Clayton

Pacific Elite, Henderson Road

The Jazz Centre

Other:

How severe is the injury? *

Use the Injury Response Plan to identify the severity of the injury. If there were multiple injuries of varying severity, select the most serious category that applies (higher on this list = more severe).

Serious (unconscious/major loss of blood/protruding bone/difficulty breathing/needs emergency medical attention)

Possible concussion (any impact to head/neck, or other concussion symptoms present)

Major (possible broken bone/muscle or joint damage)

Minor (minor strain/jarred finger/scratch or cut/feeling unwell)

What is the injury? *

What part(s) of the body is/are injured? What symptoms are there? What signs of injury can you see (e.g. blood, swelling, bruising, bits where they shouldn't be)? What is the injured athlete reporting (e.g. pain and where, feeling nauseous or dizzy)? Describe in as much detail as possible.

How did the injury occur? *

What was happening at training? Was there impact with the ground or another athlete? Were other athletes involved (e.g. a clash or drop)?

Name/s of people who applied first aid or gave assistance: *

This allows us to follow up with these people to check they're ok and get any further information if we need it.

What first aid has been applied so far? *

Also include any supplies that have been used (e.g. band aids, ice packs, bandages) so we can replace them!

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