Notification of Injury Form
SUFC Players & Members Only
Name of Person Completing this Form
First Name
Last Name
Person Completing Form is the
Please Select
Player
Parent / Guardian
Coach
Manager
Ground Official / Committee Member
Non-Committee Member
Date That Injury Occurred
-
Month
-
Day
Year
Date
Time of Injury
Please state the Kick Off time if injury time unkown.
Where Did the Injury Occur?
Please note the Field No. if at Summerhayes Park, or the name of the Away Club Venue and Field description if known.
If Known, Please Note Players FFA Number
This is used during Insurance Claim Information, but no essential to provide now.
Name of Injured Player or Member
First Name
Last Name
Contact Email of Player or Parent/Guardian
example@example.com
Contact Phone Number of Player or Parent/Guardian
Mobile Phone or Preferred Phone Number
Format: 0000 000 000.
Team Details
Please note Age Group, Division, Team Colour/Animal etc.
Nature of Injury
Briefly describe the cause of injury, the injury location, the injury severity and any further information
First Aid or Treatment Provided
Please note any treatment given to the injured person.
What Follow Up Action Was Taken?
Please Select
First Aid and Rest was sufficient
Injury Required Medical Attention Locally
Ambulance Was Called and First Aid provided ONLY (No Transportation to Hospital)
Ambulance Was Called and Injured person was transported to hospital
Please choose most appropriate action.
Post Injury, Treatment and Follow Up Information
If completing this form after date of injury, please provide any update on the injured player/member.
Submit Notice of Injury Form
Should be Empty: