Injury Report Form

Injury Report Form
Players that are injured during the season or at the SKiLLS Training Program can apply for an Insurance Claim, to find out more please direct parent/player to Football Tasmania website.

This Form is to be completed by the Head Coach or Team Manager with the parent/player, (with parent permission where needed) for record.

This Form will be sent to:

- Club Secretary

- Club Technical Director

- Club Head of Junior & Youth Development

This Form may be required by the Insurance Company.
1. Injured Player Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState

Post Code
Email
example@example.com
Age
Registration Number
2. Incident Details - when and where the incident occurred
Date

MonthDayYear
Date
Time

Hour Minutes

AM/PM Option
Location
3. Brief Description of Type and Cause of Injury
4. Person Rendering First Aid Treatment Details
Name

First NameLast Name
Phone Number
Details of any treatment:
6. Person Completing this Report
Name

First NameLast Name
Email
example@example.com
Phone
Sign

Clear
Date

MonthDayYear
Date
Once submitted this form will go to Taroona Football Club Secretary secretary@taroonafc.org
Should be Empty: