• Injury or Concussion Report

    Activity Leader

  • This report is to be completed by the Activity Leader (Coach, Team Manager/Chaperone, Meet Managers, etc.)

    Injury or concussion report

    • Physical in nature
    • Significant impact to head, neck, face or body

    All injuries involving a significant impact to the head, neck, face, or body — regardless of whether the injured person returns to activity — must be reported to Swim Ontario as soon as possible within the first 24 hours using this Form.  This allows for follow-up on possible late-onset concussion symptoms.

    Any other injury must be reported to Swim Ontario within 24 hours using this Form when the injured person did not return to activity because

    • it required an EMS call or
    • it required a medical centre/doctor visit, or
    • the pool facility advised against returning.

  •
  • Format: (000) 000-0000.
  • Occured during*

  • Injury

  • The injured person was a*
  • Was there any significant impact to the head, neck, face or body?*

  • ACTION: The injured Person cannot continue to participate in the activity until assessed for possible concussion symptoms.

    Concussion management protocols are in effect.

    This report will be sent to Darin Muma for review - darin@swimontario.com

    You will be contacted if futher details are needed.

  • Were symptoms of a concussion present?

  • If symptoms are present or develop after return to the activity, the participant shall be removed from any further Swim Ontario sanctioned activity for the remainder of the day and only return to play once they receive Swim Ontario approval.

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  • Did the Injured person return to their activity?*

  • This report will be sent to Darin Muma for review - darin@swimontario.com

    You will be contacted if further details are needed.

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