Injury Report (Wainfleet Minor Hockey)

Teams are to complete this submission to WMHA should any injury occur (serious or not) at a WMHA game, practice or event. This is NOT the official Hockey Canada Injury Report that needs to be completed. This is an internal notification of injury only.

Injury Information

Please provide the information to the WMHA regarding what injury happened, where, when and to whom in this brief submission section.

Where did the injury occur?^*

What city or arena did the injury incident take place in?

Date & Time of Injury^*

Open the calendar popup.

Open the time view popup.

Name of Person Injured^*
WMHA Team^*
What was the injury?^*
Position of individual injured^*
What immediate action was taken if any?

Please provide if this information is known at the time of completing this form. This would specifically refer to what happened at the rink. Example answers: player sent to hospital, player went home with parent, player will seek medical followup, player was bandaged and continued to play, coach that was injured has to leave the ice and rest in the dressing room
Team Event in which injury occured^*
GamePracticeTournamentOther
Did the person return to the activity/play after the injury occurred?^*
YesNoFor a short timeYes, but after time passed
Hockey Canada Injury Report Completed?^*
YesNoWill be completed soonProbably not necessary

Who is completing the form?

Please provide the name of the individual who is completing and submitting this form.

Person Completing This Form^*
WMHA Team^*
Position on the Team^*
Email of Person Completing Form^*

Example: [email protected]

Human Validation

Check The Box ^*

Injury Report (Wainfleet Minor Hockey)

Representative

Recreational