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C6
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Awards
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Coaches Area
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Menu Toggle
Meet the 2024 Premier League Players
Meet our Premier League Coaches
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Menu Toggle
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Governance
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Management Committee
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Strategic Plan
Positions Vacant
Contact Us
Injury Report Form
Please enable JavaScript in your browser to complete this form.
Name of the person who has incurred an injury
*
First
Last
Please indicate if the person is a player, coach, umpire, spectator or other
Player
Coach
Umpire
Spectator
Other
Date of injury
Name of person completing the form
Please indicate if you are a coach, team manager, primary carer, coordinator, other
Coach
Team Manager
Primary Carer
Coordinator
Other
If the injury occurred to a player, please indicate the team they are in (e.g. Inter 2) and the coach name (e.g. Jane Smith)
Type of activity at the time of injury
Training
Game day competition
Carnival
Spectating
Umpiring
Coaching
Other
Venue/area that the injury occurred
SADNA - Golden Grove
AMND / CND - Netball SA
Tango Club Rooms/Courts - Hope Valley
Other
Reason for presentation
New injury
Exacerbated/aggrevated injury
Recurrent injury
Illness
Other
Nature of Injury
abrasion/graze
sprain / ligament damage
strain e.g. muscle tear
open wound/laceration/cut
bruise/contusion
inflammation/swelling
fracture (including suspected)
dislocation/subluxation
overuse injury to muscle or tendon
blisters
concussion
cardiac problem
respiratory problem
loss of consciousness
unspecified medical condition
other
Provisional diagnosis/es
Cause of injury
Struck by other player
Struck by ball or object
Collision with other player/referee
Collision with fixed object
Fall/stumble on same level
Jumping to shoot or defend
Fall from height/awkward landing
Over exertion (e.g. tear muscle)
Overuse
Slip/trip
Temperature related e.g. heat stress
Other
Explain exactly how the incident occurred
Were there any contributing factors to the incident, unsuitable footwear, playing equipment, foul play?
Was protective equipment worn on the injured body part?
Yes
No
If yes, what type? e.g. ankle brace, taping, etc.
Initial Treatment
None given (not required)
RICER
Sling, sprint
Massage
CPR
Strapping/taping
Dressing
Crutches
Manual Therapy
Stretch/exercises
None given - referred elsewhere (e.g. First Aid room)
Other
Advice given
Immediate return to unrestricted activity
Able to return with restriction
Unable to return at present time
Referral
No referral
Medical Practitioner
Physiotherapist
Chiropractor or other professional
Ambulance Transport
Hospital
Other
Provisional Severity Assessment
Mild (1-7 days modified activity)
Moderate (8-21 days modified activity)
Severe (>21 days modified or lost)
Submit
