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Stonewall Sports - Twin Cities Accident Report Form
To be completed by an Officer, official, or captain in the event of any recordable player accident/injury at an official event.
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* Indicates required question
Who's completing this report?
*
Your answer
Date of incident
*
Date
Time of incident
*
Time
:
AM
PM
Name of injured person
*
Your answer
Email of injured person
*
Your answer
Phone of injured person
*
Your answer
Setting of injury
*
Bocce game
Cornhole game
Dodgeball game
Kickball game
Pickleball game
Tennis game
Social event
Description of incident
*
Your answer
Injuries sustained
*
Your answer
Action taken at the time (select all that apply)
*
Bandage
Immobilizing splint
Ice or cold pack
Stopped bleeding
EMS called
CPR / AED use
Injured person refused treatment
No action required
Other:
Required
Outcome
*
Returned to activity
Went home on own
Taken home by another
Transported to hospital by ambulance
Transported to hospital or urgent care by other means
Left area - no info
Other:
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