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/ Injury Report Form
Injury Report Form
Athlete of the Month Nomination Form
Travel Itinerary Form
Annual Student Driver Application
Donate to the Buff & Blue Fund
Injury Report Form
Club Sport
*
- Select -
Aikido
Badminton
Baseball
Basketball (Men's)
Basketball (Women's)
Boxing
Cricket
Cross Country
Cycling
Equestrian
Fencing
Field Hockey
Figure Skating
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Ice Hockey
JKA Karate
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Lacrosse (Men's)
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Table Tennis
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Date
*
Month
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
Year
2020
2021
2022
2023
2024
Time of Injury
*
Hour
Hour
1
2
3
4
5
6
7
8
9
10
11
12
:
Minute
Minute
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
am
pm
Name of Injured Player
*
GWid of Injured Player
Gender of Injured Player
*
Male
Female
Where did the injury occur?
*
Body Part Injured
*
Did the injury occur in a game or practice?
*
Game
Practice
Please describe the cause of the injury
*
What actions were taken at the scene?
*
How did the injured player leave the area?
*
On their Own Power
Private Vehicle
University Police
EMERG
Ambulance
Did the injured party go to the hospital?
*
Yes
No
Name of Person Filing this Injury Report
*
Email Address of Individual Filing this Injury Report
*