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Injury Report Form

A report must be sumbitted within 48 hours of each injury.

Today's Date:
Person Reporting Injury
Name of Injured Person
Eagle ID Number:
Name of Group:
Injury Location:	Alumni/ Bubble Newton Soccer/ FH Lake St/ St. Clement Fields Flynn Recreation Complex Other: (away game at UConn, off campus practice location, etc)
Body Part(s) Injured:	Location:
Date of Injury:
Time of Injury:
Were they transported to the hospital or infirmary?	No Yes If yes, which location, and method of transport:
Was medical help called? If yes, which number? Please describe the nature of the injury and any further information needed:	YES NO 911 2-4444 2-4440 (Non Emergency) Explain here.

Contact Info
Ben Bettez
Assistant Manager, Club Sports
bettezb@bc.edu
617.552.2904

Monica Capobianco
Assistant Director, Intramural & Club Sports
capobimo@bc.edu
617.552.0333

Events

updated on:12-4-08

Rec Plex Hotline: 617.552.3035

GREAT PEOPLE, GREAT PROGRAMS, GREAT PLACES...