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Injury Form

A report must be submitted within 24 hours of each injury.

 

 
 
 
 
 

 

Injury Location:

 Alumni/Bubble
 Newton Soccer/FH
 Lake St./St. Clement Fields
 Flynn Recreation Complex
 Other (Away game, off campus practice, etc.)

 

If you listed the location as "Other," please explain exactly where the injury happened:

 

Please indicate what body part(s) were injured (i.e. twisted right ankle, torn left hamstring, one inch gash above right eye, etc):

 

Was medical help called?

 Yes
 No

 

If yes, which number was called?

 911
 2-4444
 2-4440 (non-emergency)
 None

 

Were they transported to the hospital or infirmary?

 Yes
 No

 

If yes, please specify which location and method of transport were used:

 

Please describe the nature of the injury and include any further information you feel is needed: