Injury Report Form
RFU REPORTABLE INJURY EVENT REPORT
Please use this from to report any injuries that occur whilst playing rugby or taking part in organised rugby squad training sessions that fit any of the following definitions:
1. An individual who sustains an injury which results in their being admitted to a hospital. This does not include those taken to an Accident or Emergency Department and allowed home from there.
2. Deaths occurring during or within 6 hours of the game finishing.
Date of report: _____________________ Time of report:_________________
Date of injury: _____________________ Time of injury:_________________
Player's name: _____________________ DOB or Age:_____________________
Club/School: _____________________ Team:___________________________
Nature of suspected injury: __________________________________________________
1 . An injury which results in admission to a hospital.
2. A death which occurred during or within 6 hours of a game finishing.
Game Injuries Only:
Name of Referee:____________________
Injured Player Contact Details:
Phone No:_____________________ Mobile: _____________________
Next of Kin: _____________________Relationship:_____________________
Phone No: _____________________Mobile:_____________________
Name of reporting person: _________________________________________________
Position within Club/School: _________________________________________________
Contact Telephone Numbers: _________________________________________________
Once completed, please send this form to the RFU Sports Injuries Administrator:
Email: email@example.com Fax: 020 8892 4446 Tel: 0800 298 0102
Post: Sports Injuries Administrator, Rugby Football Union, Rugby House, Rugby Rd, Twickenham, TW1 1DS.