Serious Injury Form

Wairarapa Bush Rugby Union
Serious Injury Form

Serious injury reports must be completed for the following injuries:

    • Any head or neck injury that requires the player to be transported directly from the ground to an emergency department, hospital or after hours medical centre
    • Any injury that results in the admission of a player into hospital after a game
    • Any injury that is expected to prevent a player from playing for a period of 4 weeks or longer


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During training
During game
Other (please provide details below)

Concussion
Fracture
Dislocation
Serious joint

Head
Neck
Shoulder
Back
Arm
Chest/Trunk
Thigh/Hamstring
Knee
Lower Leg
Other (please specify in notes below)

Scrum Engagement
Collapsed Scrum
Lineout
Maul
Ruck
Collapsed Maul
Tackle
Post Tackle
Kicking
Running
Other (please specify in notes below)

Doctor
St Johns
Team Official
Referee Only
Other (specify in notes below)

Ambulance
Stretcher
Other (specify in notes below)





* Required