Injury/Concussion Reporting (Clarington Baseball Association)
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Injury/Concussion Reporting
Is This An Initial Report (First Report), Or A Follow Up Report (E.g. Update)
*
Initial / first report
Follow up report / update
What Program Is The Injured Person Involved In?
*
Blastball
Jr. House League (T-Ball, Blastball)
House League (Rookie to Midget)
Select
Elite
Umpire
Check All That Apply
What team is the injured person with?
*
Injured Person's Name
*
First & Last
The following fields will collect details of the injury or event. If the injury/event occurred in another sport or activity, please provide as much information as known.
Who Is Reporting This Injury / Event Or Update?
*
Athlete (or parent/guardian on behalf of athlete)
Coach/Trainer
Umpire (or parent/guardian on behalf of umpire)
Other
Check All That Apply
Has the team's head coach been notified?
*
Yes
No
Don't Know
Has the the individual's parent/guardian been notified of the injury and Removal from sport (if applicable)?
*
Yes (please add name and date of notification)
No
Not Applicable (adult injury)
If answered yes to above, please add name and date of notification
Medical Assessments & Status In Sport (Upload Medical Assessments Received)
Medical assessment confirms NO concussion, NO restrictions on participation in sport
Medical assessment confirms CONCUSSION, remains REMOVED from sport
Medical assessment permits RETURN to sport, with restrictions
Medical clearance received, FULL RETURN to sport
Other, please specify below
If you answered Other to above, please specify
File Upload
Allowed extensions: .jpeg, .jpg, .png, .gif, .pdf, .doc, .docx, .xls, .xlsx, .ppt, .pptx.
Maximum # Files: 1. Maximum File Size: 4MB.
Additional Information (If Required)
Name Of Person Submitting This Report
*
First and Last Name
Email Address Of Person Submitting This Report
*
First and Last Name
Human Validation
Check The Box
*
Human Validation Failed, Please Try Again