Please ensure Javascript is enabled for purposes of website accessibility

This report is to be completed for all on-field injuries by players, officials & coaches as soon as possible after the incident for Hockey WA records.


If an insurance claim is required, please visit the Insurance page on Hockey WA's website.

Details of Injured Person

Injured Persons Version of Events

(i.e. Struck by ball, slipped over, collision etc.)

Details of Witness

Medical Details

(i.e. Referred to a doctor, taken for X-Rays etc.)

Environmental Conditions

(approximate number at time of incident)

Form Completed By

(i.e Injured Person, Coach, Team Manager, Ground Controller etc.)