Suspected Concussion Report – Dubai Hurricanes

Player Name *

First

Last

Gender *

Player (contact) Phone *

What's the best number to contact the player or parent on?

Player (contact) Email *

Confirm Email

What's the preferred email address of the player or parent

Squad Selection *

Please confirm the concerned squad

Date / Time of Injury/Incident *

Date

Time

Please confirm the date and time (approx.) of injury/incident

Nature of Injury/Incident *

Please describe the injury (Eg. head-to-head) and how it occurred

First Responder / Medic Name *

First

Last

First Responder / Medic Email *

Confirm Email

Is Concussion suspected? *

Please confirm

Was advice on 'Signs and Symptoms' provided to the player and/or parent/s? *

Please confirm

Was 'Return to Play' advice provided to the player and/or parent/s? *

Please confirm