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Submit injury report
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I give or have obtained consent for the storage of these injury records.
Your contact details
Full name*
Contact number*
Email address*
Basic information
Injured person
Name*
Phone number*
Email*
Age at the time of injury*
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Unknown
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Details
Date*
Time*
Venue*
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Australian Taekwondo Event Venue
Club Venue
Home
MTC Glen Waverley
Off-Site
State Venue
How did the injury occur*
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Collision with fixed object
Collision with other person
Fall/stumble
Jumping
Landing from jump
Overexertion
Overuse
Slip/trip
Struck by ball (e.g. dislocated finger)
Struck by other player
Struck by playing equipment
Temperature-related (e.g. heat stress)
Twisting to pass or accelerate
Other
Description*
Additional information
Injured Person
State*
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ACT
TAS
NT
QLD
NSW
VIC
WA
SA
AT Member Number*
Club Name*
Injury Details
Type of Injury*
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Abrasion/graze
Bruise/contusion
Cardiac problem
Concussion/suspected concussion
Dislocation/sublaxation
Fracture/suspected fracture
Inflammation/swelling
Open wound/laceration/cut
Sprain - ligament etc
Strain - muscle tendon etc
Respiratory problem
Unspecified Medical Condition
Other
Protective gear worn*
Chest Guard/protector
Head Guard
Hand Guards
Groin Guard
Arm Guard
Shin Guards
Elbow Guards
Face Shield
Protective Gloves
Foot Protectors
None
Other
Other Injury Details*
Max. 255 characters
Type of activity when injured*
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Training
Match
Action & Referral
Immediate action taken*
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Assessed by onsite medical
Refused to leave the match/training
Removed from the match/training
None
Was there loss of consciousness?*
Please select...
Yes
No
Reporters Details
Your role in Taekwondo*
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Athlete
Coach/Instructor
Administrator
Official/Referee
Support Personnel (Team Manager etc)
Parent/carer
Spectator
Other
Medical Clearance
Is a medical clearance required?*
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Yes
No
Medical clearance documentation upload
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5MB
General
General comments or questions
Max. 255 characters
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