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Incident/Medical Report

Click here to download this form in Microsoft Word DOCX format


Download and use this form to document any incidents occurring at your assigned gyms in conjunction with documentation included on the scoresheets.

-PREVIEW OF FORM-


CBO Incident/Medical Report

 

Division

 

Gym Monitor

 

Date

 

Gym Location

 

Date of Incident

 

Teams Involved

 

 

Player(s) and Uniform Number

 

 

Description of the Incident or Major Medical Injury

 

 


 

 

Applicable CBO Rules and Regulations

 

 

 

Resolution

 

 

Names and Contact Information for Individuals Involved/Interviewed

Name

Contact Information

Relationship (player, coach, parent, spectator, facilities director, etc.)