skip navigation

Injury Report

Thank you for your participation in this Pilot program to determine the nature of injuries that players are incurring. It is important that you fill out the form as completely as possible.

The data is being collected and reported by the Trauma Services Department at Hennepin County Medical Center on behalf of the Minnesota Hockey Safety Committee.

This site is for youth hockey injury reports only.  Other issues relating to coaching or team problems must be directed to the local association.  Submissions that do not have a contact name and phone number will be deleted.

Instructions:
1) Complete on-line form
2) Print a copy for your records

Definition of “Injury”:
For the purposes of this form, “injury” is defined as: any medical occurrence involving a head injury/concussion or fracture that requires missing a game or practice or brings the player to medical attention.

The coach or team contact is required to verify the injury reported.


(dd/mm/yy)

(dd/mm/yy)

(dd/mm/yy)