DGS Player Injury Form

Please use this form to report any injuries that occur during DGS games

Player's First Name

Player's Last Name

Reporter's First Name

Reporter's Last Name

Reporter's Phone Number

Reporter's Email

Division

Team Name

Date of Report

Date of Incident

Time of Incident

Summary of Injury

Location of Injury

Concussion Protocol performed?

If the injury was to the head, was a concussion test performed on the player?

What Medical Attention was given?

Hospital Trip

If Yes, who took the player to the Hospital?

Verification

Type the code from the image

Required Fields