GAME INJURY REPORT FORM FOR EMAILING TO NCGSOA BOARD
Date submitting this report:
Date of injury
BOCES Contest #
Injured player's full name
School Player is from
Injured player's uniform #
Description of accident:
Probable nature of injury
Nature of injury determined by:
Was injured player taken to hospital?
Names of adults who saw accident:
What was done for Injured Player?
Injured player's Supervisor/ Coach in
charge of team:
Coach's Contact #
Home School
Visiting School
Level of play (Varsity, JV, Middle School
Referee's full name & BOCES #
submitting this form
Your Contact #
Reporting referee's email address
Referee's Partner's full name & BOCES #