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I give or have obtained consent for the storage of these injury records.
Your contact details
Full name*
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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*
Please select...
Baddeley Park: Carpark
Baddeley Park: Clubhouse
Baddeley Park: Field 1
Baddeley Park: Field 2
Baddeley Park: Field 3
Baddeley Park: Field 4
Baddeley Park: Field 5
Ballina Hockey & Sports Complex
Ballina Hockey & Turf Complex: Carpark
Ballina Hockey & Turf Complex: Clubhouse
Ballina Hockey & Turf Complex: Field 1
Bathurst Hockey Complex
Beelbangera Public School
Bega Valley Public School
Bill Rose Sporting Complex: Carpark
Bill Rose Sporting Complex: Clubhouse
Bill Rose Sporting Complex: Field 1
Bill Rose Sporting Complex: Field 2
Bill Rose Sporting Complex: Field 3
Bill Rose Sporting Complex: Field 4
Bill Rose Sports Complex
Bruce Pryor Hockey Field: Carpark
Bruce Pryor Hockey Field: Clubhouse
Bruce Pryor Hockey Field: Field 1
Central Coast Grammar School
Central Coast Hockey Complex
Central Coast Hockey Park: Carpark
Central Coast Hockey Park: Clubhouse
Central Coast Hockey Park: Field 1
Central Coast Hockey Park: Field 2
Central Coast Hockey Park: Field 3
Central Coast Region
Christison Park: Clubhouse
Christison Park: Field 1
Christison Park: Field 2
Cintra Hockey Complex
Cintra Hockey Field: Carpark
Cintra Hockey Field: Clubhouse
Cintra Hockey Field: Field 1
Clarence Valley Regional Hockey Complex: Brent Livermore Field
Clarence Valley Regional Hockey Complex: Carpark
Clarence Valley Regional Hockey Complex: Clubhouse
Clarence Valley Regional Hockey Complex: Field 1
Clarence Valley Regional Hockey Complex: Field 2
Clarence Valley Regional Hockey Complex: Field 3
Clarence Valley Regional Hockey Complex: Field 4
Clarence Valley Regional Hockey Complex: Field 5
Clarence Valley Regional Hockey Complex: Legends Field
Coffs Coast Sport and Leisure Park
Coffs Harbour
Coffs Hockey Complex: Carpark
Coffs Hockey Complex: Clubhouse
Coffs Hockey Complex: Field 1
Coffs Hockey Complex: Field 2
Coffs Hockey Complex: Field 3
Coffs Hockey Complex: Field 4
Coffs Hockey Complex: Field 5
Coffs Hockey Complex: Field 6
Coffs Hockey Complex: Field 7
Cooke Complex: Carpark
Cooke Complex: Clubhouse
Cooke Complex: Field 1
Cooke Complex: Field 10
Cooke Complex: Field 11
Cooke Complex: Field 2
Cooke Complex: Field 3
Cooke Complex: Field 4
Cooke Complex: Field 5
Cooke Complex: Field 6
Cooke Complex: Field 7
Cooke Complex: Field 8
Cooke Complex: Field 9
Cooke Hockey Complex
Cowra High School
Croome Hockey Centre: Carpark
Croome Hockey Centre: Clubhouse
Croome Hockey Centre: Field 1
Croome Hockey Centre: Field 2
David Phillips Memorial Fields: Carpark
David Phillips Memorial Fields: Clubhouse
David Phillips Memorial Fields: Field 1
David Phillips Memorial Fields: Field 2
David Phillips Memorial Fields: Field 3
Dobell Road Oval: Field 1
Doyle Ground: Field 1
Doyle Ground: Field 2
Dubbo Hockey Complex: Carpark
Dubbo Hockey Complex: Clubhouse
Dubbo Hockey Complex: Field 1
Dubbo Hockey Complex: Field 2
Dubbo PCYC: Carpark
Dubbo PCYC: Clubhouse
Dubbo PCYC: Court 1
Dubbo PCYC: Court 2
Elm Drive Hockey Fields: Carpark
Elm Drive Hockey Fields: Clubhouse
Elm Drive Hockey Fields: Field 1
Elm Drive Hockey Fields: Field 2
Ernie Smith Reserve: Carpark
Ernie Smith Reserve: Clubhouse
Ernie Smith Reserve: Field 1
Ernie Smith Reserve: Field 2
Ernie Smith Reserve: Field 3
Ernie Smith Reserve: Field 4
Ernie Smith Reserve: Field 5
Federal Park: Clubhouse
Federal Park: Field 1
Forsyth Park: Field 1
Forsyth Park: Field 2
Frank Gray Oval: Field 1
Gold Coast
Goonellabah Turf Complex
Goonellabah Turf Complex: Carpark
Goonellabah Turf Complex: Clubhouse
Goonellabah Turf Complex: Field 1
Goonellabah Turf Complex: Field 2
Goulburn Hockey Centre
Goulburn Hockey Complex: Carpark
Goulburn Hockey Complex: Clubhouse
Goulburn Hockey Complex: Field 1
Goulburn Hockey Complex: Field 2
Grafton Hockey Centre
Greenhills
Griffith COD Centre- Beelbangera Public School
Gundary Oval: Carpark
Gundary Oval: Clubhouse
Gundary Oval: Field 1
Gundary Oval: Field 2
Gundary Oval: Field 3
Gundary Oval: Field 4
Gundary Oval: Field 5
Gundary Oval: Field 7
Gundary Oval: Field 7
Hunter Region
Illawarra Hockey and Sports Centre: Carpark
Illawarra Hockey and Sports Centre: Clubhouse
Illawarra Hockey and Sports Centre: Court 1
Illawarra Hockey and Sports Centre: Court 2
Illawarra Hockey and Sports Centre: Field 1
Illawarra Hockey and Sports Centre: Field 2
Inverell Hockey Complex: Carpark
Inverell Hockey Complex: Clubhouse
Inverell Hockey Complex: Field 1
Inverell Hockey Complex: Field 2
Inverell Hockey Complex: Field 3
Inverell Hockey Complex: Field 4
Inverell Hockey Complex: Field 5
Inverell Hockey Complex: Field 6
Inverell Hockey Complex: Field 7
Inverell Sporting Complex
Jean Todkill Park: Carpark
Jean Todkill Park: Clubhouse
Jean Todkill Park: Field 1
Jean Todkill Park: Field 2
Jean Todkill Park: Field 3
Jean Todkill Park: Field 4
Jean Todkill Park: Field 5
Jenola Park: Clubhouse
Jenola Park: Field 1
Jenola Park: Field 2
Jenola Park: Field 3
John Fisher Park: Carpark
John Fisher Park: Clubhouse
John Fisher Park: Field 1
John Fisher Park: Field 2
John Fisher Park: Field 3
John Fisher Park: Field 4
Jubilee Park
Jubilee Park: Carpark
Jubilee Park: Clubhouse
Jubilee Park: Field 1
Jubilee Park: Field 10
Jubilee Park: Field 2
Jubilee Park: Field 3
Jubilee Park: Field 4
Jubilee Park: Field 5
Jubilee Park: Field 6
Jubilee Park: Field 7
Jubilee Park: Field 8
Jubilee Park: Field 9
Keith Thompson Hockey Centre
Keith Thompson Hockey Centre: Carpark
Keith Thompson Hockey Centre: Clubhouse
Keith Thompson Hockey Centre: Field 1
Kuringai Hockey Centre: Carpark
Kuringai Hockey Centre: Clubhouse
Kuringai Hockey Centre: Field 1
Kyeemagh RSL Hockey Field: Carpark
Kyeemagh RSL Hockey Field: Clubhouse
Kyeemagh RSL Hockey Field: Field 1
Lithgow Hockey Centre
Lithgow Hockey Centre: Carpark
Lithgow Hockey Centre: Clubhouse
Lithgow Hockey Centre: Grass 1
Lithgow Hockey Centre: Grass 2
Lithgow Hockey Centre: Grass 3
Lithgow Hockey Centre: Grass 4
Lithgow Hockey Centre: Grass 5
Lithgow Hockey Centre: Turf 1
Lithgow Hockey Centre: Turf 2
Macarthur Hockey Centre: Carpark
Macarthur Hockey Centre: Clubhouse
Macarthur Hockey Complex: Blue Field
Macarthur Hockey Complex: Frank Hirka
Macarthur Hockey Complex: Neidra Hill Field
Macarthur Regional Complex
Maitland Hockey Centre: Carpark
Maitland Hockey Centre: Clubhouse
Maitland Hockey Centre: Field 1
Maitland Park
Manly West Public School
Marang Parklands: Carpark
Marang Parklands: Clubhouse
Marang Parklands: Field 1
Marang Parklands: Field 2
McGlynn Sporting Complex
McGlynn Sporting Complex: Field 11
McGlynn Sporting Complex: Grass 1
McGlynn Sporting Complex: Grass 2
McGlynn Sporting Complex: Grass 3
McGlynn Sporting Complex: Grass 4
McGlynn Sporting Complex: Grass 5
McGlynn Sporting Complex: Grass 6
McGlynn Sporting Complex: Mariah Williams Field
McGlynn Sporting Complex: Stephen Davies Field
Minto Basketball Stadium: Carpark
Minto Basketball Stadium: Court 1
Minto Basketball Stadium: Court 2
Molong Field: Carpark
Molong Field: Clubhouse
Molong Field: Field 1
Moorebank Hockey Centre
Moree
Moruya Public School
Mudgee High School
NEGS Field 1
Nepean Hockey Centre
New England Hockey Centre: Carpark
New England Hockey Centre: Clubhouse
New England Hockey Centre: Field 1
New England Hockey Centre: Field 10
New England Hockey Centre: Field 11
New England Hockey Centre: Field 12
New England Hockey Centre: Field 2
New England Hockey Centre: Field 3
New England Hockey Centre: Field 4
New England Hockey Centre: Field 5
New England Hockey Centre: Field 6
New England Hockey Centre: Field 7
New England Hockey Centre: Field 8
New England Hockey Centre: Field 9
Newcastle International Hockey Centre
Newcastle International Hockey Centre: Carpark
Newcastle International Hockey Centre: Clubhouse
Newcastle International Hockey Centre: Field 1
Newcastle International Hockey Centre: Field 2
Newcastle International Hockey Centre: Field 3
Newcastle Region
Niagara Park Stadium
Niagara Park Stadium: Court 1
Niagara Park Stadium: Court 2
Niagara Park Stadium: Court 3
Orange Hockey and Sports Stadium: Carpark
Orange Hockey and Sports Stadium: Clubhouse
Orange Hockey and Sports Stadium: Field 1
Orange Hockey and Sports Stadium: Field 2
Orange Hockey and Sports Stadium: Field 3
Orange Hockey and Sports Stadium: Field 4
Orange Hockey and Sports Stadium: Field 5
Orange Hockey Centre
Orange PCYC
Orange PCYC: Carpark
Orange PCYC: Clubhouse
Orange PCYC: Court 1
Orange PCYC: Court 2
Orange PCYC: Court 3
Parkes Hockey Field
Parkes PCYC: Court 1
PCYC Orange
Pennant Hill Hockey Field: Carpark
Pennant Hill Hockey Field: Clubhouse
Pennant Hill Hockey Field: Field 1
Pennant Hill Hockey Field: Field 2
Pennant Hills
Penrith Valley Regional Sports Centre: Carpark
Penrith Valley Regional Sports Centre: Court 1
Penrith Valley Regional Sports Centre: Court 2
PH Jeffery Reserve
Pioneer Park Dubbo
Pittwater RSL Futsal Courts
Port Macquarie Hockey Centre
Ron Harborne Oval: Carpark
Ron Harborne Oval: Clubhouse
Ron Harborne Oval: Field 1
Ron Harborne Oval: Field 2
Roseville Chase Oval: Carpark
Roseville Chase Oval: Clubhouse
Roseville Chase Oval: Field 1
Roseville Park: Field 1
Salamander Sports Complex: Carpark
Salamander Sports Complex: Clubhouse
Salamander Sports Complex: Field 1
Salamander Sports Complex: Field 2
Scone Hockey Fields
SCU Campus: Carpark
SCU Campus: Court 1
Shoalhaven Hockey Centre: Carpark
Shoalhaven Hockey Centre: Clubhouse
Shoalhaven Hockey Centre: Field 1
Southern Highlands Hockey Complex
Southern Highlands Hockey: Carpark
Southern Highlands Hockey: Clubhouse
Southern Highlands Hockey: Field 1
Southern Highlands Hockey: Field 2
Sport UNE
Stephen Davies Hockey Field: Carpark
Stephen Davies Hockey Field: Clubhouse
Stephen Davies Hockey Field: Field 6
Stephen Davies Hockey Field: Field 7
Steyne Park: Clubhouse
Steyne Park: Field 1
Sutherland Hockey Centre
Sutherland Hockey Park: Carpark
Sutherland Hockey Park: Clubhouse
Sutherland Hockey Park: Field 1
Swapit Gully: Clubhouse
Swapit Gully: Field 1
Swapit Gully: Field 2
Sydney Olympic Park Hockey Centre
Sydney Olympic Park Hockey Centre: Clubhouse
Sydney Olympic Park Hockey Centre: Field 1
Sydney Olympic Park Hockey Centre: Field 2
Tamworth Hockey Complex
Tamworth Regional Sporting Complex: Carpark
Tamworth Regional Sporting Complex: Clubhouse
Tamworth Regional Sporting Complex: Field 1
Tamworth Regional Sporting Complex: Field 1A
Tamworth Regional Sporting Complex: Field 1B
Tamworth Regional Sporting Complex: Field 2
Tamworth Regional Sporting Complex: Field 2A
Tamworth Regional Sporting Complex: Field 2B
Tamworth Regional Sporting Complex: Field 3
Tamworth Regional Sporting Complex: Field 3A
Tamworth Regional Sporting Complex: Field 3B
Tamworth Regional Sports Complex
Taree Hockey Centre: Carpark
Taree Hockey Centre: Clubhouse
Taree Hockey Centre: Field 10
Taree Hockey Centre: Field 11
Taree Hockey Centre: Field 12
Taree Hockey Centre: Field 13
Taree Hockey Centre: Grass 1
Taree Hockey Centre: Grass 2
Taree Hockey Centre: Grass 3
Taree Hockey Centre: Grass 4
Taree Hockey Centre: Grass 5
Taree Hockey Centre: Grass 6
Taree Hockey Centre: Turf 1
Taree Hockey Centre: Turf 2
Taree Hockey Centre: Turf 3
Taree Recreational Centre
Tasker Park: Carpark
Tasker Park: Clubhouse
Tasker Park: Field 1
Tasker Park: Field 2
Tasker Park: Field 3
Tasker Park: Field 4
Tasmanian Hockey Centre - Hobart
TBA
The Crest Hockey Complex: Carpark
The Crest Hockey Complex: Clubhouse
The Crest Hockey Complex: Field 1
The Crest Hockey Complex: Field 2
The Den (Armidale HS)
The Illawarra Hockey Stadium
The Shellharbour Hockey Centre
Tony Wicks Memorial Fields: Carpark
Tony Wicks Memorial Fields: Clubhouse
Tony Wicks Memorial Fields: Field 1
Tony Wicks Memorial Fields: Field 2
UNE Hockey Complex
UNE Hockey Complex - Field 1
UNE Hockey Complex - Field 2
Uni of Wollongong: Carpark
Uni of Wollongong: Clubhouse
Uni of Wollongong: Field 1
Valley Fields: Carpark
Valley Fields: Clubhouse
Valley Fields: Field 1
Valley Fields: Field 2
Valley Fields: Field 3
Various Locations
Veolia Arena Goulburn
Veolia Complex: Carpark
Veolia Complex: Clubhouse
Veolia Complex: Court 1
Veolia Complex: Court 2
Veolia Complex: Court 3
Walkers Oval
Warringah Frank Gray Fields
Wayne Richards Sporting Complex: Carpark
Wayne Richards Sporting Complex: Clubhouse
Wayne Richards Sporting Complex: Field 1
Wayne Richards Sporting Complex: Field 2
Welby Hockey Centre
West End Oval: Carpark
West End Oval: Clubhouse
West End Oval: Field 1
West End Oval: Field 2
Western Sydney Hockey Fields: Carpark
Western Sydney Hockey Fields: Clubhouse
Western Sydney Hockey Fields: Field 1
Western Sydney Hockey Fields: Field 2
How did the injury occur*
Please select...
Collision with fixed object
Collision with other person
Fall/stumble
Jumping
Landing from jump
Other
Overexertion
Overuse
Slip/trip
Struck by ball (e.g. dislocated finger)
Struck by other player
Temperature-related (e.g. heat stress)
Twisting to pass or accelerate
Description*
Additional information
Concussion Details
Does this injury relate to a suspected or actual concussion?*
No
Yes
Was there loss of consciousness?*
Please select...
Yes
No
Has the injured person sustained multiple concussion injuries?*
Please select...
Yes
No
Reporter's Details
Your role in hockey*
Please select...
Athlete
Coach
Administrator
Official/Upmire
Support Personnel (e.g. team manager/SSSM personnel)
Parent/carer
Spectator
Other
Injured Person's Details
Injured person's club/team*
Injured person's Member Association*
Please select...
Hockey ACT
Hockey NSW
Hockey NT
Hockey Queensland
Hockey SA
Hockey Tasmania
Hockey Victoria
Hockey WA
Unknown
Additional Injury Detail
Activity when injured*
Please select...
Training
Match
Match activity when injured*
Please select...
Penalty Corner
Normal game play
Shoot Out
Hockey action when injured*
Please select...
Drag Flick
Tomahawk
Overhead
Other
Other injury details*
Max. 255 characters
Medical Clearance
Is a medical clearance required?*
Please select...
Yes
No
Medical clearance documentation
Choose file...
Max
5MB
Injury details
Add an injury
Body part*
Select...
Head
Ear
Nose
Cheek
Mouth and Lips
Teeth
Jaw
Gums
Eye
Neck
Shoulder
Upper Arm
Elbow
Forearm
Wrist
Hand
Thumb
Index (2nd) Finger
Middle (3rd) Finger
Ring (4th) Finger
Pinky (5th) Finger
Chest (Thorax)
Abdomen
Pelvis
Hip
Thigh
Knee
Lower Leg
Ankle
Foot and Toes
Back
Side*
Select...
N/A
Left
Right
Tissue(s) affected
Skull
Scalp/hair
Skin
Soft tissues
Skin
Soft tissues
Skin
Soft tissues
Skin
Soft tissues
Temporomandibular joint
Bone
Fillings
Bone
Globe
Cornea
Eyelid
Orbit
Sclera
Cervical vertebrae
Muscles
Joint capsule and ligaments
Skin
Trachea
Oesophagus
Nerves
Blood vessels
Other
Gleno-humeral joint
Acromio-clavicular joint
Sterno-clavicular joint
Anterior soft tissues - joint capsule, tendons, ligaments
Posterior soft tissues - joint capsule, tendons, ligaments
Superior soft tissues
Inferior soft tissues
Skin
Blood vessels
Other
Anterior soft tissues
Posterior soft tissues
Skin
Blood vessels
Other
Radio-humeral joint
Ulnar-humeral joint
Proximal radio-ulnar joint
Medial soft tissues
Lateral soft tissues
Nerves
Skin
Blood vessels
Other
Radius
Ulna
Medial soft tissues
Lateral soft tissues
Skin
Blood vessels
Other
Distal radio-ulnar joint
Carpals and wrist joints
Soft tissues - ligaments, tendons
Nerves
Skin
Blood vessels
Other
Bones (metacarpals)
Joints (CMC, MCP)
Soft tissues - ligaments, tendons
Skin
Blood vessels
Other
Bones (Phalanges)
Joints (MCP, IP)
Soft tissues - ligaments, tendons
Skin
Blood vessels
Other
Bones (Phalanges)
Joints (MCP, IP)
Soft tissues - ligaments, tendons
Skin
Blood vessels
Other
Bones (Phalanges)
Joints (MCP, IP)
Soft tissues - ligaments, tendons
Skin
Blood vessels
Other
Bones (Phalanges)
Joints (MCP, IP)
Soft tissues - ligaments, tendons
Skin
Blood vessels
Other
Bones (Phalanges)
Joints (MCP, IP)
Soft tissues - ligaments, tendons
Skin
Blood vessels
Other
Thoracic vertebrae
Soft tissues - posterior muscles
Soft tissues - anterior/lateral muscles
Soft tissues - ligaments, tendons
Ribs
Internal organs (lungs, heart)
Sternum
Skin
Other
Internal organs (stomach, kidneys, spleen)
Muscles
Skin
Blood vessels
Other
Hip bones (ileac, pubic, sacral)
Buttock muscles
Groin muscles
Soft tissues - ligaments, tendons
Nerves
Skin
Blood vessels
Other
Hip (ilio-femoral) joint
Lateral hip muscles (TFL)
Anterior hip muscles (iliopsoas)
Blood vessels
Nerves
Other
Femur
Anterior muscles (quadriceps)
Posterior muscles (hamstrings)
Medial muscles (long adductors)
Skin
Blood vessels
Other
Tibio-femoral joint
Patello-femoral joint
Proximal tibio-fibular joint
Soft tissues - cartilage, meniscus
Soft tissues - ligaments, tendons, joint capsule
Blood vessels
Skin
Other
Tibia
Fibula
Anterior compartment muscles
Posterior compartment muscles
Skin
Blood vessels
Other
Talo-crural joint
Distal tibio-fibular joint
Soft tissues - ligaments, joint capsule
Soft tissues - posterior tendons (Achilles)
Soft tissues - anterior/lateral tendons
Blood vessels
Skin
Nerves
Other
Tarsal bones
Metatarsal bones
Phalanges
Soft tissues - plantar fascia, muscles
MTP joints (hallux valgus)
Soft tissues - ligaments, tendons
Skin
Blood vessels
Nerves
Other
Lumbar vertebrae
Soft tissues - posterior muscles
Soft tissues - ligaments and tendons
Skin
Other
Soft tissues
Nature of injury*
Select...
Abrasion, graze
Blisters
Bruise, contusion
Cardiac problem
Concussion
Dislocation, subluxation
Fracture, suspected fracture
Inflammation, swelling
Loss of consciousness
Open wound, laceration, cut
Other
Overuse injury to muscle
Respiratory problem
Sprain (e.g. ligament tear)
Strain (e.g. muscle tear)
Unspecified medical condition
Protective gear*
Select...
Box
Braces, guards, orthoses
Eye goggles
Face mask
Flotation device
Footwear
Gloves
Helmet
Helmet, mouthguard, wrist/elbow/knee pads
Mouthguard
None
Other
Padding
Splints
Taping
Thermal devices (e.g. thermoskin, wetsuit)
Vehicle restraints
Previous history of injury
Initial treatment*
Select...
CPR
Dressing
Manual therapy
Massage
None given - not required
None given - referred elsewhere
RICER
Sling/splint
Strapping/taping
Stretch/exercises
Submit report